We define health equity as the standard of excellence in care delivery across every community we serve. We believe that true equity must account for both access and excellence in quality of care, rather than access alone. These are not competing priorities but inseparable elements of achieving the best health outcomes for all. This is a goal we all strive for, but organizations like the Lown Institute that fail to measure the value of excellence in outcomes and impacts in their regular reports are misrepresenting where work needs to be done, to the possible detriment of communities most in need.
Measures of health equity are often focused on access based on race and ethnicity, without fully addressing the broader social determinants of health. Irrespective of access, factors such as socioeconomic status, education attainment, neighborhood environment, food insecurity and other social drivers play a critical role in shaping disparities in health outcomes. As a recent National Academies of Science study notes, “health care that is socioculturally informed and delivered by a multidisciplinary team has significant potential to reduce inequities in health care and health outcomes.” By centering excellence in care delivery and adopting this comprehensive perspective, we aim to create interventions that address the root causes of health inequities and deliver transformative care across diverse populations.
As leaders in this space, we have consistently seen how excellent quality-of-care leads to health equity. At NYU Langone’s Family Health Centers, for example, we devised an intervention to address lower cervical cancer screening rates in Arabic-speaking women. An Arabic-speaking patient navigator reached out to patients overdue for cervical cancer screening, educating them about the importance of early detection and addressing misconceptions. The navigator also assessed social determinants of health and helped overcome barriers like transportation or childcare challenges. This patient navigator intervention led to an increase in cervical cancer screenings from 57% to 65% in one year, demonstrating how community-tailored, high-quality care can close gaps in health outcomes.
In another illustration, at NYU Langone—Long Island, the Department of Obstetrics and Gynecology identified opportunities to reduce maternal anemia at delivery by 20%. To achieve this, an interdisciplinary quality improvement project at our Garden City and Hempstead locations provided education to patients and providers about maternal anemia screening and iron treatment. By integrating and standardizing comprehensive, equitable screening and care delivery with culturally informed practices, we improved outcomes by reducing anemia at admission and achieving an 82% reduction in anemia among African American patients.
These examples demonstrate that achieving health equity is dependent on providing the same excellent care to all patients, regardless of socioeconomic background, primary language, or race and ethnicity. However, many of the existing tools used to measure health equity – such as the Lown Institute’s Fair Share Spending report – would have us believe that equity, access, and outcome are distinct. This creates a false and hackneyed portrait of how we should approach health equity, to the detriment of the very communities for which Lown claims to be advocating.
The Lown Institute emphasizes factors like executive salaries, charity care, community investments, and Medicaid revenue in its equity domain, which accounts for 60% of its score. However, there is no published evidence directly linking any of these metrics to either the quality of care that patients receive or to measurable differences in health outcomes. The remaining 40% of their equity score measures inclusivity—whether a hospital’s patient population reflects its surrounding community. However, this is calculated using lagged data that broadly approximates social determinants of health without directly addressing health-related access needs or barriers.
By cherry-picking categories of community benefit, measurement approaches like the Lown Institute’s fail to recognize crucial investments and costs associated with high quality patient care, such as research into lifesaving cures and the financial strain hospitals absorb from Medicaid and Medicare underpayments. While efforts to measure health equity are commendable, flawed methods pose real dangers. Misleading metrics can lead to misallocation of resources and neglect the true drivers and outcomes of health inequity, such as access to high-quality care and tailored interventions that address patients’ social and medical needs.
If we rely on these metrics, which downplay the importance of quality care, to shape our understanding of health equity, we risk developing solutions that fail to address the real problem. This perpetuates the serious consequences of healthcare inequity not only at the individual level, but also at the population level. These consequences include increased costs due to lower productivity and high healthcare expenditures (avoidable hospitalizations, emergency department use, and readmissions), poorer quality of life, and shorter life expectancy. In September 2024, Deloitte published an analysis showing that a multipronged approach to addressing health equity gaps could add $2.8 trillion to the U.S. GDP. Clearly, it is crucial to position excellence in healthcare quality as a standard to address health inequity.
Expanding access to care means little if the quality of that care does not meet the highest standards. At NYU Langone, we are committed to ensuring that every patient receives the same high standard of excellence in care delivery. Whether through culturally informed patient navigation, data-driven interventions, or multidisciplinary care teams, we strive to create health equity through excellence. Because equity in healthcare is meaningless without excellence in quality-of-care.
Fritz François, MD, is executive vice president and vice dean, and chief of hospital operations at NYU Langone Health.
Gbenga Ogedegbe, MD, is director of the Institute for Excellence in Health Equity at NYU Langone Health and the Dr. Adolph and Margaret Berger Professor of Medicine and Population Health at NYU Grossman School of Medicine.
