Why Aren’t We Treating Health Disparities Like the Crises They Are?

Maulik S. Joshi, DrPH, Allen L. Twigg, MBA, and Carly Critchfield, MHA
8 Min Read

Joshi is the leader of a health system and an adjunct professor of health management and policy. Twigg is a clinical professional counselor and health services management expert. Critchfield is an administrative fellow.

If prompted to think of a recent national or international crisis, many people would likely point to the COVID-19 pandemic. It affected a large number of people and put them in danger. By this definition, healthcare disparities are also crises.

Yet, our approaches to these two crises don’t look the same. For the most part, our actions to deploy COVID-19 vaccinations were swift and measured with one goal in mind: control the COVID-19 pandemic. The rollout of COVID-19 vaccines happened with an urgency and degree of teamwork rarely seen at the national scale — because it was a crisis. Barriers were eliminated and the impossible became possible.

Why aren’t we applying this same approach to the crisis of healthcare disparities?

Using the COVID crisis and initial rollout of vaccines as a model, we identified five key elements that are essential to tackling a crisis:

  1. There is a specific action plan with measurable goals and timelines
  2. The plan is driven at a macro level
  3. Data are bountiful
  4. Time is a design parameter
  5. Testing and improving are the expected norms

A specific action plan with measurable goals and timelines. When initially rolling out COVID vaccines, there were established guidelines (by state) as to how vaccines should be prioritized across the population, goals for how many shots per day, target time frames, and adjustments along the way. Now, let’s consider a similar approach to health disparities using a major disparity: the disparity in diabetes control with a HbA1c <9 between race and ethnicity. Every healthcare delivery organization (perhaps at a local or state level) could be asked to develop and submit an action plan to reduce that disparity by 50% in 2 years. Each organization could develop its own plan specific to their population and context, but the underlying key would be one measure, one focus, with a targeted reduction, and deadline. Each organization would have to submit progress data.

A plan driven at a macro level. In practice, vaccine rollout varied across vaccination sites on the ground. However, the main “macro” organizer was the state, which provided direction concerning who should get vaccinated and when, in order to ensure there was a concerted effort to reach everyone. In the diabetes disparity example, numerous “aggregators” could drive a macro level plan. For example, state hospital associations or medical societies could set statewide goals for members. Each local health coalition could set a goal for its entire community and its providers.

Bountiful data. A tremendous amount of data was shared at multiple levels (national, state, local) during the pandemic and displayed on public dashboards to inform responses. In our diabetes example, there must be data available frequently (such as monthly) and at a granular level (by primary care practice, by health system, by location) so that individuals can determine what is and isn’t working well, and where. Robust data allows for more targeted and effective improvement strategies.

Time as a design parameter. From the outset, it was clear that of the many factors that went into vaccine planning and rollout (such as supply of vaccines and who to deploy to first), time was a paramount design element. An action plan without a timeline is not an action plan. Yet, setting a clear timeline to achieve specific goals is not common in today’s health disparities work. If an initiative was set to reduce a specific disparity by 50% by the end of 2 years, that would require immediate action. Too often, health systems add disparity work to their laundry lists of goals, which present it as more of an optional target — rather than as the life versus death issue it often is.

Testing and improving are expected norms. During the vaccination rollout, responding to new challenges as they arose was paramount. Disparities are multifactorial, complex topics that require systemic and isolated changes. Thus, testing and learning are necessary for meaningful progress. In the diabetes example, providers and health systems must implement and monitor new approaches frequently to determine which changes are impacting the disparity metric. Practices could test changes in provider education, patient education, office workflow, reminder systems, and clinical protocols, among others. This cycle of continuous monitoring and adjustment must be the norm.

While the initial COVID vaccine rollout was far from perfect, these five elements helped confront the pandemic crisis as effectively and efficiently as possible. However, when applied to eliminating healthcare disparities, most of these elements aren’t apparent. The sense of urgency, measured actions, and overall improvement are lacking. The current status of most organizations is that they acknowledge there’s a problem, and perhaps collect social determinant of health data, adopt a health equity lens, and embrace the “it’s a marathon, not a sprint” mindset.

The point of this op-ed is not to overlook the valuable contributions that have been taking place to improve health equity. For example, some of these themes can be found in accreditation requirements and regulation guidelines from The Joint Commission, CMS (CMS Framework for Health Equity), and other national bodies.

But when comparing these small steps to the five we identified from the COVID vaccination crisis, the urgency to address the crises of health disparities is severely lacking. Progress has largely been isolated and slow-moving. To reach the point of true transformation, the status quo must be challenged.

There are many systemic issues at play, but let’s not get discouraged. Let’s keep at it. Let’s call it what it is — a crisis — and change how we confront it.

Maulik S. Joshi, DrPH, serves as the president and CEO for Meritus Health and president of the proposed Meritus School of Osteopathic Medicine in Hagerstown, Maryland. He is also an adjunct faculty member in the department of health management and policy at the University of Michigan School of Public Health in Ann Arbor, Michigan. Allen L. Twigg, MBA, is a licensed clinical professional counselor, and serves as the executive director of Behavioral and Community Health for Meritus Health. He co-chairs the Leadership Equity and Diversity Council (LEAD) for the health system, and was recently appointed to serve on the Maryland Commission for Public Health. Carly Critchfield, MHA, is the administrative fellow at Meritus Health.

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