Seven Common Misconceptions about Health Equity
Posted on March 01, 2019
Reducing misconceptions or biases that cloud thinking is a challenge hospitals face when working to achieve health equity in their communities. In the past, I’ve met with hospital staff who have claimed they are working toward this goal, but have not fully considered all the social determinants of health (SDOH) factors that impact health outcomes. Equity encapsulates a wide range of demographic and socio-economic conditions. The only way to fully achieve health equity is to address health disparities across the entire spectrum. Below are seven of the most common misconceptions I hear from hospitals and health systems. Understanding these are imperative to hospitals that are on a health equity journey.
1) Access = Equity. Health insurance coverage and access to care is the most important factor to good health.
One of the biggest misconceptions and obstacles is the notion that access equals equity. However, studies show that poor access to care is responsible for only about 20 percent of risk of premature death among Americans. Health inequities are shaped by multiple complex determinants of health (social, economic, environmental, structural) that play a larger role in health outcomes.
2) We can achieve equity by ensuring equal access to resources for all patients.
Paula Dresser, founder of Race Matters Institute, stated that “the route to achieving equity will not be accomplished through treating everyone equally. It will be achieved by treating everyone justly according to their circumstances.”
It’s important to understand that not everyone starts from the same place and needs the same things. Therefore, a one-type-fits-all model will not address and improve disparities for all. We must develop care plans that fit the patients’ needs and address the root causes. We can’t do that without determining those needs.
3) Some groups of people have worse health outcomes than others because they make unhealthy choices or don’t take care of themselves.
Options impact choices. Many patients lack resources, support and information and are limited in their options to make healthy choices in their environments. Understanding the role of social determinants of health elements will help determine the root causes that lead to unhealthy choices and will help in developing resources to overcome barriers in managing health.
4) Health disparities are based solely on race.
Often, the term disparity is associated with race or ethnicity. There are many dimensions of disparity that exist in the United States - race or ethnicity, sex, sexual identity, age, disability, socio-economic status and geographic location. Populations of low socio-economic status, rural and inner-city populations, and disabled populations often experience significant disparities. However, our systems rarely devote initiatives and resources to addressing the needs of these specific populations.
5) Social determinants of health categories, such as employment and economic stability, housing, nutrition and neighborhood context play the biggest role in poor patient outcomes.
These categories are extremely important and play a significant role in patients’ health outcomes, but one cannot overlook the elements of loneliness and social isolation, which are rising in the United States. Studies show that isolated individuals who report frequent feelings of loneliness suffer higher rates of morbidity, mortality, infection, depression and cognitive decline. It’s important to recognize that physical, mental and social health are connected and, if we want to improve the well-being of our patients, we must tackle the epidemic of social isolation and commit to addressing loneliness.
6) Disparities only occur in urban settings.
Health disparities can be seen everywhere. The disparities that exist in Southeast Michigan are different than those in the northern region of our state. That is why it is important to collect a variety of patient demographic data to understand the needs of your populations. According to the Health Resources & Services Administration (HRSA), while only 20 percent of the nation’s population resides in rural areas, those residents comprise more than half of the geographic population centers that lack basic medical care, including more than 50 percent of all behavioral health shortage areas.
7) Socio-economic data is just more noise in an already data-overloaded world.
As stated above, medical care determines only 20 percent of overall health outcomes, while the remaining 80 percent is determined by nonclinical factors, such as social determinant elements. If organizations want to effectively achieve better health outcomes for their patients, they cannot ignore the majority of what determines their patients’ overall health. Yet much of this data remains uncollected or unused. Screening for SDOH can help identify barriers that must be addressed to improve patients’ self-management skills. But it doesn’t stop with data collection. We must put SDOH into action. Using this data to help hospitals define problems is the first step, but forming community partnerships to improve patient care across the continuum must follow.
Ewa K. Panetta, CPPS, is the manager of safety and quality at the MHA Keystone Center.
P.S. The Great Lakes Partners for Patients Hospital Innovation Improvement Network (GLPP HIIN) will host a Health Equity Regional Learning Session March 12 at the VisTaTech Center – Schoolcraft College, Livonia. The event will address pertinent issues surrounding health equity and specific ways to implement change with a data-driven approach in communities and healthcare organizations.
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