February 2021: To Advance Equity, Leaders Across Departments Need to Move Upstream Together

Dear friends,


Organizational commitments to health equity are growing.


We see it in the blossoming of new leadership positions focused explicitly on health equity. Our friends and colleagues Dr. Aletha Maybank, the AMA’s first Chief Health Equity Officer; Dr. Nwando Olayiwola, the new Chief Health Equity Officer at Humana; and Dr. Michelle Morse, the first Chief Medical Officer for New York City’s Department of Health and Mental Hygiene, are among the most prominent recent examples.


At the same time, we’re seeing health systems strengthen their offices of Diversity, Equity & Inclusion (DEI)—representing a crucial expansion from emphasizing diversity alone.


We also see leaders in other health system departments—in population health management, care management, community benefits, data analytics and research, human resources, and quality improvement—stepping up to improve health equity. Many are now asking themselves and each other: “How are we advancing health equity?”


This is the opportunity—and the imperative—that we have now. As a growing number of leaders across health-system departments work to improve health and equity by addressing factors beyond the hospital or clinic walls, we need to connect these efforts more than ever. In forging these connections, we have a major opportunity to advance health equity by setting clear goals and bold strategies to improve the social and structural drivers of health equity.


This principle is already familiar to Upstreamists. We know that cross-sector collaboration  between healthcare, public health, and community partners is essential to moving upstream. Now we need to apply that principle internally, to our own organizations as well.


I’m inspired to see the trailblazing teams in HealthBegins’ national learning collaboratives already doing this and reaping dividends. Leaders from the population health management department at New York-based Mount Sinai Health System, for example, joined forces with their system’s DEI office and other departments to identify concrete opportunities to dismantle structural racism. And in Virginia, health systems in our statewide learning collaboratives have brought leaders across departments together to move upstream and advance health equity. In one system, a cross-departmental team launched an inclusive design process to develop community-centered, equity-based solutions to improve food security for patients with diabetes.


The lesson is that cross-departmental efforts are just as vital to health equity as cross-sector efforts. No one department shoulders the responsibility to advance health equity. This commitment must be embedded enterprise-wide. Working together, cross-departmental teams can quickly recognize shared interests, streamline approaches to improve patients’ social needs, and align on ways to collaborate with community partners to improve social and structural determinants of health equity. The whole is greater than the sum of its parts.


So if you’re a leader or manager in any one of these departments and you’re looking to advance your health equity efforts, ask yourself: When did you last meet with a colleague in one of these other departments? Does your system have a clear, shared enterprise-wide plan that requires each department to identify concrete actions to improve health equity? Do your health equity plans include an explicit focus on improving the social and structural drivers of health equity for your patients and communities?


If you haven’t considered forging these links before, be inspired. Now’s your time. If you’ve considered it but haven’t tried it yet, be emboldened. Now’s your time. If you’re already working hard to implement a cross-departmental plan to improve the social and structural drivers of health equity, be proud.


And, regardless of where you are on the upstream journey, if we can help to encourage or support you, let us know. The stronger we build connections with each other—within our institutions and across sectors—the better and faster we can build health equity. Now’s our time.



Rishi Manchanda, MD, MPH

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