Leadership Corner: Seven Common Misconceptions about Health Equity

MHA Keystone Center Leadership Corner

Reducing misconceptions or biases that cloud thinking is a challenge many hospitals face when working to achieve health equity in their communities. In the past, I’ve met with hospital staff who have shared 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 socioeconomic 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 heard from hospitals and health systems. Understanding these are imperative to hospitals that are on a health equity journey.

Ewa Panetta1.     Access = Equity. Health insurance coverage and access to care is the most important factor for 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 10% of the 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, “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 networks 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 assist in developing successful strategies 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, socioeconomic status, veteran status and geographic location. Populations of low socioeconomic 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 play a significant role in patients’ health outcomes. Still, 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 from those in the northern region of our state. It is important to collect a variety of patient demographic data to understand the needs of populations. According to the Health Resources & Services Administration, only 20% of the nation’s population resides in rural areas. However, those residents comprise more than half of the geographic population centers that lack basic medical care, including more than 50% of all behavioral health shortage areas.

7.       Socioeconomic data is just more noise in an already data-overloaded world.

As stated above, medical care determines only 20% of overall health outcomes, while the remaining 80% is determined by nonclinical factors, such as social determinant elements. If organizations want to achieve better health outcomes for their patients effectively, 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 data 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.