With the release of its strategic plan for advancing health equity, the AMA has given notice that it intends to confront the root causes and historical harms that have led to health inequities while working to dismantle structural racism and center pathways to truth, reconciliation, healing and transformation.
The strategy provides a framework “that encapsulates what we know about health inequities, what contributes to them, how they manifest in great inequities for historically marginalized groups, and what to do about it,” said AMA Executive Vice President and CEO James L. Madara, MD.
“Achieving equitable solutions requires disruption and dismantling of existing norms and taking collective action,” said AMA Chief Health Equity Officer Aletha Maybank, MD, MPH. “It also requires a sense of urgency and ambition, and the time is now.”
Dr. Maybank leads the AMA Center for Health Equity, which was launched as a result of policy adopted by the AMA House of Delegates at the 2018 AMA Annual Meeting. Delegates at the November 2020 AMA Special Meeting also adopted other foundational policies related to health equity, such as the recognition of racism as a public health threat.
The AMA’s “Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity: 2021–2023” provides a framework for advancing greater equity in health care, outlining five strategic approaches.
The AMA commits to:
- Embed equity and racial justice throughout the AMA by expanding capacity for understanding and implementing anti-racism equity strategies via practices, programming, policies and culture.
- Build alliances with marginalized physicians and other stakeholders through developing structures and coalitions to elevate the experiences and ideas of these health care leaders.
- Push upstream to address determinants of health and root causes of inequities by strengthening, empowering and equipping physicians with the knowledge of and tools for dismantling structural and social drivers of health inequities.
- Ensure equitable structures and opportunities in innovation through embedding and advancing racial justice and health equity within existing AMA efforts to advance digital health.
- Foster pathways for truth, racial healing, reconciliation and transformation for AMA’s past by accounting for how policies and processes excluded, discriminated against and harmed communities, and by amplifying and integrating the narratives of historically marginalized physicians and patients.
“With this blueprint for embedding racial and social justice, we are dedicated to comprehensively analyzing the structures, systems, policies and practices that have had harmful impacts within our organization and beyond,” Dr. Maybank said.
AMA President-elect Gerald E. Harmon, MD, noted that, while the health equity strategic plan was several years in the making, individuals and organizations “have been fighting for decades to call attention to the imprint of racism and social injustice on health care and society.”
“As a family physician in coastal South Carolina for more than 30 years, I certainly was aware that widespread inequities were negatively impacting the health of my patients,” Dr. Harmon said. “I could understand how job security, education, availability of fresh fruits and vegetables, access to public transportation, and a host of other factors could influence a person’s or a family’s chance for a healthy life.”
What he didn’t immediately see, however, was how these pieces fit together and how these gaps “were different elements of the same troubling story” that led to severe health outcomes among Black, Latino/Latina/Latinx/Hispanic, Indigenous and Alaska Native, LGBTQ+ and other historically marginalized communities.
“When I became AMA board chair in 2018, I was in position to do something about this,” Dr. Harmon said. “Building on momentum and a groundswell of support from both inside and outside the AMA, I appointed a health equity task force to explore health inequities, what caused them, and to return with specific instructions on how we could help.”
The task force’s recommendations were included in an AMA Board of Trustees’ report, which led to the creation of the AMA Center for Health Equity and its adoption of “optimal health for all” as the AMA’s definition of health equity.
The AMA’s strategic plan centers on an aspirational vision of a nation in which all people live in thriving communities where resources work well; systems are equitable and do not create or exacerbate harm; everyone has the power, conditions, resources and opportunities to achieve optimal health; and all physicians are equipped with the consciousness, tools and resources to confront inequities.
The consequences of inequity are far too great for the AMA and the physician community to look on as passive bystanders, Dr. Harmon said. Instead, “it requires the largest players in organized medicine to step up and speak out.”