• Inequalities in health care can lead to additional costs racial and ethnic minorities.
  • Some health systems are incorporating health equity programs into their business strategies.
  • Collaboration with local health organizations is key.
  • This article is part of the “Big Trends in Healthcare” series examining the top trends shaping the future of the industry.

Although Keneica Moore didn’t anticipate problems during her sixth pregnancy, she’s grateful she attended a doula-led support group aimed at eliminating health care disparities experienced by pregnant Black women.

“The biggest takeaway was that you can defend yourself,” Moore, 39, said. She said that thanks to the support group, she gained the confidence to refuse epidural anesthesia during labor due to her scoliosis. “Black women’s voices are often disregarded when it comes to their health,” she said.

The support group Moore is participating in is a pilot program offered through Mobilizing African American Mothers Through Empowerment, in partnership with Duke Health, that aims to improve the health of Black mothers. According to the Centers for Disease Control and Prevention, black women are three times greater risk of death for pregnancy-related reasons as white women.

MAAME doulas taught women relaxation techniques, breathing exercises and self-presentation skills, with the goal of empowering them to talk to their doctors about their care. “We created this group with great intentions because we realized that many gaps in social support were not being addressed,” said Dr. Sarahn Wheeler, who serves as vice president for equity, diversity and inclusion in the department of obstetrics and gynecology at Duke Health.

Wheeler, who is also an associate professor of obstetrics and gynecology and director of Duke’s Prematurity Prevention Program, said that more people in the U.S. health care system are aware of the disparities in the quality of care offered to some patients, especially Black and non-Black patients. color. “However, dismantling and reorganizing systems is not a quick process,” she said.

A healthcare system that does not address inequities can take a toll on patients. Some hospitals devote resources to programs that focus on outreach and community partnerships, recognizing that these disparities can lead to poor patient outcomes and additional health care costs for patients.

The cost of health inequality

A 2023 report from the National Institute on Minority Health and Health Disparities found that racial and ethnic health disparities cost the U.S. economy $451 billion in 2018which is a 41% increase since 2014. The report shows that health inequalities lead to increased costs related to premature death, loss of productivity at work and excess medical expenses.

This was demonstrated by a separate analysis conducted by the Deloitte Health Equity Institute Inequality costs approximately $320 billion annual health care spending, and if nothing is done to address the problem, that number could rise to $1 trillion by 2040. The institute found that health inequities contribute to late diagnosis and complications of costly conditions, such as diabetes, asthma and cardiovascular diseases.

“Our analysis likely covers only one floor, given our focus on gender inequalities, socioeconomic inequalities, and racial and ethnic inequalities,” said Dr. Jay Bhatt, managing director of the institute and the Deloitte Center for Health Solutions.

Bhatt said health equity is less a side project and more a key factor in strategic operations that influence how hospitals and health systems think about their businesses — for example, integrating equity programs into quality and safety strategies and initiatives .

“When you build on health equity, you can create value, better outcomes and lower costs,” he said. “Health equity is not just a moral imperative, it is an economic imperative.”

Strategies to improve health equity

Bhatt said creating effective health equity programs requires health systems to focus on community-based efforts to build and maintain trust.

In addition to MAAME, Duke Health is partnering with Born in Durham, Healthy For Life, a joint effort between the county’s public health department and a coalition of local health organizations and advocacy groups focused on perinatal equity and reducing maternal and neonatal morbidity and mortality.

Wheeler described the group as a meeting place to discuss and address the needs of the local community. Duke Health also partners with Diaper Bank of North Carolina, which aims to provide enough diapers to families with infants and children living in poverty.

Together, health care systems and their community partners, which may include nonprofit health care organizations, health groups, and places of worship, can better address the problem social determinants of healthor non-medical factors that influence health, such as the environment in which people live, work and play. Lack of access to fresh, affordable food and the inability to get to appointments safely are common barriers to good health, Bhatt said.

Other social determinants of health that Wheeler sees at the clinic include lack of child care, income uncertainty and language barriers. The lack of social support is particularly problematic. “It’s painful to walk into a room with a 19-year-old who has a very complicated pregnancy and she’s there alone,” Wheeler said. She added that research, such as her work on preventing premature birth, is often integral to understanding and reducing barriers to care.

Bhatt said health care systems can pursue health equity by creating diverse care teams. “One step to building trust with patients is to employ clinicians and care teams who share experiences and demonstrate empathy with the communities they treat and serve,” Bhatt said. Hospital boards and leadership should also reflect the demographics of the communities they serve.

“If you build on health equity,” Bhatt said, “there is an opportunity to improve outcomes, build consumer loyalty and trust, and create economic value.”


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