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The Big Story: Trends in Health Equity Legislation by State and Implications for Healthcare Organizations Chartis

States collectively have enacted hundreds of legislative statutes designed to promote health equity and address gaps in specific health-related needs. Areas of focus include increasing access, addressing social drivers of health, providing timely behavioral health care, and improving outcomes in maternal health. 

Awareness is driving focused action; more education needed 

By James Cervantes
3-minute read

We’ve made so much progress in the past few years. 

Health disparities – long acknowledged but, historically, given more lip service than action – are receiving attention and action as never before. State lawmakers are codifying rules to drive more equitable care. Healthcare rankers – such as U.S. News and Lown Institute – are measuring and reporting equity metrics. The public is expressing an awareness of disparities and an understanding of the need to fix the system. 

But we’re still a long way from attaining the highest levels of health for all. 

Provider organizations are pressing ahead because they know there are gaps that need to be closed. In our conversations with health systems pursuing health equity work, a common theme is an acknowledgement that their internal data shows the care they provide to certain populations can be more equitable. 

Our national conversation about health equity has evolved over the past three years. The pandemic launched a meaningful conversation about health disparities, and the murder of George Floyd brought a wider focus to equity across society. With that established, we’re now seeing more emphasis on specific metrics and outcomes, such as maternal and infant health.  

In parallel, healthcare consumers are telling us that things aren’t where they need to be. For example, in our recent survey of 840 US adults:

  • Nearly two thirds said that providers do not do enough to help low-income patients get good care. 
  • Nearly six in 10 people said that patients have better outcomes when they’re able to see a clinician who comes from a similar background. 
  • More than six in 10 agreed that U.S. healthcare needs more people from diverse backgrounds working as physicians. 

These catalyzing events and shifting public sentiment are drivers of legislative change. Our colleagues at the Chartis Center for Health Equity & Belonging have been tracking state trends in health equity legislation. Their report shows that “legislatures are adding a rapidly growing body of statutes and programs to advance health equity.” In fact, 41 states “have new, expanded or planned Medicaid initiatives to address racial and ethnic health disparities.” 

All told, we see encouraging, exciting progress. Let’s keep it going.

There are some signs that momentum on health equity might be slowing a bit after three years of meaningful activity. We, as communicators, have a powerful role to play in maintaining the momentum: More action is needed to share the story of where disparities exist, who is being affected and what can be done to remedy the situation. 

For example, when we polled consumers asking if anyone in the U.S. can get the healthcare they need regardless of race/ethnicity, gender, sexual orientation or socioeconomic status, the public was split: 29 percent strongly agreed, 25 percent strongly disagreed. 

There’s a lot of good in those numbers, but they also reveal something of a disconnect on how people think about health equity and how it plays out in access to care.  

So where should healthcare leaders and communicators go from here? First, we encourage you to review the recommendations in Chartis’ report here. Beyond that, healthcare provider organizations should consider focusing on these four imperatives:

  • Start the conversations from within. Getting your employees aligned to the need should be one of the first things you do. There’s always internal work to do to advance a culture grounded in inclusivity and belonging. Certain states already mandate healthcare professionals complete implicit bias training. This should be table stakes for your entire organization, regardless of what state you’re in or how diverse your workforce is. It’s 2023, and it’s time everyone accepts that we all can benefit from these teachings. 
  • Be the convener for your community. Focus your organization on direct patient care, but partner smartly with others who provide related services. Based on our data, most Americans believe the role of a hospital or health system should be to provide medical care more than address things like food, housing and transportation. That said, it’s unrealistic to think that healthcare and social determinants of health can be addressed separately. Find established, trusted partners in your community who you can work with to address non-medical needs. Then, facilitate conversations about the work ahead.
  • Leverage data to tell your story. Beyond developing a dashboard that summarizes data on disparities in quality and access, use that data to tell your story. Create a narrative around why you and your partners are advancing health equity, beyond the regulatory requirements (which won’t resonate with most people). People need to understand the driving force behind a focus on specific populations or outcomes, and data can be a powerful way to unite your employees and community around the cause. For example, we know that Black and American Indian women have higher rates of pregnancy-related death compared to white women, and the increased awareness and attention to maternal and infant health have contributed to a rise in efforts and resources focused on improving health outcomes in these areas and reducing disparities across multiple populations.
  • Create a common language. How is health equity different – though related – to diversity, inclusion and belonging? How does it apply to different populations? How does helping one population serve to support others? These are all questions your employees – and leaders and boards – are asking. It’s time to create clear definitions and map them to your mission. 

Contributors:  David Shifrin, Emme Nelson Baxter
Image Credit: Shannon Threadgill