Shifting the Health Equity Focus from Accessibility to Outcomes

Access to Care < Health Outcomes?

Background

Source: http://www.nyas.org/

It is well documented that racial and ethnic minorities face worse health and health care disparities than any other group. Several socioeconomic factors such as neighborhood, educational attainment, and income level lead to a lesser standard of health care and worse health outcomes in minority communities. To address these disparities, several health care organizations have begun to develop interventions focused on narrowing the gap between social determinants of health and health equity. For years, the focus these interventions has been access to care, which hemmed on the belief that issues such as lack of insurance, cost of services, and availability of providers were the major sources of disparity. However, difficulties in reducing these disparities have prompted public health and healthcare practitioners to look elsewhere.

A Shift in Focus

"Health organizations can promote and sustain equity by broadening the scope of health care systems and promoting interventions that focus on the core contributors to disease."

In the article Achieving Health Equity by Design, authors from the American Medical Association suggest health practitioners shift their health disparities work from efforts to increase cultural competence, patient safety, and health literacy to those that target equity in health outcomes. The authors suggest that instead of focusing on efforts to "retrofit the current healthcare system to make it more accessible to patients," health care organizations should focus more on the factors that cause disproportionate lack of access and sustained treatment in minority communities. This shift requires health care organizations to adopt unconventional methods to provide education and services in places where racial and ethnic minorities live and work. Some health care organizations have already begun to move toward this framework.

Source: media.npr.org

For example, in 2010, the CDC piloted barbershop hypertension management programs in Los Angeles and St. Louis to implement system-level hypertension control interventions for African American men. These programs trained barbers and stylists in the African American community to become community blood pressure specialists who measure and record blood pressure readings of customers, provide information about hypertension,a nd make referrals to providers. Barbershops were specifically targeted because, in the African American community, barbershops are quintessential, gender-specific places for gathering and fellowship. An evaluation of the barbershop intervention found that African American men who received service through the intervention had a decrease in blood presure and an increase in hypertension treatment and control. These results show promise for future collaborations between heatlh care organizations and nontraditional partners such as faith-based organizations, fraternities and sororities, and barbershops. Through these partnerships, health care organizations can circumvent social determinants of health and move minority communities toward health equity. 

Sources:

Centers for Disease Control and Prevention. A Closer Look at African American Men and High Blood Pressure Control: A Review of Psychosocial Factors and Systems-Level Interventions. Atlanta: U.S. Department of Health and Human Services; 2010.

Wein, Harry. "Barbers Help Black Men Beat High Blood Pressure - NIH Research Matters National Institutes of Health (NIH)." NIH Research Matters. National Institutes of Health, n.d. Web. 23 Sept. 2015.


Wong, Winston F., Thomas A. LaVeist, and Joshua Sharfstein. "Achieving Health Equity by  Design." The Journal of the American Medical Association 313.14 (2015): 1417-1418. JAMA Network. American Medical Association. Web. 23 Sept. 2015.