Health Equity Cross-Tactic Team
The Health Equity Team has been charged with collaborating with primary care organizations, medical schools across the United States, and other stakeholders to reduce health disparities and increase health equity.
Reducing health disparities and improving health equity for all Americans is a daunting and enormous task. The Health Equity Tactic Team is approaching this work by:
- Working with the other six FMAHealth Tactic Teams to identify ways to keep health disparities and health equity front and center in their work.
- Engaging multiple stakeholders in order to coordinate and amplify the voice of all who are working to reduce health disparities and improve health equity.
- Addressing the challenge of increasing the social accountability of Family Medicine and other Primary Care organizations across the United States.
The Health Equity Team has been working on a number of projects, one of which is featured here:
Additional projects the Health Equity Team is working on include:
- Social Determinants of Health Curriculum Toolkit: The toolkit is designed for medical students, residents, and those outside of traditional teacher environments; from novice to expert learning levels. It uses products from the Starfield Health Equity Summit to provide a framework for teaching health equity and educating learners on social determinants of health and the impact of disparities on health outcomes. It will be available by mid-2018.
- The Business Case for Health Equity: The team is developing a business case for health equity – clearly identifying tangible economic benefits that result from reducing the level of chronic, preventable health conditions that come about due to health disparities – that can be adapted to engage multiple stakeholder organizations. Once the plan is developed, the team will engage a diverse group of organizations to help transform health care policy.
Viviana Martinez-Bianchi, MD, FAAFP – Team Leader; Family Medicine Residency Program Director, Duke Department of Community and Family Medicine
Bonzo Reddick, MD, MPH, FAAFP; Associate Dean, Diversity & Inclusion at Mercer University School of Medicine
Jennifer Young Choe Edgoose, MD, MPH; Faculty, University of Wisconsin School of Medicine and Public Health
Kim Yu, MD, FAAFP; Clinical Preceptor, Central Michigan University Family Medicine Residency and Past Board Chair of Michigan Academy of Family Physicians
Jewell Carr, MD (Technology Team rep); Family Physician, Carolinas Medical Center
Christina Kelly, MD, FAAFP (Workforce Team rep); Faculty, Savannah Family Medicine Residency and Director, Mercer University School of Medicine Primary Care Accelerated Track
Jay Lee, MD, PhD (Practice Team rep); Chief Medical Officer, Venice Family Clinic
Ronna D. New, DO (Research Team rep); Geriatrician, Johnston Memorial Hospital
Karen Smith, MD (Payment Team rep); Practicing Physician, Family Medicine Practice of Karen L. Smith, MD
Jane Weida, MD, FAAFP – FMAHealth Board Liaison to the Team; Associate Director & Professor, University of Alabama Department of Family Medicine Residency
Danielle Jones, MPH; Manager, AAFP Center for Diversity and Health Equity
Additional Health Equity Project Team Leaders/Advisors
Brian Frank, MD
Laura Gottlieb, MD, MPH
Ronya Green, MD
Health Equity Summit Planning Team Members
Viviana Martinez-Bianchi, MD, FAAFP – Summit Leadership Team
Jen DeVoe, MD, DPhil, FAAFP – Summit Leadership Team
Erika Cottrell, PhD, MPP – Summit Leadership Team
Ronya Green, MD – Summit Leadership Team
Andrew Bazemore, MD
Jennifer Edgoose, MD, MPH
Winston Liaw, MD, MPH
Sonja Likumahuwa-Ackman, MID, MPH
Starfield Summit II – Primary Care’s Role in Achieving Health Equity
The second Starfield Summit, focused on expanding the role of primary care in achieving health equity, was held in Portland, OR on April 22-25, 2017. The Summit brought together a diverse and dynamic group of attendees to strengthen and expand existing work on achieving health equity – and tapped into the strength of current partnerships to pave action-oriented paths toward achieving health equity and social accountability.
The FMAHealth Health Equity Team took a leadership role in the planning and execution of the event – and in recruiting key stakeholders to build Action Plans to propel work forward following the Summit. The team partnered with, and would like to thank, a number of other sponsors including: OCHIN, the Pisacano Scholar Leadership Foundation, Oregon Health & Science University, NAPCRG, and the ABFM Foundation.
The Summit featured experts in health equity speaking from multiple perspectives – highlighted by keynote speaker, Dr. David Williams, PhD, MPH, of the Harvard School of Public Health. IGNITE speakers launched discussions on four major themes over the course of two days: Social Determinants of Health; Vulnerable Populations; Economics & Policy; and Social Accountability.
Additionally, the Summit hosted an action-planning session for representatives from almost 50 organizations working to increase health equity and reduce health disparities. The goals of this session were to increase collaboration among these organizations and create ways for all to speak with one voice about the role primary care can play in achieving health equity.
The Health Equity Summit addressed four major themes:
Theme 1: Social Determinants of Health in Primary Care
Social determinants of health (SDoH) are those “conditions in the places where people live, learn, work, and play” [that] affect a wide range of health risks and outcomes”.
1 These are now recognized to be the primary drivers of health outcomes across the lifespan, eclipsing both quality of care and access to care.
Theme 2: Vulnerable Populations
As we examine health disparities, who lies on the wrong side of the equation? “Vulnerability involves several interrelated dimensions: individual capacities and actions; the availability or lack of intimate and instrumental support; and neighborhood and community resources that may facilitate or hinder personal coping and interpersonal relationships.”1 Such a definition brings us closer to an understanding of health inequities: “when disparities are strongly and systematically associated with certain social group characteristics such as level of wealth or education, whether one lives in a city or rural area.”2 We explore disparities through the lens of different vulnerable populations and add a further layer of complexity as we introduce the topic of “intersectionality.”
1 Mechanic D, Tanner J. Vulnerable people, groups, and populations: Societal view. Health Aff (Millwood). 2007;26;1220-1230.
2 Wirth ME, Delamonica E, Sacks E, Balk D, Storeygard A, Minujin A. (2006b). Monitoring Health Equity in the MDGs: A Practical Guide. New York: CIESIN and UNICEF
Theme 3: Economics & Policy
To understand how to address health inequities through policy and economics, it helps to look at global efforts. Ontario found sizable inequities driven by social determinants of health (SDoH) in a setting of universal health care. The United Kingdom and New Zealand use models demonstrating payment adjustments based on ecologic SDoH indicators. In the United States, the Affordable Care Act has opened the way to exploring SDoH as part of its move toward value-based care. Capturing community vital sign data and personal SDoH data has enormous potential to begin the process of leveling the playing field for patients and populations.
Theme 4: Shifting the Paradigm Toward Social Accountability
Social accountability in healthcare intentionally targets healthcare education, research, and services, and addresses social determinants of health, towards the priority health concerns of the people and communities served, with the goal of health equity for all. Multi-sector and multi-stakeholder collaborations are critical. Amongst these key partners are vulnerable communities who must be included, heard, and supported by an environment that promotes engagement between healthcare systems and people.