Dear friends,

Here’s a riddle: What’s a welcome sign of progress that also includes lots of potential pitfalls? 

The answer may be: many health equity efforts right now in U.S. healthcare institutions.

Over the last year, the pandemic and social movements like Black Lives Matter put a nation-sized spotlight on racial health inequity and structural racism.

More health systems are paying attention to this now than ever, searching for—and too often finding—racial and gender inequities in realms such as cancer treatment, vaccines, or diabetes care. They’re seeking to measure and embed equity in access, quality, safety, and population health management efforts. I’m proud to say that we’re supporting a number of institutions to do just that. 

But this work, while essential, is only a fraction of the full picture. And as we widen the lens we see pitfalls and sinkholes on the horizon. If we’re not careful of these risks, many new equity efforts in health care—necessary as they are—may stumble or succumb. Here are a couple to watch for. 

First, we run the risk of medicalizing the path to health equity. One way structural racism manifested in health care over many decades was by reifying biomolecular, genetic approaches to understand and treat disease, while abdicating biopsychosocial analyses and excluding people who sought to address the social and structural drivers of health inequity. If we focus only on the most visible thorns and stems of the problem, while failing again to prioritize action on the roots—we will miss the mark on equity. 

By staying mired in the biomedical model, leaders might also miss the opportunity to support and connect their internal equity work with the equity and justice efforts already happening in their communities, beyond hospital walls—potential collaborations that could actually ensure that health systems improve equity.

Another potential risk is that health care gets away with simply giving lip service to accountability. Relying solely on healthcare institutions to hold themselves accountable for advancing equity hasn’t worked to date. We must also demand proof that healthcare leaders and policymakers are building the capacity of stakeholders—including patients and residents from marginalized communities—to hold institutions more accountable for equity. (To support this goal, we’ll have a guide for health systems, developed with trusted partners, available free next week. Join us for the introductory webinar on July 29.)

There are other risks, of course, which I’ll detail in an upcoming post on The Upstreamist blog. What’s essential now is that we be clear-eyed and resolute in naming and avoiding these potential pitfalls. And that we support each other at every step in the challenges of addressing them—from the roots up.

Best,

Rishi Manchanda, MD, MPH