What’s Racial Equity Have to Do with Health Equity?
Achieving health equity inherently requires us to address racial equity. According to the Robert Wood Johnson Foundation, “health equity means that everyone has a fair and just opportunity to be as healthy as possible… [and] requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.” For the last several hundreds of years, racism has been imbedded across every aspect of society in the United States, including culture, housing, education, business practices, healthcare, and law. If we’re being generous, it has only really been within the last half century that progress has been made to substantially reduce the impacts of structured racism and work towards providing equitable opportunities for people of color and indigenous communities, including fair and just opportunities to reach their fullest health potential. Historically, communities of color and indigenous peoples have been, and continue to be selectively disadvantaged by institutions across every single sector, resulting in worse health outcomes, or health disparities, compared to non-Hispanic white communities. If we want to achieve health equity, we cannot do so without utilizing a racial equity lens to focus on those communities facing the greatest inequities.
You Betcha Racial Equity Should Be a Priority
Blue Cross Blue Shield Minnesota (Blue Cross MN), the largest health plan in the North Star State and a Root Cause Coalition partner, has been prioritizing racial equity in its work and practice. While once a predominantly homogenous state, Minnesota has become incredibly racially and ethnically diverse in the last few decades. However, Minnesota has some of the nation’s largest racial disparities across health, housing, and education metrics. For example, Minnesota GO found that African American Minnesotans were almost four times as likely to be living in poverty compared to non-Hispanic white Minnesotans. According to a report released by MN Community Measure, only 40% of immigrant patients born in Laos had been screened for colorectal cancer compared with 70% of non-Hispanic white Minnesotans statewide. As an organization uniquely positioned to be able to reach a large proportion of Minnesotans, along with its partnerships with community-based organizations, healthcare systems, and government entities, Blue Cross MN has enormous social capital to make a dent in reducing racial disparities. From an economic perspective, racial inequities produce poor health outcomes that are a huge cost and financial burden to health insurers. Indeed, Blue Cross’ own Cost of Health Inequities study that it conducted with the University of Minnesota in 2018, estimates that figure to be $2.26 Billion annually in Minnesota. Nationwide, according to the International Journal of Health Services, it was estimated in 2011 that eliminating health disparities for minorities would reduce direct medical care expenditures by $230 billion. With everything considered, Blue Cross MN has taken the dual approach of advancing equity internally within its four walls and externally through its community engagement initiatives.
Within the organization, Blue Cross MN has acted to promote racial equity among its staff members and business practices at all levels of the organization. Senior executives participated in the Disparities Leadership Program hosted by the Disparities Solution Center at Massachusetts General Hospital to learn how to better the organization with an equity lens. Staff members regularly engage in cultural competency workshops and discussions focusing on the intersections between race and health. Product managers utilize an equity scorecard to evaluate products for various equity factors, such as language accessibility and cultural sensitivity. Change cannot happen if equity frameworks are not embedded into everyday practices across the entire organization. Beyond the organization, Blue Cross MN prides itself in taking the lead to advance racial equity in Minnesota. As such a large organization, Janelle Waldock, Vice President of Community Health & Health Equity, believes it is their responsibility to work towards shifting more power to communities directly impacted by inequities. Rather than Blue Cross MN deciding what is the best intervention to implement in communities, community members and community-based organizations should have the largest role in making such decisions as they best understand the issues and often know the best solutions. Therefore, Blue Cross MN maintains partnerships with community-based organizations across the state to support local efforts to reduce health disparities. Beyond these vital community connections, Blue Cross MN just last year sought to use its role as the largest health plan in Minnesota, and as a business leader in seeking to create greater understanding, engagement and change in the business community on health equity. Focusing on both the altruistic drive for greater equity, as well as the business-driven imperatives, they launched the Health Equity: Make it Your Business animated video series urging businesses to start seeing inequities and take tangible actions to address them. The campaign included seven community created animated videos that discuss factors related to health inequities offering viewers perspective on the difference between equity and equality, how health is impacted by race, income, gender identity and where you live, as well as the cost of health inequities to the state in terms of lives and dollars lost.
No One Ever Said It Would Be Easy
Organizations who have not yet made racial equity a priority in their work should consider utilizing a similar strategy as Blue Cross MN that engages both internal and external stakeholders. Although some progress has been made across the country, the process of eliminating racial disparities has been slow. As Stephanie Molliconi, Principal Health Care Design Consultant, explains, “the pace of addressing racial inequities doesn’t match the pace in which healthcare typically measures metrics,” making progress difficult to quantify since outcomes may take a long time to produce measurable results. Even though progress may be slow, Waldock urges everyone to make racial equity a long-term focus and investment. “We didn’t get to where we are [in racial inequities] overnight, so we need to bring a level of urgency to the work we’re doing and make racial equity a priority.” Everyone, across all sectors and organizations, should evaluate how racially equitable their practices and policies are. Although there is a long road ahead of us to achieving racial and health equity, the investments will be worthwhile to ensure everyone an equal opportunity to living a healthy life.
Blue Cross and Blue Shield of Minnesota (bluecrossmn.com), with headquarters in the St. Paul suburb of Eagan, was chartered in 1933 as Minnesota’s first health plan and continues to carry out its charter mission today as a health company: to promote a wider, more economical and timely availability of health services for the people of Minnesota. Blue Cross is a not-for-profit, taxable organization. Blue Cross and Blue Shield of Minnesota is an independent licensee of the Blue Cross and Blue Shield Association, headquartered in Chicago.
Thank you to Janelle Waldock, Vice President of Community Health & Health Equity, and Stephanie Molliconi, Principal Health Care Design Consultant, for informing this blog post.