Health care organizations are on the front-lines of addressing health equity. They play key roles in delivering care, offering products to access care, as employers, and as social safety nets in their communities. Leaders from health systems and health plans are searching for ways to address health equity within their organizations and the communities they serve. They are seeking to understand how they can confront systemic racism and bias and improve health equity.
The Deloitte Center for Health Solutions wanted to understand what health care organizations are doing to address health equity. What steps have they already taken, what have they learned, and what are they planning to do next? We surveyed 20 CEOs and interviewed 28 additional executives from health systems, health plans, and the pharmaceutical sector. Here’s what we found:
• Health equity is a top priority for many organizations. Half of the CEOs we surveyed said health equity was among their top three organizational priorities for 2021. Every interview revealed a leadership and/or financial commitment to health equity.
• Organizations are at different stages in their health equity journey. Some organizations have had executive leadership focused on health equity for years. Others are just beginning to define what health equity means for their organization. Of the 20 CEOs we surveyed, 17 said they have a dedicated team, task force, or committee and budget dedicated to health equity.
• Leaders are taking many different approaches toward health equity.The executives we interviewed discussed different definitions of health equity. Some viewed diversity, equity, and inclusion (DEI) as strongly linked to health equity while others had different approaches for diversity efforts in their workforces.
Interviewed executives acknowledged that there is a lot of work to be done. Inequities exist, especially among Black, indigenous, and people of color (BIPOC) individuals. The executives we interviewed shared the following as effective strategies to drive change throughout the organization:
• Change needs to be driven from the top.A clear strategy and vision for health equity should come from top leadership, including the board. These leaders should also understand the specific needs of the communities they serve so that their organizations can then determine how to help address those needs.
• Leaders need a shared understanding of how health equity is a moral and business imperative. Many executives said they are trying to help leaders recognize health equity as an addressable issue that can also support business goals such as improving clinical outcomes, improved consumer engagement, and better financial performance. Health equity should be instilled in each part of the business, not an add-on measure, to ensure accountability. Having a mix of organizational data on how disparities affect the bottom line, along with personal stories from patients and employees, can make a clear argument for investment in health equity.
• Change needs to be funded and supported.Health equity initiatives that are not well funded or not led from the top are at high risk of failure or neglect, especially when cost reduction becomes a priority. Support from the top could help ensure a commitment of dollars, resources, and goals for a long-term impact.
• A chief equity officer role and a clear governance structure should be created. A named leader, including a clear structure of responsibilities, ensures accountability and execution on health equity strategies for the organization. Interviewed executives discussed how having a chief equity officer report to the CEO and present frequently to the board can demonstrate the organization’s commitment to health equity.
• Efforts should be measured and evaluated.Efforts to achieve health equity (whether drivers of health investments, diversity efforts with the workforce, or other specific initiatives) should have clear goals and measures to track progress and to provide insights to continue or shift strategies and investments. Executives discussed the importance of measuring the impact of efforts on business goals (financial, outcomes, consumer engagement), developing community-specific health equity dashboards, and in balancing the available data with the desire to use analytics to identify problems.
Health equity is a complex, multifaceted issue, and organizations should be thoughtful in how they approach it. Achieving health equity requires leaders to deliberately design and build systems where the outcome is advancing health equity. Each leader should be accountable, and every initiative should be measured for impact on investment. Strategies that address multiple dimensions tend to be effective, as does each leader understanding and taking action on their role for achieving health equity within their organization, offerings, community, and ecosystem. Success can be dependent on long-term strategic and financial commitment to leadership, resources, and accountability.
Introduction: Health equity is a moral and economic imperative for health care organizations
Ensuring that every individual has an equal opportunity to achieve their full potential in all aspects of health and well-being is a far cry from what exists in the United States today. Achieving greater equity will require a reduction in health disparities—quantifiable differences in health-related outcomes.2
Health inequity is pervasive across race, gender, age, and income, but is especially apparent along lines of race. For example, the mortality rate for Black infants in the US is double that of white infants. And the maternal mortality rate among Black women is more than three times higher than among white women and higher than for all other races in the US.3 Even when incidence rates are similar for a disease, Black Americans tend to die at higher rates than white Americans. For example, Black women have slightly lower incidence rates of breast cancer compared to white women, but Black women have a 42% higher mortality rate. Moreover, Black men are twice as likely as white men to die of prostate cancer.4 Racial disparities often exist across all income and education levels. For example, Black women have a higher risk of pregnancy-related death regardless of income or education levels.5
Over the past year, the world has endured crises that reinforce the importance of health equity. The COVID-19 pandemic resulted in millions of hospitalizations and nearly 600,000 American deaths at the time of this publication.6 People of color endured significantly higher rates of hospitalization and mortality than other groups.7 Black and Hispanic Americans, for example, are three times more likely to contract and twice as likely to die from COVID-19 than white Americans.8 The high profile deaths of George Floyd, Breonna Taylor, and other Black Americans in 2020 shined a brighter spotlight on racial injustices and underscored the importance of addressing inequities.