Federal, state and local government laws and regulations that created or exacerbated health inequities can be reversed and made to work toward undoing historical policy-driven harms.
Examples of how this can be done and tips on how to do it were included in “Learning and Using the Policy Making Process to Serve Minoritized Communities.” The recorded session is available free on-demand for CME credit and was co-hosted by the AMA and the American College of Preventive Medicine.
Pervasive inequities “started going back to our history of slavery and continued through the Jim Crow era with housing segregation or redlining and enforced by federal policies and programs,” William Jordan, MD, MPH, said during the session, which was funded by a Centers for Disease Control and Prevention Cooperative Agreement Strengthening Public Health Systems and Services Through National Partnerships to Improve and Protect the Nation’s Health grant called “Improving Minority Physician Capacity to Address COVID-19 Disparities.”
Dr. Jordan, who directs health equity policy at the AMA Center for Health Equity and is a family physician in New York City, noted how physicians have the shared experience of working with a patient with chronic illness “who has a complex life that makes it hard to stay healthy,” including a reliable way to get to physician appointments. And while practices or health systems may seek to assist such patients with vouchers to help pay for transportation to their doctor’s appointments, it does not address the underlying policy cause of inadequate public transit.
Attorney Kimberly Ramseur, MPH, a senior policy analyst for the AMA Center for Health Equity, listed examples from private organizations and government entities of policies related to care coordination and health-related social needs.
Examples include an AMA policy that declares that the provision of health care services “is an ethical obligation of a civil society.” Another AMA policy advocates developing alternative payment models that link quality measures and payments to outcomes specifically aimed at reducing health inequities.
Ramseur also noted the AMA’s support for federal legislation, the “Social Determinants Accelerator Act of 2021.” Provisions of the bill were contained in the Consolidated Appropriations Act that President Joe Biden signed last year, such as $8 million for a pilot program on social determinants of health.
Policy can explicitly address health equity, legacy systems of oppression and undo historical policy-driven harms, Dr. Jordan said. He shared examples of “equity policy principles” from different organizations such as Race Forward. Key principles include:
- Fixing systems, not people.
- Ensuring solutions are grounded in, and emerge from, the experience of historically minoritized and marginalized communities most affected by engaging leaders accountable to those communities.
- Committing to collecting demographic data and using it to track and prioritize the greatest needs.
- Setting measurable, results-based equity goals with specific attention to disparate impact.
The term “minoritized” refers to the process of historically relegating people to a subordinated status based on a dominant category intended to oppress groups based on a given social standing.
Dr. Jordan also shared the Race Forward steps needed for a successful equity-informed policymaking process. These include:
- Defining the problem and identifying structural entry points.
- Researching and identifying existing models and solutions.
- Applying a structural racism lens to existing policy and potential models.
- Identifying and assessing the impacts we wish to see in our policy solutions.
- Engaging the community throughout the process.
An essential “ingredient to equitable policy processes is stakeholder engagement,” Dr. Jordan said. “Engaging those who are most adversely impacted by an issue will help to more accurately name and frame the problem in context and dig into root causes without assigning blame.”
For example, developing nutrition policy could begin by framing the problem as “child hunger is unacceptable, but one-quarter of all children” experience it in the U.S. The next step would be to analyze who is disproportionately affected and how the inequity began.
“When you're thinking about policy solutions, you'll want to start with what already exists nationally and in your own jurisdiction,” Dr. Jordan said.
“There may be good policy on the books that's just not implemented or enforced, or you may want to actually update existing policy,” he added. “If you're starting with more of a blank slate, then you'll want to look for what other jurisdictions have tried or what other policies have been proposed.”