Written by Maria Mercedes Avila, Ph.D., associate professor of pediatrics, director of Vermont Leadership Education in Neurodevelopmental Disabilities (LEND) and health equity liaison in the Larner Office of Diversity, Equity & Inclusion
“Everyone has a fair and just opportunity to be as healthy as possible.”
– Definition of “health equity” from The Robert Wood Johnson Foundation
I present and teach about health equity in Vermont and across the country, and have so far reached more than 8,000 providers across 27 states and 150 organizations. My research shows that the biggest knowledge gaps for providers relate to history. Many aren’t familiar with some of the more appalling aspects of the history of this country, including the Eugenics movement, forced sterilizations, boarding schools for Native children, and unethical research with vulnerable groups. This lack of knowledge about the root causes of today’s health disparities means many people do not have a context for COVID-19’s racial disparities and the most recent horrific acts of violence against Black/African American communities. We have to know our own history to be able to understand the pain and trauma communities have endured for hundreds of years.
The World Health Organization (WHO) defines health disparities as “differences in health which are not only unnecessary and avoidable but, in addition, are considered unfair and unjust” and “occur by gender, race or ethnicity, education or income, disability, living in rural localities, or sexual orientation” (Healthy People 2020). Health disparities are preventable; we can actively work towards eliminating these disparities and start narrowing gaps that disproportionately affect historically disadvantaged groups.
In discussions about “underlying conditions,” we have to understand that these conditions are the direct result of exposure to poverty, redlining, gentrification, food deserts, food insecurity, historical trauma, inequitable disciplinary practices in schools, healthcare disparities, and environmental, structural, systemic, and institutional racism. We cannot assume people know these connections. We have to focus on teaching critical thinking and emotional intelligence for all disciplines, but especially in health and allied health professions. We tend to focus on intellectual teaching, but we do not always focus on nurturing just human beings.
COVID-19 has resurfaced long-standing health and racial disparities in the U.S. If we look at the demographics of our state for non-Hispanic whites, Vermont is the second whitest state in the country, yet we still see racial disparities related to COVID-19 across the state. This speaks to the systemic nature of racism in Vermont and the U.S. Some cities are declaring systemic racism a public health issue. I strongly believe every city across the U.S. should be taking this action.
Addressing these disparities and inequities means that we need to invest in culturally responsive approaches to working with unserved and underserved communities. We need information translated to languages used by local communities, and we need to ensure interpretation and information reaches communities in real time. We need to meaningfully work with communities and community-serving organizations to ensure funding is equitably allocated. Communities need to be part of the planning, implementation, and evaluation of initiatives and projects.
We must also remove barriers to quality health and health care. Effective approaches to reducing health disparities include diversifying the workforce and expanding community outreach initiatives. Additionally, we need to ensure students, faculty and providers receive ongoing education and training about structural competence, cultural humility, and dismantling systemic racism. Culturally responsive providers understand that we all have biases and prejudices, and they are committed to unlearning these biases and dismantling systemic oppression. Best practice guidelines like National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care standards support these recommendations. In 2013, the U.S. Agency for Healthcare and Research Quality released a report that states: “Minority populations, in particular, continue to lag behind whites in a number of areas, including quality of care, access to care, timeliness, and outcomes. Other health care problems that disproportionately affect minorities include provider biases, poor provider-patient communication, and health literacy issues.”
We are all responsible for speaking up against racism, classism, ableism, heterosexism and many other forms of prejudice and discrimination. We also have to educate ourselves and embrace lifelong learning. Engaging in this work is a journey and not a destination. There is still a lot of work and learning and healing ahead of us.