By Consuelo Echeverria
Does equity matter?
This is the question that shaped the UHCC April meeting as Dr. J, (AKA Dr. Karen Johnson) stepped in to shed some light.
But first, a bit of vocabulary.
This graphic demonstrates the difference between equity and equality. Equality is represented by all boxes being the same height but only those tall enough are able to see the game. Equity lens ensures everyone gets to see the game.
The WA universal health model must address the Social Determinants of Health
To further expand on the equity lens, health means not only an absence of disease but a state of complete physical, mental, and social well-being (World Health Organization). For example, we must build a healthcare system that when treating a child who has lived trauma with a high Adverse Childhood Experience score, (ACEs) their health care providers and the system in which the providers work must attend to that child’s wider world. Addressing social determinants of health requires that healthcare workers understand and have the tools to reduce the impacts of poverty, substandard housing, discrimination, fractured communities with friends and family dying young from disease or violence, in other words, address the social determinants of health that shape the environment of the child.
- An unequal health system is expensive.
A 2022 report found that “the US spends more than $3.8 trillion dollars a year on health care, or nearly 18% of the gross domestic product, according to the US Centers for Medicare & Medicaid Services Office of the Actuary. If left unaddressed, health inequities could add $1 trillion to overall health spending by 2040.” by the US Centers for Medicare & Medicaid Services Office.(Davis, Dhar et al, 2022). Health systems that fully address the needs of the most vulnerable save money.
Why is this number so big? Because those that live with inequity, poor folx, our elders, BIPOC and rural communities tend to be sicker and cannot always access, afford, or receive preventative health care. So many end up at the ER, where healthcare is much more expensive.
Dr. Chaniece Wallace experienced systemic racism and implicit bias which nullified her lived experience. Dr. Wallace, a chief resident in pediatrics, died in October 2020, two days after giving birth to daughter Charlotte, from postpartum complications related to preeclampsia. Preeclampsia is one of the most preventable complications in pregnancy. This was not a sole incident, the CDC found that Black women are 3 times more likely to die in pregnancy related events than white women and the gap is widening (>10% for African American women vs <1% for White women).
- How to make an equitable model?
Specific actions that a universal single payer health care model must address are, not only acknowledging and addressing past historic injustices but listening and acting upon the voices of those most impacted. That is, those who have been traditionally marginalized, people with disabilities, BIPOC communities, rural areas, and low-income White population, or who face structural barriers to accessing health care such as lack of English, transportation, childcare, or ability to take time off work to go to the doctor.
The model must:
- Listen and act upon the voices of those most impacted
- Increase funding for community health centers and other healthcare providers that serve low-income populations.
- Promote diversity and inclusion in healthcare systems and providers
So keep the public comments coming as we do not want a performative system that mouths equity and yet seems unable to respond.