Health Equity Is Both a Moral and Business Imperative | Deloitte US has been saved
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By Alison Muckle Egizi, MPP, manager, Leslie Korenda, manager, and Alex Schulte, program officer, Deloitte Services, LP
Health equity was a key theme at AcademyHealth’s recent Annual Research Meeting in Washington, D.C. Strategies for making high-quality care more accessible—and the barriers historically marginalized populations can face when seeking care—were discussed at several sessions, in the exhibit hall, and during various coffee breaks and hallway discussions.
At the conference, we shared some of our research into the root causes of health inequities—and the challenges of addressing them (here is a video of the information we shared at the conference). For example, our report, Rebuilding trust in health care, explores how a lack of trust in health systems and institutions can influence decisions about medical services, preventive screenings, and mental health care. The report describes findings from anonymous, online focus-group discussions with 525 Americans who identify as Black, Hispanic, Asian, or Native American. Sixty-three percent of participants said they have skipped or avoided care because they did not like the way they were treated by a health care provider or staff member. Moreover, after an experience where trust was lost, four out of five participants said there was nothing the provider or health system could do to get them to return.
We also shared our research into why some people have not received a COVID-19 vaccine. Difficulty in scheduling appointments, transportation issues, inconvenient site hours, misinformation about the safety of vaccines, and a general mistrust of the medical system have kept some people—particularly those living in historically marginalized communities—from being vaccinated (see our latest research, Removing barriers could help increase vaccination rates). We also presented information about how cross-sector collaborations could help address the drivers of health and improve health equity (see Addressing the drivers of health). Our research suggests that a growing number of health care organizations are screening patients and members for health-related social needs. We also found that few organizations are actively connecting patients in need to services (via community partners or in-house programs).
The conference also gave us an opportunity to highlight some of the lessons learned from the Deloitte Health Equity Institute’s (DHEI) first year. DHEI was launched in spring 2021 to improve health equity through a combination of philanthropic investment and pro bono strategic services. For example, DHEI collaborated with the Robin Hood Foundation, a New York City poverty-fighting philanthropy, to increase vaccination rates in low-income neighborhoods, particularly in racially and ethnically diverse communities (read our Q&A with Robin Hood's chief of grant strategy). We are also funding several organizations in the greater Washington, D.C. area that are using community-based ecosystems to improve equity and reduce disparities.
Why is Deloitte focusing on health equity?
Some conference attendees seemed surprised that Deloitte is conducting research into health equity and providing financial support to help make health care more accessible and equitable. We believe that advancing health equity is both a moral and business imperative. Every organization, across every industry, has a role to play in making health more equitable—within their organizations, in the communities they serve, and across ecosystems. As one of the largest professional services firms in the world, Deloitte supports a growing number of businesses, non-profits, and government agencies that are working to diversify their workforces and remove health inequities. According to our recent report on the future of the public's health, fostering healthy and diverse communities can help businesses recruit and retain workers. There is also a business case to be made. Health inequities that limit access to affordable, high-quality care cost the US health system approximately $320 billion in annual spending, according to a new actuarial analysis from Deloitte (see our report, US health care can't afford health inequities.)
There was agreement among many conference attendees that little has changed in the 20 years since the Institute of Medicine (IOM) released its assessment of racial and ethnic disparities in health care. The report, Unequal Treatment, determined that Black and Hispanic Americans typically received lower quality of care—across a range of diseases—when compared to white Americans. While a growing number of health care leaders are working to make improvements, health disparities persist. Improving this situation will require a strong, enduring commitment among all stakeholders in the health care ecosystem. We are optimistic the story will be different 20 years from now.
Clinicians, public health workers are also facing challenges
While accessing equitable care continues to be a challenge for some populations, people who provide those services are facing challenges of their own. During one of the final conference sessions, Vivek Murthy, MD, discussed some of the factors that can accelerate burnout among clinicians. Dr. Murthy, a vice admiral in the US Public Health Service Commissioned Corps, is the 21st US Surgeon General. Last month, he issued an advisory calling for solutions to address burnout among the nation’s health care workers.
During his Fireside chat session, Dr. Murthy noted that the work environment can have a direct impact on burnout of medical professionals. Excessive workloads and high levels of stress could inadvertently worsen disparities in treatment, which can negatively impact care quality, he explained. Moreover, when employees feel isolated, productivity, creativity, and retention can suffer. But burnout isn’t limited to clinicians. Our report on The future of public health found that the pandemic had a significant impact on many public health departments, which often serve as “providers of last resort” for historically marginalized populations. At least 181 state and local public health leaders in 38 states resigned, retired, or were fired between April 2020 and December 2020.1 Some of them resigned or were fired for political reasons. Many of those who remain could be suffering the effects of burnout.
Dr. Murthy also suggested that more attention needs to be paid to prevention. “The voice of prevention is low and soft,” he told attendees. The health care sector should “turn up the volume” and help communities understand why it is important to prevent disease or detect it during the earliest stages, he added. Prevention and early detection is at the heart of Deloitte’s landmark report on the Future of Health.
The need to reduce clinician burnout, improve health equity, and strengthen community trust is not new. Many organizations have been fighting hard for decades to create a more effective and equitable health care structure. Progress will likely require new types of collaboration and a substantial and sustained commitment from all health care stakeholders. We are excited for the chance to contribute to this important work.
¹ Pandemic backlash jeopardizes public health powers, leaders, Kaiser Health News, December 15, 2020
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