02/11/2021

Health Equity Q&A with OSMA President Anthony Armstrong, MD

OSMA Thought Leadership

The COVID-19 pandemic and elevated conversations about racial justice have brought the issue of healthcare equity to the forefront for healthcare professionals everywhere.

OSMA is dedicated making sure health care is fully inclusive and attainable so that everyone has access to necessary medical services regardless of race, ethnicity, sexual orientation, or any other defining characteristic.

As we support members in 2021, we’re pleased to share thoughts from OSMA President Anthony Armstrong, MD, on health equity and what this means for Ohio physicians. This topic will also be addressed in more detail at OSMA's upcoming Symposium Keynote Webinar on March 9th.

Q: “Health Equity” or “Healthcare Equity” are terms that have been part of the larger healthcare dialogue in recent months. Can you describe for the audience what is meant when people talk about issues related to health equity?

A: Equity in it’s simplest form means a state, quality or ideal of being just, impartial and fair. Most would equate it with simply “being fair and just” – whether that be in the health care system, social arena, criminal justice, education etc.

Equality, by contrast, tries to ensure that everyone has a “level playing ground.” Everyone should have equal access and opportunity for things like fair housing, health care access, education and job opportunities.

Equity and equality must go hand in hand in the sense that we all should be able to have the things that we feel are most important to enjoy full lives in the pursuit of health and prosperity.

Q: Where do you see the biggest disparities happening in healthcare in Ohio and our nation?

A: Disparity implies “a difference or lack of parity.”

In healthcare, this may relate to access amongst many other issues that ultimately affect health care outcomes, which are manifest in the disparity in these outcomes in our vulnerable and minoritized populations. 

Social determinants of health (SDOH) are the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems that shape the conditions of daily life. We however sometimes overlook that this also includes our economic policies, social norms, social policies and our political systems.

Years of research demonstrate these determinants may have up to a six-fold greater impact on health outcomes in actual clinical care. Nine medical determinants like environment, health behaviors and social factors likewise are also greater contributors to premature death than quality of health care. Addressing SDOH within the state of Ohio as well as nationally is of paramount importance and requires collaboration across multiple sectors including medical care, public health, social /mental health care services and more.

Q: How has the COVID-19 pandemic shed light on racial disparities in healthcare, and minority communities being disproportionately impacted by the pandemic?

A: Centuries of oppression and discrimination rooted in racism have undoubtedly and understandably had a disproportionate effect on people of color.

This is not a new concept, and Dr. Alan Nelson, former AMA president 1989, recognized this in a book he authored on unequal treatment – which was one of the first to recognize racism as the root cause of unequal treatment in healthcare.

Whether it’s a reality or misperception, African Americans in particular have a historical mistrust of the health care system. They may not access healthcare often, or when they do they may enter later which may have potential negative effects on overall health outcomes. For all these reasons (and more) we do see higher comorbidities in African American populations, Hispanic /Latinx and Native Americans. The pandemic has simply allowed to express this disparity more explicitly.

Q: What are some initiatives taking place in Ohio to fight healthcare inequity and ensure all racial and ethnic groups have equitable access to healthcare services and supports? Are there particular initiatives OSMA is championing around this issue?

A: On April 20, 2020, Governor Mike DeWine launched the COVID-19 Minority Health Strike Force. This group of advisors worked with state and local leadership to provide feedback on the immediate actions necessary to address COVID-19 and its disproportionate impact on Ohioans of color.

I was honored to be part of this workforce, which developed a 35 page “Blueprint” with 35 actionable recommendations.

OSMA has been proud to take part in a variety of groups working to address racial equity in healthcare. OSMA was invited to participate in an AMA sponsored co-branded PSA on taking public health precautions, and OSMA CEO Todd Baker and I were also invited to participate in the Ohio Department of Health COVID-19 Vaccination Providers Workgroup. Representing OSMA, I also participated in the Minority Health Vaccine Team. Lastly, I have been very active in the V project (Victory Over COVID-19 in Northwest Ohio). It is a large collaboration of both the public and private sectors of NOW coming together to educate and distribute vaccines throughout the community.
 

Q: What can Ohio physicians do to help raise awareness about and promote healthcare equity in their own practices? 

A: Some rather simple steps that you can engage your practice in addressing social determinants of health are:

• Understand an engage your community. You might begin by knowing the health needs of the communities you serve by reviewing your local Community Health Needs Assessment. The review should be in collaboration with the local public health department and FQHC’s along with community input.
  
  
• Engage key leadership. You would most likely want to reach out for support from key local leadership such as a chief executive officer, chief operating officer, chief medical officer and chief medical information officer.
  
  
• Assess your practice or organization's readiness. Do you have the proper infrastructure, financing, staffing etc.
  
  
• Know where your resources lie. Examples such as referrals to local food banks or food pharmacies; where to get vouchers for transportation; and dietary, social and mental health services. And importantly, where can your patients go to learn more regarding these important topics.
   

Q: Anything else to add?

What do hospitals and health systems need to do to make real progress in strengthening diversity in our leadership structures and talent management strategies?

A: Despite many of the nation's hospitals pledging to increase diversity on their boards and in management ranks and physician workforce, and many installing chief diversity officers (the majority of which are minorities), only 14 percent of hospital board members and 9 percent of CEOs are minorities, according to The American Hospital Association's Institute For Diversity In HealthEquity. This percentage has remained static for the past eight years.

Minorities represent only 11 percent of executive leadership positions in hospitals compared with 12 percent in 2013. Many experts believe that there are better outcomes from a workforce that resembles the diversity of its patient population simply because it does not foster patient trust and compliance while mitigating bias.

With respect to GME teaching programs, our country's increasingly diverse community will result in a more diverse patient population moving towards a majority- minority balance by 2043, according to the projections from the US Census Bureau. These changing demographics unfortunately are reflected in patient populations but none as of yet reflected in healthcare administrative leadership. Although change starts from the top, it begins with recruitment. We must create an affable environment to recruit, promote, retain and have fair equal opportunity for advancement of health care careers at all levels to diverse populations.