“It is evident that health is not treated as a human right in this country,” said Camara Jones, MD, MPH, PhD, presidential chair at UCSF, family physician and epidemiologist focused on the impact of racism on health and well-being. “But furthermore, we don't even acknowledge the full humanity of everybody in this country. One of the huge barriers that we are facing is not only racism, but racism denial.”
Dr. Jones, known for her work in naming, measuring and addressing the impacts of racism on health and well-being, was among four panelists appearing Thurs., Jan. 20 at the second annual Dr. Martin Luther King Jr Health Justice Symposium, “Health is a Human Right: Why We Must Act Now.”
Participants discussed health as a human right, action steps needed to reach optimal health and the barriers impeding that goal such as racism, racism denial and more, in a panel moderated by Medell Briggs-Malonson, MD, MPH, MSHS, chief of Health Equity, Diversity and Inclusion, UCLA Hospital and Clinic System, associate clinical professor of medicine at the DGSOM.
“Why in the wealthiest nation in the world do we have the highest poverty rates of all industrialized nations?” said Rep. Tony Cárdenas, congressman in California’s 29th District in a pre-submitted video for the event.
Cárdenas, who was unable to attend the live panel, said health does not happen in a vacuum. It is “directly affected by societal and structural factors, which often arise from certain political decisions and policies.”
Following his video, Dr. Briggs-Malonson asked panelists what health as a human right looks like to them and if we’ve achieved that principle.
“We have an industry that has embraced diversity, equity and inclusion as an objective to speak about and launch initiatives and centers, but hasn't done the really, really hard work to begin to actually move the system to take better care of people,” said panelist Sachin Jain, MD, MBA, president and CEO of SCAN Group and Health Plan.
“We have to stop thinking of health equity as a talking point or a checkbox, but start thinking about it as a central function of the organizations that we lead.”
Abner Mason, founder and CEO of ConsejoSano, a cultural experience company dedicated to removing barriers to care, said unfortunately, the U.S. is not where it should be – yet he remains cautiously optimistic.
While on the Presidential Advisory Council on HIV/AIDS in 2005, Mason was part of a team that delivered life-saving retroviral drugs in rural Uganda.
“If we could build the infrastructure to deliver a pretty complicated therapy and in one of the poorest places on Earth, I said to myself, there is no reason why we can't have a health care system that delivers quality health care to people in the wealthiest nation on Earth,” Mason said.
A challenge, he added, is that the U.S. has dramatically changed demographically, while the health care system has remained the same since the 1970s. The “one-size fits all” approach doesn’t work anymore.
“We need to start treating people like who they are matters – we're not all the same,” Mason said. “We're never going to have a healthcare system that creates equity if we don't accept this idea that we are different. We have the tools today available to us to build a healthcare system that delivers care in a more personalized, customized way.”
Other topics covered during the 90-minute Zoom panel included:
Data collection and paying for health care
To establish a baseline and understand where the disparities are, Mason said data must be collected “seriously.”
“We know that so much of a person's health is not determined by what happens in the clinic,” he said, but instead are due to “upstream factors” like education, transportation, safe housing, and clean water.
“Our system of financing is organized to profit when people are sick,” Dr. Jain said. He wants society to think differently about how health care is paid for.
“We will provide people with exquisite care once we've totally screwed up their lives,” he said. “If we've got untreated diabetes, untreated hypertension, we will pay for you to be dialyzed in dialysis centers for years at a cost of $70, $80, 90,000 a year. But we won't pay for a community health worker to come to your home and help you actually take medicines.”
He thinks a fundamental reallocation of resources is necessary.
“Our goal as an organization in the business of actually providing health care services is oriented around ‘how do we drive up the utilization of things?’ as opposed to ‘how do we prevent their need in the first place?’”
Value-based Care
“There's a long history of the insurance industry avoiding giving care to people who are disadvantaged,” Dr. Jain said.
Mason believes value-based care that rewards health care providers with incentive payments could be an accelerator toward equity. Value-based care emphasizes proactive health care instead of reactive care as a way to prevent problems before they start.
“When you move toward value-based care, you create incentives for healthcare stakeholders to begin to care about the whole population,” he said. “They will start to look for innovative solutions that can help them to meet the needs of the whole population.”
The ideal outcome is fewer readmissions and less frequent hospitalizations.
“[The value-based care model] puts a lot of the risk and a lot of opportunity in the hands of primary care teams, who then can envelop patients with the kinds of interventions that they need to actually stay out of the healthcare system, which is our goal,” Dr. Jain said.
Solutions to achieving health equity
Dr. Jones shared her cliff analogy and three principles for achieving health equity:
- Valuing all individuals and populations equally
- Recognizing and rectifying historical injustice
- Providing resources according to need
She also shared six action steps that we can take today:
- Ask “is there something differential going on here by race, language immigration status, zip code, urban/rural setting, religion, anything?”
- Create opportunities at the individual and institutional levels for bubble bursting “so we can experience our common humanity on the other side of town in different circumstances.”
- Be interested in the stories of others, believe the stories of others and then join in the stories of others.
- Develop a sensitivity to see the absence of who's not at the table, what's not on the agenda, what policies are not in place.
- Reveal inaction and lack of action in the face of need.
- Recognize that action is power and that collective action is power.
To watch the full symposium, click here.
Learn more about health equity, diversity and inclusion efforts at UCLA Health.
