Be aware of racial equity in health

Posted: 08/24/2021 21:19:24 PM Massachusetts is often celebrated nationally as a leader in health care. But if we look closely, we ...



Posted: 08/24/2021 21:19:24 PM

Massachusetts is often celebrated nationally as a leader in health care. But if we look closely, we see another painful reality – sinkhole after sinkhole of racial and ethnic health inequalities in the Commonwealth – created by generations of structural racism and socio-economic inequality.

Of a study recently reported by WGBH, “Black women in Massachusetts are 2.5 times more likely to die from pregnancy-related causes than other women.” The last Directorate of Public Health (DPH) The data show that the rate of COVID-19 infections in Massachusetts is more than three times higher for people who identify as Latinx than for whites. And the austere and ugly list could go on and on from here on out.

What if we could ensure that a governor’s administration and the state legislature should prioritize racial and ethnic equity in health – at all levels of state government – during the budgetary and political decision-making? This would mean that all of the major spending choices, all of the policies that flow from them, would be evaluated to determine whether they have increased or harmed racial equity.

If the decisions had the potential to make conditions worse for people of color, we would not move forward. And conversely, decisions that could close the racial and ethnic health gaps would be a priority.

This is what I am looking for after this legislative session and why I tabled S.1388, An Act to establish equity in health care at all levels of government, also known as The Healing Act.

The COVID pandemic has demonstrated how brutal inequalities can mean the difference between life and death. This is why this legislation tackles structural racism head-on by centering health equity across government in every agency, with leadership in the governor’s office and sharp, community-led accountability measures.

Health equity is not a new concept. Groups like the Western Massachusetts Health Equity Network and individuals like Dr Frank Robinson, Baystate’s vice president of public health, has been leading the way for years.

Over time, the imperative of health equity has attracted more and more academic research. After facing significant criticism for his take on structural racism, the August 17 issue of the Journal of the American Medical Association, or JAMA, is devoted to disparities and inequalities in medicine and health care. In one article, researchers studied nearly 600,000 people from 1999 to 2018 and found that, regardless of increased access to health insurance, people of color largely had persistent health inequalities that reflected by poorer health outcomes and higher death rates.

It is a racial justice imperative. It is also an urgent matter of health policy. And the related problems are so massive that we cannot reform ourselves. We have to transform.

The HEALING Act initiates three concrete steps to (1) create a culture of health equity throughout Commonwealth government; (2) provide government agencies and the legislature with tools and structures to engage; and (3) ensuring accountability through community oversight.

The bill assumes that our individual and community health depends only partially on our health care system. The government also has a significant impact on our health through what it does in education, housing, transport, environmental policy, etc.

Why go about it like this? We spoke with experts from other states who have created successful similar initiatives. The legislation proposes a HEALING initiative within the DPH, a new center that would advise other state agencies and monitor decisions across state government. The initiative would also educate the public about the connection between the choices of our state government and our health.

Because the best time to examine how a policy will affect health equity is before it becomes law, the Healing Act also gives the DPH and the legislature a new tool – the equity assessment in health. health – to assess the potential impact of pending legislation and spending decisions.

Health equity requires real buy-in from all sectors that contribute to the social determinants of health. Thus, the HEALING Act requires each agency to take charge of its own health equity work. The legislation proposes that agencies develop strategic health equity plans, subject to the approval of the DPH HEALING Initiative and a well-constructed Community Oversight Board.

If that sounds like pansy in the sky, it isn’t.

A state-wide 16-member health equity task force (with Dr Robinson as a key member) dismissed the recommendations that closely follow this legislation:

■ Create a cabinet-level executive equity office responsible for creating three- to five-year strategic plans, and create accountable equity offices within each secretariat.

■ Create a practice of equity in all policies to assess the impact of state policies and programs.

■ Ensure equity of data and dashboards on multidimensional indicators to monitor measurable progress and enhance transparency and accountability.

What we need now is the political and social will to make this necessary and very possible change.

Is this the only action we should take? Absolutely not. Thanks to the Health Equity Task Force, we now have a statewide equity roadmap. You can read it here: https://malegislature.gov/Bills/192/SD2731.

I am all for pushing this agenda forward with advocates and colleagues who have been leading for years and years. And in partnership with voters.

Jo Comerford represents 160,000 people living in 24 towns and villages in the District of Hampshire, Franklin and Worcester in the Massachusetts Legislature.



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