Health equity is, at last, on everyone’s lips. The tragedies and strains of the past few years have made plain a truth that many of us long knew: that real health for all can only come with equity, and that equity must therefore be central to any effort to improve health for individuals or communities.
But this moment of opportunity to meaningfully advance equity presents us with a simultaneous challenge: How do we separate signal from noise? How do we demonstrate impact, not just make promises, to eliminate health and social inequities and reduce gaps in care?
These were always critical questions, but they’re especially relevant this year as more healthcare leaders and institutions finally make commitments to health equity. This year, more than ever, we have to keep the real, rigorous pursuit of health equity front and center. And the way to do that is to focus on impact.
A sincere commitment to equity is essential, as are clear equity-focused goals and a detailed strategic plan designed with broad stakeholder input to address social needs and broader structural drivers of health inequities. But from there, any Upstreamist leader or institution also has to ask: Once we’ve committed to improve equity, how do we demonstrate that inequities are actually decreasing? How do we ensure that care gaps for diabetes patients, for example, are closing, or that we’re actually eliminating racial inequities in health and related-social inequities, including food insecurity and housing instability? How do we ensure that our healthcare-based patient-focused equity efforts are aligned with broader community-led campaigns to advance health equity and supporting national efforts to counteract mechanisms of structural violence?
Where we’ve seen the potential impact of a new strategy sometimes unravel is on the ground—in the daily workflows, processes, data, and relationships that are essential to the healthcare and social-service workforce implementing any plan. We call these the last-mile challenges.
One method that we know works to bring well-laid plans into practice is Community Health Detailing, which can help reduce inequities and close care gaps. The origins of the model lie in pharmaceutical “detailing”—the tailored, one-on-one conversations that drug-company representatives use to influence doctors’ prescribing behaviors. In Community Health Detailing, community members or staff with lived experience learn techniques for communication, goal setting and tracking, and the use of new workflows and tools. Then these “detailers” sit down with busy healthcare providers—usually for no more than 8-10 minutes—and educate them on how best to implement new practices to promote equity, improve care, and address health-related social needs.
Last year, for example, this method helped member organizations of the YMCA of the U.S.A. work with clinics serving lower-income residents and increase clinical referrals to community-based diabetes prevention programs and social services by nearly 50% across three states. This year, Medicaid managed care plans and providers have asked us to apply this same method to help them meet growing state and federal performance requirements and drive demonstrable reductions in specific health inequities.
This method effectively builds health equity in part because it is built on equity. It taps the power of CBOs not only as providers of social services, but as solvers of last-mile challenges to health and social care integration. It views community members with lived experiences not only as beneficiaries of healthcare equity, but also honors them as drivers of health equity transformation on the front lines, by supporting and compensating them to help clinicians improve care.
With those values front and center, we’re eager to see the real impact that this year can and must bring—and to help courageous leaders, through programs like Community Health Detailing, effectively tackle those last-mile challenges to translate promises of equity into practice.
Rishi Manchanda, MD, MPH. Sadena Thevarajah, JD