Efforts to achieve health equity have been underway for more than two decades. And yet, their effects have only been "marginal," according to a recent report from accounting firm Ernst & Young.
Chatter surrounding health equity converged into a mainstream conversation in 2002, Yele Aluko, MD, EY's chief medical officer and a co-author of the report, told Becker's. That's when Congress commissioned the Academy of Sciences and the Institute of Medicine to research whether racial and ethnic disparities existed in U.S. medicine. The 2003 report "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care" affirmed that, yes, inequity was present.
The U.S. government, corporations and philanthropic organizations have dedicated at least $179 billion toward advancing health equity between 2002 and 2022, EY researchers confirmed. But despite the large sum of money allotted to propel it, equality has stalled: Populations of color still have higher maternal mortality rates and shorter life expectancies than white populations, and they are three times more likely to be uninsured.
So, EY asks, "Why have past efforts failed?"
Not all allocated money has been spent, for starters — especially from the government. Missouri's health department has received $36 million toward health equity and spent none of it. Illinois has only spent 0.5 percent of the $29 million it received, and California has spent 11.6 percent of its $33 million allocation. This suggests capacity and infrastructure barriers are hindering efficient use of the funds, the report said.
There are several reasons why this might be, according to Dr. Aluko. The workforce to execute initiatives with the funding may be insufficient, along with the states' processes and IT infrastructure. Political misalignment between states and the federal government could also cause processes to stall.
Philanthropic organizations and corporations also lack a single rallying call. Their leaders might choose to allocate money toward their own significant interests; For example, breast cancer or cardiovascular disease may garner funds because of a personal family involvement.
"That's not a wrong thing to do," Dr. Aluko said. "It's just that it may not be done in a strategic manner."
The lack of clarity surrounding health equity extends to hospitals and health systems, which are not all holding their DEI initiatives accountable. Other industry challenges like the labor shortage can also play a role.
"If a healthcare system's priority — which it should be — is to deliver health care, and you don't have enough people to provide healthcare, other important issues that will enable the workforce to be culturally competent tend to fall apart," Dr. Aluko said. "When the workforce is constrained, the ability to drive systemic enterprise-wide DEI and health equity initiatives, and to hold them accountable and to staff them with appropriate leadership and resources, tends to become deprioritized and therefore ineffectual."
Overall, the field has lacked a unified call to action, according to Dr. Aluko.
"When 'Unequal Treatment' was published, it emphatically recommended a focused process to address systemic racism in healthcare," Dr. Aluko said. "That has not happened."
Consistency is key if the needle is to actually move, according to Dr. Aluko and EY, adding that funders, healthcare organizations and reporters need to be on the same page about the current health equity impact and the path forward.
Individual hospitals and health systems can start by rethinking their health equity strategies and results, Dr. Aluko said.
"Those strategies must be well thought out," Dr. Aluko said. "They should be developed to be systematically executed across the entire organization and they should be empowered with accountable entities in the C-suite as well and all the way downstream."
Along the way, all parties should avoid falling into a complacency trap.
"A lot of invested money is being invested into initiatives and processes and people are busy doing stuff. But the gap hasn't closed. We need to ask why," Dr. Aluko said. "Organizations should not conflate activity with actionable success."