Understanding health inequities

Acknowledgments

This article is the first in a series corresponding to PAN’s four-part Health Equity in Action webinar series, presented in partnership with CVS Specialty.

We thank Dr. Dara Richardson-Heron, physician, Fortune 100 leader, board director, patient advocate, and transformative change agent, for moderating all four webinars in the series. Dr. Dara set the stage by educating us on the principles of health equity, the root causes of health inequity, and why it all matters. Her work serves as the inspiration and the foundation for this blog series. We are grateful for her pioneering ideas, emphasis on cultural humility, and sharing practical tools and tips on advancing health equity in everyday practice.

We also thank Joel Helle, Vice President of Physician Services for CVS Specialty, and James Ridley, Senior Manager of Clinical Affairs at the PAN Foundation, for joining the first webinar in the series as guest expert panelists.

The root causes of health inequities

Equity vs. equality

Health equity is achieved when everyone can attain their full potential for good health, regardless of their background or circumstances. Equity and equality are related concepts, but they have different meanings. Equality means treating everyone the same without considering their individual circumstances. Equity recognizes that people have different needs and works to address those differences.

Addressing health inequities

Social drivers, such as income, education, employment, housing, and access to healthcare, can significantly affect health outcomes and contribute to health disparities. Health disparities refer to differences in health outcomes between different populations or groups, such as those based on race, ethnicity, socioeconomic status, or geographic location.

To achieve health equity, it is necessary to address health disparities by identifying and addressing the root causes of these disparities. This requires focusing on the social drivers of health and the systemic and structural factors contributing to health inequities. By addressing these underlying factors, we can work towards creating a more equitable and just society where everyone can achieve their full potential for good health.

3 key steps to promote health equity

#1: Screen patients for concerns related to social drivers

Screening patients for social drivers of health can help you identify potential barriers to accessing care and provide resources to help patients overcome those barriers.

For example, a patient with difficulty finding or affording transportation to a healthcare appointment may be referred to assistance programs like our transportation fund.

Certain social determinants may impact patients differently, and organizations can choose to screen for social determinants that are most relevant to their unique patient communities.

How do we screen patients for specific needs?

• Use a screener—like this free tool we created—with strategic survey questions to address patients’ most pressing concerns
• Ask open-ended questions to gain insight into your patient’s social circumstances and potential barriers to care
• Review electronic health records to better understand the patient’s current situation, such as their employment status, income, and housing situation

#2: Cultivate cultural humility

Cultural factors, such as language, values, and beliefs, can also influence health outcomes by affecting communication, trust, and healthcare utilization. The Cultural Humility Imperative¹ helps advance health equity by promoting cultural sensitivity, improving trust and communication between healthcare professionals and patients, and reducing bias and discrimination in healthcare.

Cultural humility is a framework that encourages healthcare professionals to recognize their biases and approach patients from different backgrounds openly and nonjudgmentally. By adopting this approach, healthcare professionals can better understand and address the social and cultural factors influencing health outcomes.

Cultural humility can also help to reduce bias and discrimination in healthcare. By acknowledging and addressing their own biases and limitations, healthcare professionals can provide care that is more equitable and non-discriminatory. This is particularly important for marginalized populations who have historically been subject to discrimination in healthcare.

How do we put cultural humility into practice?

• Reflect on your own biases and assumptions and be open to feedback from patients and colleagues
• Take the time to understand each patient’s perspective and work with them to develop a care plan that is tailored to their needs and preferences
• Embrace cultural humility as an ongoing process that requires ongoing commitment and effort

#3: Meet people where they are

Meeting people where they are requires recognizing that everyone has unique needs and tailoring approaches to meet them where they are in their health journey.

When meeting people where they are, it is essential to establish rapport and communicate in a respectful, culturally responsive, and empathetic way.

How do we meet people where they are?

• Provide services and interventions in different settings, such as community centers, schools, or places of worship in schools
• Strive to create clear, simple communications available in multiple formats and languages
• Work with community leaders to co-create solutions that are relevant, feasible, and impactful

Moving forward on the path to equity

Understanding health inequities is a critical first step in addressing them. Moving forward on the path to equity requires a multi-faceted approach that includes the use of screening tools, cultural humility, and meeting people where they are.

By recognizing the structural and systemic factors that contribute to these disparities, we can begin to work towards a future where everyone can live a healthy life, regardless of their background or circumstances.

Citations

1. Tervalon, M., & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of health care for the poor and underserved,  9(2), 117.