A fair game: Establishing health equity in America.

Understanding equity 

Health equity is a broad consideration and starts with the premise that good health is a right, and not a privilege. Therefore, health equity is about a fair opportunity—for everyone—to be and stay healthy based on need, not means. 

Don’t confuse health equity with the concept of health equality. Despite the similarity in terms, there is an important distinction. 

While health equity focuses on fair opportunities for good health based on need, health equality champions the idea that the same healthcare services should be available to all people and that everyone will be treated the same way. 

That might be fine except that health equality doesn’t consider an individual’s actual need. People are different; not everybody (or every community) requires the same services.

The cause

Inequities are rife in the U.S. healthcare system and the causes are well known. Chief among them are the institutional and systemic differences in distribution of resources and access to them where disparities exist in education, income, and housing. That’s a mouthful, but there’s even more to chew on. Healthcare inequities are also fed by racial and ethnic discrimination, as well as sexism, classism, xenophobia, homophobia, and physical disabilities. That’s only a partial list. 

Availability of broad healthcare services is limited in many parts of the country and in many urban neighborhoods, particularly low-income communities, and communities of color. Even when available, access is often thwarted by affordability, healthcare’s high costs proving too prohibitive for many people. 

The effect

The effects of inequity are also understood. A higher risk of health issues, poorer chances of positive outcomes, and lower life expectancy are all known manifestations of healthcare inequity. According to the CDC, average life expectancy among Black or African American people in the U.S. is four years lower than that of White people.^[1]

The effects go deeper. Alcohol and substance abuse, crime and violence, and the ability to trace and treat infectious diseases can all be linked to health inequities in the U.S. 

There’s a vicious cycle at work too: lower income leads to poorer health which leads to lower income. Further, disadvantaged populations often incur more costs simply by the fact that they often present with more advanced illnesses or conditions when they do find care.

All which is to say, yeah, this is a tough issue for healthcare and all Americans.

Not a new concept

The idea of health equity can be traced back to 1801. But it wasn’t until the 1960s that health equity research became formative. In the 1990s, research through the World Health Organization unified an international medical community in agreement that health equity is an essential element for health system development. 

Not that there was a movement to create true health equity that immediately followed. On the contrary, health inequities have only broadened since. 

Healthcare inequities drive up the cost of healthcare for everybody.

• Inequities in the U.S. health system today cost $320 billion.
• If unaddressed, inequities will cost $1 trillion by 2040.[2]

Picking up steam

Established in 2010, The Affordable Care Act (ACA) put health equity on its agenda and provided much-needed momentum in its favor. Reforms such as individual insurance plans, coverage for pre-existing conditions, physical and mental health insurance coverage parity, and expanded Medicaid eligibility are all logical steps toward health equity, as is more funding for the expansion of community health centers. Indeed, the National Institutes of Health found that “the ACA reduced income inequality and that the decrease was much larger in states that expanded Medicaid than in states that did not.”^[3]

More steps toward equity can be found in the 21st Century Cures Act which established important reforms to foster standardization of information-sharing technology and that give patients unfettered access to and ownership of their own medical records. 

But getting to true health equity is a bit like trying to turn around an ocean liner. It’s going to take more work—a slow and wide turn—to get headed in the right direction. 

What’s more, we cannot simply rely on government action to ignite change. Healthcare organizations and entities need to identify and knock down their own blockers to health equity and work toward real solutions.  

Newer elements to equity

Those of you familiar with what we’re building at MediSprout know that data sharing, information transparency, and technological design are subjects close to my heart. These three issues are playing an increasingly important role in healthcare and are vital components to health equity now and in the future. 

Until healthcare systems become more efficient at transferring and sharing data, and patients embrace the opportunity to control and share their own health records, the healthcare experience for patients in any socio-economic demographic will continue to be uneven and inequitable. 

Further, healthcare needs to stop holding its hands over its cards. No other consumer-driven industry shrouds patrons in such darkness over rightful information like healthcare. Patients struggle to understand costs, coverage, terminology, and a litany of issues that are critical to their care and quality of life. It doesn’t take rocket science to simplify medical speak and write an EOB that’s more easily understood. We know how to do this. 

The digital divide

Consumers are growing more reliant on technology to access care and to organize their personal healthcare ecosystems. That might be fine were it not for the fact that design systems embedded within much of the consumer-facing healthcare technology are complex and confusing. That’s an obstacle to health equity. Is it a fair thing to ask elderly arthritis sufferers to access their care via a smartphone and all if its tiny text and disorienting navigation? We know how to fix this, too.

It’s not just about patients. Providers struggle with healthcare technology that doesn’t meet the needs of modern practices and therapists. Inefficient technological functionality affects care, fuels provider burnout, and widens the digital divide. 

Technology can be a great thing if its design is equitable and inclusive. It needs to work for everybody. As is, healthcare technology is a monster tripping point for far too many providers and patients. 

A pivot to advocacy

Data sharing, information transparency, and digital technology that function as advocates and not like obstacles rest at the core of the MediSprout vision. Our vision drives our design system thinking and execution. We start with the premise that healthcare is a right for all, not a privilege for a few. We design from there. If a new feature doesn’t meet the promise of the right to live a healthy life, then we work on it and test it until it does. 

You can see evidence of our thinking (and our vision) in a feature just added to our patient onboarding experience. With MediSprout, families can establish one account for all family members using just one email address for everyone. Many other practice management platforms require each individual family member to have a unique email address, even toddlers. That’s an obstacle to care for many families.

Change starts at the top

Government support is important. But to realize true health equity, it can’t stop there. The private sector needs to step up and play big. The most difficult task may be what needs to happen first: a universal shift in attitude at the highest levels of healthcare. In the boardroom and at the executive level, leaders need to come forward and establish new guidelines that reflect a patient’s fundamental right to live a healthy life, executed via a fair opportunity to access the right kind of care whenever, wherever they need it.  

We already know how to do the rest.

Samant Virk, MD, is the founder and CEO of MediSprout.

1. Centers for Disease Control and Prevent, What is Health Equity

2. Deloitte. Insights, US health care can’t afford health inequities

3. NIH National Library of Medicine, The Affordable Care Act Reduced Income Inequality In The US