What can America do to make health and wellness outcomes more equitable?

In 2003, Americans learned how inadequate health care was in the United States.

A major report by a leading expert group has shown major gaps in how people of different races and ethnicities received care for a wide variety of conditions—even if they had and equal pay or insurance coverage.

It is true that Blacks, Hispanics, Native Americans and other backgrounds had lived with that inequality for centuries. And researchers had written it since the 1960s.

But an important report, called «Unequal Treatment,» brought the issue to the attention of all Americans, and prompted action in many cases. It helped introduce the Affordable Care Act, including new programs such as Medicaid expansion to reduce the number of people of all backgrounds who did not have health insurance.

Did it make a difference? Has inequality fallen?

To some extent, yes—but more action is needed, according to a new report, «Ending Unequal Treatment,» released for the first time late last month by the National Academies of Sciences, Engineering and Medicine.

One of the authors of the new report, John Z. Ayanian, MD, MPP, leads a large center at the University of Michigan that focuses on health care research and policy, including health equity.

Back in 2003, he was one of the researchers whose studies helped form the basis of the first report.

«More than 20 years later, our committee found that there has been progress, but it has been inconsistent and incomplete in ending the health care divide and promoting health equity,» he said. said so. «We can also find a lot of correlation between inequality in health care and inequality in health outcomes for individuals and populations.»

In other words, the data now clearly shows that inequality hurts people’s lives.

«We find that racial and ethnic disparities remain a fundamental flaw in the US health care system, and that they are driven by complex interactions between different forms of power,» says Ayanian, who is a professor of internal medicine, public health and society. policy at UM as well as directing the UM Center for Health Policy and Innovation.

He adds, «We also document specific practices that have been shown to improve health care equity—for example, community health workers engaging with people with chronic conditions, community needs that health-related, or risk factors—but these methods have not been widely publicized or implemented frequently enough to make a significant difference.»

The committee also notes that despite the success made by the health policy changes, other policy changes may introduce new major obstacles.

So what can be done? Key recommendations of the committee:

• Continuing efforts that began after the first report of Unequal Treatment to diversify the workforce for health care research and health services in order to be more representative of all US citizens.
• More efforts to increase health equity, going beyond the incremental and limited changes of the past. For example, Ayanian points to New York City’s success in increasing colon cancer screening among Asian, Black, and Hispanic populations, which has not been adopted by other cities or regions.
• More research and analysis to understand inequality more deeply, and improve development. Ayanian and colleagues discussed the importance of this work in a special panel in early July at the National Academy of Health researchers’ meeting.
• Accountability for implementing current laws and policies, such as non-discrimination restrictions under the Affordable Care Act. For example, to help more people understand how to file a complaint, include information in multiple languages ​​so that people with limited English skills can understand how to file a complaint if they believe they have received proper care. unequal.
• Clearer and more applicable standards, through the Internal Revenue Service and the Department of the Treasury, for nonprofit hospitals to report on what they do to address community health needs which they work for.
• Congressional action to make health insurance available to everyone, including those living in states that have not expanded Medicaid, and immigrants regardless of status.
• Congressional action to make Medicaid payments to doctors and hospitals equal to the payment amount they provide for similar services for people with Medicare. Because of the current low payment, only about half of the doctors who see patients have Medicaid coverage, which contributes to health care inequities because people of color tend to qualify for Medicaid due to low incomes.
• Fully support Indian health services, serving Native Americans and Alaska Natives nationwide.
• Addressing the Medicaid funding gap for US territories such as Puerto Rico and American Samoa, which currently have far less funding and coverage than the 50 states and the District of Columbia.
• New standards to guide better data collection on race and ethnicity by all parts of the federal government for health care workers and patients with any source of insurance or no insurance.
• Expansion of demonstration projects that seek to address public health-related needs.

In addition to the report and related webinar, committee members presented policy ideas and recommendations in a new section on. Fast forward to Health issues.

The new report comes at a unique time, says Ayanian, given the inequality that has come into sharp focus during the COVID-19 pandemic.

Although the number of deaths from COVID-19 has decreased significantly due to vaccinations, increased natural immunity, and effective treatment, the epidemic has set back more than a decade of progress in reducing the life expectancy gap between of people of different races and ethnicities.

Life expectancy for African-Americans and Native Americans had actually reached that of whites before 2020, and Hispanics had actually achieved longer life expectancies in than white Americans in 2018. higher rates of premature death among people of color.

The committee behind the new report shows the huge economic consequences of health care inequality, as well as the injustice it represents.

Ayanian says, «We hope that this report will be a guide for effective policy and process changes for years to come, just as the first report was used to inspire such efforts 20 years ago.»