2020, the year that rattled healthcare systems around the world. The COVID-19 pandemic highlighted the deep racial inequities that exist in healthcare and beyond. For many systems, the last 18 months have been a time of awakening. While Boston Medical Center (BMC) has historically been committed to providing equitable care for all people, regardless of their background, the hospital has faced the fact that large gaps in health outcomes persist across different races and ethnicities. In particular, the COVID-19 pandemic has disproportionately affected people of color, and BMC recognized that being more intentional and explicit in addressing health injustice is imperative to achieve health equity.
As the largest safety net healthcare system in New England, BMC Health System (BMCHS) is intimately familiar with the how the lack of economic opportunity and mobility impacts the populations we serve. A majority of BMC’s patients live at or below the federal poverty line, and we see clearly the upstream drivers of perpetual low health status, unstable health, and predictable poor health outcomes.
The connection between health and wealth
One of the main root causes of inequity is the connection between health and wealth. Patients who have limited resources cannot prioritize health because they must deploy the limited resources they have toward survival, such as paying to secure some type of housing, to feed their families, and to keep on utilities. These patients and families have nothing left to allocate to healthy food, necessary prescriptions, and transportation to medical appointments.
“I see the Accelerator as a modern, fresh, intentional approach to defining what equity really is, through laser interrogation of inequity.”
While BMCHS has innovated and demonstrated creativity in meeting the unmet social needs of our patients, there is still much work to be done. To ultimately end health inequities and promote and sustain economic mobility for BIPOC communities, the system must change from filling gaps to eliminating them and from charity to measurable, scalable, and replicable approaches to financial stability. And to ensure that this hypothesis is borne out, the impact of these changes on health outcomes must be tracked and measured.
Systemic discrimination’s impact on health outcomes
Barriers to economic mobility are not the only obstacles keeping us from health equity. As Elena Mendez-Escobar, PhD, MA, executive director of the new Health Equity Accelerator, tells HealthCity, systemic racism and discrimination is also a major hurdle to health equity.
“We need to acknowledge that deep systemic discrimination against people of color permeates our society, including health systems,” she says. “There are important dynamics we all must address within our four walls, such as unconscious bias or the fact that health institutions overall have not always been culturally competent or worthy of the trust of patients of color.”
The last 18 months have also helped BMCHS recognize that there is another side of this story, and barriers to economic mobility are not the only ones keeping us from health equity.
“Despite our best efforts, people of color are disproportionately affected by a wide range of health issues, including, most recently, COVID-19,” Mendez-Escobar says. “The pandemic has forced us to face the fact that what we were doing is not enough. We need to be more intentional and explicit in addressing health injustices.”
For example, even when controlling for economic status, differences in health outcomes, such as pregnancy-related deaths, premature cancer mortality, or mental health outcomes persist between white and BIPOC patients.
Launching the Health Equity Accelerator
BMCHS has established a unique Health Equity Accelerator to propel its efforts to revamp its health system to achieve racial health equity, under leadership from executive directors Mendez-Escobar and Thea James, MD. The Accelerator is built to transform healthcare to deliver health justice and wellbeing by creating an infrastructure that brings together three tools that normally operate independently: leading-edge research methodologies, patient insights and community partnerships, and clinical operations capabilities.
These three functions will work together to systematically uncover and address the root causes of inequity, including barriers to economic mobility, systemic bias, and racism.
“The Accelerator combines ingredients that already exist in new ways to propel change,” says Mendez-Escobar. “It creates cross-functional teams, including researchers, clinicians, and members of our community, that are able to tear apart a problem and extract insights and solutions at a much faster pace than traditional models have done.”
“Together, we can eliminate the barriers that keep us from health justice and ensure that everyone can live a long and healthy life, regardless of their race or ethnicity,” she adds.
Furthermore, the Accelerator will also be a vehicle to exchange insights with the rest of the medical community through publishing of findings and engaging in policy conversations.
“I see the Accelerator as a modern, fresh, intentional approach to defining what equity really is, through laser interrogation of inequity,” explains James. “We are beginning downstream and walking it back upstream to the root cause. I envision that the lessons learned can then be applied for transformation across entire corporations, health systems, education systems, housing, and financial systems—all sectors, really.”
Intentionality around health justice is core to BMCHS and permeates the system.
To focus the Accelerator’s work and propel change, teams have identified five clinical areas where the gaps in health outcomes are the largest: maternal and child health, infectious diseases, behavioral health, chronic diseases, and oncology and end-stage renal disease.
“Most of all, I look forward to how the Accelerator impacts the data over time, the lives, the disparities we have come to expect,” says James. “I am hopeful that it will very significantly narrow the gaps and change life course trajectory.”
