Strategies and Lessons Learned for Tackling Racial Health Disparities

As part of its ongoing commitment to ending health injustice, Boston Medical Center (BMC) launched its Health Equity Accelerator (the Accelerator) in 2021 to uncover and eliminate barriers to achieving health equity. In a June 7 commentary in New England Journal of Medicine (NEJM) Catalyst, members of BMC’s Health Equity Accelerator team describe how they are addressing health inequities, illustrate their approach in action, and share lessons learned.

A Novel Approach to Achieving Health Justice

“The pandemic has forced us to acknowledge that we are not doing enough to fulfill our mission of providing ‘exceptional care without exception’ and equally promote health for people of all races and ethnicities,” write the commentary’s nine authors, including Elena Mendez-Escobar, PhD, MBA and Thea James, MD, executive directors of the Health Equity Accelerator. “The way we seek inequities, interrogate to find the root cause of those inequities, and the how we implement to course correct with explicit intentionality to close the equity gap, differentiates the Health Equity Accelerator and its approach to achieving health equity.”

As the team reflected on the need to develop a new path, they realized that, in order to improve outcomes for all, they needed to be much more intentional and explicitly address health injustices in traditionally underserved and underinvested populations such as Black and Hispanic or Latino communities. They launched the Health Equity Accelerator to elevate equity to a top priority, further interrogate their data, and develop new, innovative approaches to achieving health justice.

The Accelerator’s clinical care agenda was determined by the clinical areas with the largest health equity gaps, based on research and data,  as well as in partnership with patients and community leaders:

• Equity in pregnancy
• Infectious diseases
• Behavioral health
• Chronic conditions
• Oncology and end-stage renal disease (ESRD)

“Health systems owe it to their patients to take a more intentional approach to racial health equity and develop bold, innovative solutions to finally address this long-standing problem of racial health inequity,” write the authors. Their approach is agile, multi-disciplinary, and inter-professional.

How to address racial health inequities during pregnancy

The first area in which they are testing their novel approach to addressing racial health inequities is pregnancy(equity in pregnancy), which is consistently one of the areas with the largest gaps in health outcomes by race across the country. Beginning in 2021, they convened a multidisciplinary team of more than 20 BMC experts to update their methodologies, including data and analytics support, multiple rounds of patient surveys and interviews, an intensive literature review, and input from frontline staff and pregnancy experts.

The Accelerator team was able to uncover complications from preeclampsia as one of the main drivers of inequity in severe maternal morbidity (SMM) rates between Black and white pregnant people. They also found socioeconomic disparities to be associated with racial inequities in the rate of babies who are small for their gestational age (SGA). With the insights gained during their research, the Accelerator team is now implementing a range of interventions to reduce inequities in pregnancy:

• Improving patient education and supporting patient agency

• Enhancing access, quality, and experience
• Approaching clinical care with an anti-racist lens
   
• Understanding the experience of racism in pregnancy care
• Standardizing approach and protocols to reduce variation (e.g., hypertension and preeclampsia management in pregnancy)

• Expanding BMC’s OB-GYN capacity to address issues of inequity

Steps to move health systems toward health equity

While there is no quick fix to ending health inequities, other health systems can accelerate their journey toward closing the gaps by learning from BMC’s work and incorporating the following principles into their approach for health equity:

1. Shift focus from describing inequities to interrogating and eliminating them.
2. Take a multidisciplinary approach that includes patient and community voices and has a bias to action.
3. Prioritize and resource efforts focused on racial equity in a sustainable way.
4. Approach the work with a long-term commitment, not just a short-term initiative.
5. Ensure that there is an academic approach to studying the current situation.
6. Focus on one clinical area at a time and address it from many angles.
7. Leverage insights from others.
8. Consider community context.

As these principles take time to implement, the journey toward health equity requires a long-term commitment. “Our belief is that health justice can be accomplished with intentionality, innovation, and sustained commitment,” write the authors. “Our hope is that our journey will inspire other health systems to address inequities as a moral imperative in their communities.”