Health systems and hospitals are leading the way in many communities by addressing health care disparities in order to provide equitable care to every person in every community.¹ The Centers for Disease Control and Prevention defines heath equity as a state that is achieved when every person has the opportunity to “attain his or her full health potential.”⁴ Key elements of the framework to guide healthcare leaders include⁴: make health equity a strategic priority, establish a governance structure and processes around health equity and provide resources to support health equity initiatives, deploy specific strategies to address the multiple determinants of health on which healthcare organizations can have a direct impact (socioeconomic status, physical environment, health behaviors and healthcare services). 

How does a health system or hospital begin to address health care disparities? A suggestion is to begin with this brief Health Equity Self-Assessment⁴:

• Is health equity a strategic priority for our organization?  Why or why not?
• Does our organization have the internal governance structure to make progress on this work?
• What data do we have on race/ethnicity and primary spoken language, and what is the quality of that data?
• Have we developed a standard process for collecting this data?  Do we use these data to identify disparities?
• How are we using disparity data? Are we using the data to drive quality improvement work?
• Do quality improvement efforts focus first on how better to meet the needs of disadvantaged populations?
• Do we consider the resources available to underserved populations in the design of quality improvement initiatives (e.g. will patients be able to afford medications; are their language and/or transportation barriers to care that need to be considered)?
• Do we have a primary care system that is committed to closing disparity gaps?  What health disparity gaps are we trying to close with better primary care?
• Do we provide training for staff to help them identify equity and disparity gaps in the organization in order to decrease structural racism (defined by the Aspen Institute as “a system in which public policies, institutional practices, cultural representations and other norms work in various, often reinforcing ways, to perpetuate racial group inequity”)?

In 2015, the Institute for Diversity in Health Management, an affiliate of the American Hospital Association (AHA), commissioned the AHA’s Health Research and Educational Trust (HRET) to conduct a national survey of hospitals and health systems to quantify the actions that they are taking to reduce health care disparities and promote diversity in leadership and governance. Collected through a national survey, there was a 17.1% response rate from the 6,338 hospitals who were mailed the survey. The 32% minorities in the patient population was similar to the 37% minority of the US population reported in other national surveys.³ 

American Hospital Association launched the #123forEquity Pledge in 2015 with over 1,100 organizations pledging. Three hospitals from Hawaii (Healthcare Association of Hawaii, Kona Community Hospital and Kaiser Permanente Medical Center) pledged to begin taking specific actions in the next year to eliminate disparities in care.  Resources include toolkits with best practices and strategies for achieving success and webinars featuring hospitals and health systems leaders. More information on this pledge is available at http://www.equityofcare.org/

What have other health care systems or hospitals done to address disparities? NYU Lutheran in Southwest Brooklyn has:

• Partnered with faith-based and community-based organizations, as well as other groups in an effort to reduce health care disparities for the diverse communities it serves. Southwest Brooklyn is becoming increasingly diverse with a predominant Hispanic population, along with Chinese and Arab-American communities. Together they developed a successful asthma program, targeting Latinos who regularly used the emergency department for asthma treatment. The program focused on Spanish-speaking home health care providers and educators who monitored medication usage and taught patients how to manage asthma in their home environment. So successful, this program dramatically decreased emergency room utilization and there is no longer a need for the program.
• Onsite a mosque, Sabbath elevators, and an interfaith chapel.  They serve Kosher, Halal and Chinese meals throughout the system and provide patient guides in Spanish, Chinese, Russian, and Arabic along with English. Staff, physicians and community organizations partner for input and fundraising for all these initiatives.
• Taken cultural competency as a core function in terms of equity care efforts. Cultural competency training starts at new employee orientation with additional training for nursing, physicians, house staff and medical students. Topics include Latino and Chinese values and health beliefs, Ramadan, homelessness, mental health, palliative care, domestic violence, working with Muslim families and many others.⁵ 

Richard Pollack, President and CEO of the American Hospital Association in 2015 recommended the following priorities¹: increasing the collection and use of race, ethnicity, language preference and other characteristic data and applying them to care improvement efforts; increasing cultural competency training for employees so they are prepared to address unique cultural and linguistic factors and increasing diversity in hospital leadership and governance to reflect the communities served.

Together, healthcare and community organizations can make an impact in diminishing health care disparities.