Working Towards Health Equity Must Be a Daily Habit

The COVID-19 pandemic and the social and political unrest following the police violence against George Floyd, a Black man in Minneapolis, MN, has magnified the systemic racism on communities of color. While the urgent need for change is obvious, there is a long road ahead to address the systemic and structural factors that have us where we are today. To discuss the implications of systemic racism – in general, in the context of health and healthcare, and the role Regional Health Improvement Collaboratives play in overcoming health disparities – we talked with Tanikka Price, JD, Director of Data and Finance for the Central Ohio Pathways Hub program at the Health Collaborative of Greater Columbus (HCGC). Working to overcome health disparities in underserved communities is not only her job, but her passion and inspiration.

In a recent blog “Using the Mirror to See One Another,” Tanikka reminded us that the only way to reach racial reconciliation is if we look not outward but inward and confront our own biases. We began our conversation asking Tanikka Price how those biases play out in the field of healthcare.

NRHI: In your blog “Using the Mirror to See One Another,” you take the position that that we should look inward rather than outward to find the change we need in relation to race and racism. The reason is that we all have biases and we need to account for them to allow for any conversation that leads to institutional change. If we think about the state of health and healthcare in the US today, what are some of the implicit and explicit biases that people have?

Tanikka Price: I think the culture of individualism has done a lot of damage to the relationships and communities in this country. People are no longer living close to relatives or meeting their neighbors on a regular basis. In this time of racial unrest, it has become clear that we are not seeing others as we see ourselves; that we have allowed ourselves to dehumanize others based on stereotypes or previous experiences. An example from the healthcare field would be that some medical staff would not prescribe pain medication for African Americans as frequently as they do to patients of other races because they believe that Blacks feel less pain.

Particularly striking recent examples of how race (and gender) impacts the quality of provided healthcare services are Beyoncé and Serena William’s pregnancy complications. Their pregnancy and post-pregnancy complications could have been fatal if it was not for their celebrity status.

Implicit bias allows doctors who work with underserved population to feel they are doing their patients a favor by even being there which leads to them being dismissive or even rude to their patients. Even Serena Williams celebrity status did not help when she was asking for specific tests. She faced deaf ears when telling the medical staff about her medical concerns.

The explicit biases are present in beliefs about cultures – the belief that Black women are always single parents, or on medical assistance or uneducated. Even in cases where those things are true, those women still deserve the same quality healthcare as any other person.

NRHI: From your experience working with the Central Ohio Pathways HUB, how have those biases impacted communities and community health?

Tanikka Price: Well, the most obvious ways are the myriad of ways systemic racism harms African Americans. It affects every aspect of our lives from housing to the legal system to health and safety to policing and transportation. There is no facet of the American society that is not touched by the legacy of slavery and the inability of America to admit the harm to African Americans and the benefits to white Americans that slavery has produced. Probably, most harmful are the ways African Americans have internalized the racists ideology that suggests that they are lesser just because of their skin color. This shows up in domestic violence, parental abuse, and youth violence in our communities. If those people were taught that they were valued in our society, their choices would be different across their lifespan.

NRHI: What are some strategies for changing any harmful practices and improving strategies that lead to health equity?

Tanikka Price: Educating both African Americans and White Americans about the harm/benefit that slavery produced is a great start. Also acknowledging that African history started before slavery by educating on the contributions that African Americans made to society that are often covered up or erased by history. Conversations across the aisles which encourage medical professionals to see the patients they serve as they see themselves, their children, siblings and parents facilitate understanding. And then, of course, deep self-reflection, acknowledging that racism is a poison that we have all ingested, and we all must be cognizant of the effects of that poison.

NRHI: HCGC is a Regional Health Improvement Collaborative (RHIC), and by its nature serves as a neutral convener of multiple stakeholders- patients, providers, payors, and purchasers. Where do you see the role of RHICs and their collaborative organizational model in improving health equity in the communities they work with?

Tanikka Price: Health and healthcare organizations (not only RHICs) need to make health equity foundational and be very strategic about it. It is important to look at who is at the table and make sure there is diversity at the table – racial, ethnic, and socio-economic. We (as organizations) need to make sure at every level – from the board all the way down to the people who are the boots on the ground – we need to make sure that we are reflective of the communities we serve.

We need to make sure that health equity is not just something we hit quarterly but we have to figure out how we work every single day on achieving our goals, what daily habits we have that are pushing health equity forward. What we do every day that makes different people feel accepted at the table and continue doing those things until we see a difference in the outcomes. It is a long-term goal. It won’t happen in one or two years because it is a result of decades of injustice.

As for HCGC [and for RHICs in general], community health workers (CHWs) are our boots on the ground and serve as mediators between the community and healthcare. HCGC has diversified our Board. Health equity is built into our strategic plan as the undercurrent of all the work that we do.
HCGC has started including data from the Central Ohio Pathways HUB in our Quality Transparency Report. Including the social determinants of health (SDOH) data in the report, which has historically presented only clinical data, helps us show where there are gaps. Health equity and SDOH need to be woven through all the work that RHICs do. We strive to make health equitable for all people, and that is not possible without weaving together SDOH and health equity.

In conclusion, Tanikka noted “It is not about us coming together only, we need to look in the [inward] mirror to evaluate the ways that we treat others that continue to contribute to inequality. Until we take personal accountability for the way we are showing up and not challenging the system or we are benefitting from the system, things will continue to be the same.”

The conversation with Tanikka Price is not over. Just like she said, overcoming health disparities and systemic racism should become a daily practice, NRHI has committed to advancing health equity as a fundamental principle of our work.

Additional Resources

Heidi Christman, Director of Communications, HCGC

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