May 2021: From A Moment To Momentum

Dear friends,


The past month presented significant moments for health equity and racial justice. The Biden administration’s American Rescue Plan, which has major health equity implications, went into effect in April. A jury found a former police officer guilty of George Floyd’s murder. But at the same time, the deaths of Daunte Wright, Ma’Khia Bryant, Adam Toledo and others—along with rising legislative attempts to suppress voting rights and criminalize public protest—remind us that racial justice remains a work in progress. All told, it’s been a momentous month for those of us who care about inequity and injustice—a reminder that we all need to keep taking steps forward in this journey. 


At HealthBegins, we’ve seen our partners take important steps forward: 

  • Healthcare teams from North Carolina, Ohio, and Oregon are diving into work through our Social Drivers of Health Equity Learning and Action Collaborative. This collaborative is already helping healthcare systems understand and confront the structural determinants of health inequity—such as redlining, voter suppression, and other forms of structural racism—and build capacity to help dismantle them in concrete ways.
  • The just-launched South Carolina Roadmap to Food Security Learning Collaborative advances a larger effort we’re supporting to address the social drivers of health and advance racial equity in South Carolina through the development of a statewide strategy—designed by community-led teams.
  • This month we’re building on our longstanding work with the Virginia Hospital and Healthcare Association to launch a Maternal Health Upstream Learning Collaborative, assisting eight hospital-based teams to design and implement Upstream Quality Improvement Campaigns aimed at decreasing Black maternal health inequities across Virginia.
  • I had the honor recently of representing the Community Based Workforce Alliance in a meeting with the White House COVID task force, convened by Partners in Health and the Public Health Jobs Now! Coalition, to describe the crucial role of community-based health workers in COVID response efforts.


All these steps together add up to a sense of momentum—more present and powerful than any I’ve felt before now in the Upstream Movement. 


Momentum, however, does not mean we get to coast. Instead, this is exactly the moment to dial up our rigor, to ensure that the steps we’re taking will result in real change—meaningful, impactful, and long-lasting. And that requires accountability.


Institutional accountability is fundamental to addressing the social and structural drivers of health inequity. That’s why we’re clarifying what it looks like and supporting teams to build it into their work.


So how do we make sure health care and community partners are accountable?


I spelled out five key components of accountability in our last newsletter. We deepened that discussion in our May 11 webinar, “Health Equity and Institutional Accountability: Setting a New Standard for Health Care,” where Dr. Michelle Morse of the New York City Health Department, Professor Alnoor Ebhrahim of Tufts University, and Dr. Nahid Bhadelia of Boston Medical Center explained what it takes to ensure that healthcare systems’ efforts to advance racial justice and improve the social and structural drivers of health equity are effective. You can find the recording here.


We’ll be moving this work forward in coming weeks and months, convening and partnering with health systems, payers, and advocates to dive deeper on accountability for all kinds of healthcare institutions, as well as explore the ways in which community organizers and social movements can drive institutional accountability for health equity in health care.


Only by seizing this chance to refine our work can we build momentum and make the most of this moment. As always, please let us know how we can support you.



Rishi Manchanda, MD, MPH

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