Health Services Research, Journal Year: 2023, Volume and Issue: 58(S3), P. 281 - 283

Published: Nov. 28, 2023

It is much more important to know what sort of a patient has disease, than disease has. Despite powerful narratives echoing purported existence meritocracy in our society, major racial and ethnic disparities health healthcare have persisted for hundreds years. Yet clear understanding structural societal inequities not innate group differences underlying the was articulated nearly 200 years ago by Dr. James McCune.1 His position reified findings from “The Philadelphia Negro,” an elegant sociological epidemiological study W.E.B. Du Bois late 1800s.2 However, their voices were largely ignored because Native Black Americans been devalued America maintain myth inferiority. until 1985 Report Secretary's Task Force on Minority Health, led Margaret Heckler, that nation could accept such as problem worthy consideration. Soon thereafter, 2003 Institute Medicine report entitled “Unequal Treatment: Confronting Racial Ethnic Disparities Health Care” sought only codify outcomes, but emphasized these due how people treated attributes. also identified this mistreatment quality access care. The emerging focus care at turn 21st century embraced Agency Healthcare Research Quality (AHRQ) who started formally track delivery it relates socioeconomic factors priority populations. This formal tracking played critical role developing evidence base systems improve advance ability provide best all us. Spurred Coronavirus 2019 (COVID-19) pandemic 2020 murder George Floyd, US system faced social equity justice movement. movement racism inequitable distribution determinants (SDoH), broad set forces shaping conditions daily life, driving root causes In 2022, AHRQ sponsored Equity Summit bring together multiple working groups 2021 Agenda Action Plan created help guide priorities equity. commentary addresses two interrelated articles, written Chisholm et al.3 Jindal al.4 describe AHRQ's 2022 highlight stages key action steps future equitable delivery. six research themes promote population health, while strengthening care: (1) institutional leadership, culture, workforce; (2) data-driven, culturally tailored care; (3) equity-targeted performance incentives; (4) equity-informed approaches consolidation access; (5) whole-person (6) whole community investment. They propose complementary plans follows: publish white papers toolkits evidence-informed support policies require race ethnicity language data collection providers payers; develop assist organizations integrate metrics into management well publicly available equity-focused evidence-based indicators; development geographic information changes access, quality, arising and/or policy changes; accelerate outcomes linked needs; new funding models with allocated directly partnership universities or using Small Business Innovation model. last theme meaningful engagement, investment, partnerships local communities serve many ways greatest potential transform begin truly addressing more.5 need leverage other federal agencies public–private pursuit undoing systemic barriers inequities, describes five dimensions agenda focuses improving approachability, acceptability, availability accommodation, affordability, appropriateness. Complementary actions include: collaboratively evaluate trustworthy anti-racism toolkit systems; champion use tools racism; fund collaborative identify burnout lens intersectionality mistreatment; examine costs maintaining flexibility state Medicaid programs, coverage improvements Affordable Care Act, find eliminate discriminatory accessing insurance; patient-centered decision-making de-implementation low-value elimination individual-level race-based algorithms. note, “progress will be made when there common acceptance arise process rooted experience infrastructure rather DNA”. Together, articles reflect importance must done consideration intersectionality, emphasize high-quality inform These recommendations optimally address care, once again perpetuated legal decisions during time limits we achieve SDoH pathway through which works given implications Supreme Court rulings, can consider “an applicant's discussion affected his her discrimination, inspiration, otherwise.”6, 7 words, cannot used criterion admission alone, yet, applicant discuss they may impacted (or racism). A similar approach undertaken if extrapolation university care.11 prescient its timing, preceded landmark events landscape—the recent rulings (Students Fair Admissions, Inc. v. President Fellows Harvard College Students University North Carolina; 303 Creative LLC Elenis), ended affirmative college admissions yet allowed discrimination based free expression despite public accommodation laws. do mean identity-based no longer exist, particularly regard health. limit those focused workforce composition regulations requiring equal provision service. We collectively innovate ensure appropriate implement requisite solutions reduce why explicitly critical, driver necessary innovation priorities. Some argued are equipped take allocation (SDoH).8 Many patients interfacing suffering systematic indifference life-affirming resources. inability approve resources creates dilemma ultimately afford ignore SDoH, continue long-term effects utilization costs. Indeed, Laviest al. estimated direct indirect economic burden exceed $400 billion year.9 As noted both lead way determine partnering service more, private–public partnerships. reverse longstanding issues underpin partner closely communities.3, 4, 10 Direct buy-in needed investigator teams successful work conducting communities, subsequently allow success agenda. slowly beginning occur broadly universities, hospitals large, organization become “Anchor Institutions” commit financial, human intellectual challenges, inextricably outside walls.11 Ensuring us receive systems, especially components affect Implementation proposed infuse would toward achieving Ong receives relevant (K12 HS026407) Department Veteran Affairs Services & Development (CIN 13-417). Norris National Institutes (P50MD017366, P30AG021684, UL1TR000124).

Language: Английский