U.S. needs national leadership to coordinate fight against health inequity

© National Academy of Medicine

The United States needs national leadership to promote health equity and rectify decades of unjust treatment of racial, ethnic, and tribal groups.

The National Academy of Medicine (NAM) called for the president to create a new national entity responsible for bolstering equity across the federal government. In addition, Congress should create a new scorecard to grade how future policies might affect health equity.

The recommendations were part of “Federal Policy to Advance Racial, Ethnic, and Tribal Health Equity,” a consensus study report that NAM published late last month. The problem: “Racially and ethnically minoritized populations and tribal communities often face preventable inequities in health outcomes due to structural disadvantages and diminished opportunities around health care, employment, education, and more,” the report said.

“The health inequities experienced by millions of people living in the U.S. today are in part the result of past and current policies that exclude or deprioritize these populations — putting them at a disadvantage that affects their well-being and life expectancy,” study committee co-Chair Sheila Burke said in a news release. Burke is an adjunct lecturer at the John F. Kennedy School of Government at Harvard University, and chair of the Government Relations and Policy Group at Baker Donelson.

“The time to act is now, and we lay out specific steps in our report that the federal government can take to advance health equity,” Burke said.

Racially and ethnically minoritized populations experience higher rates of illness and death for many important health conditions, such as infant mortality, maternal death, and chronic conditions such as heart disease, according to the report.

“These populations also have lower life expectancies compared to non-Hispanic White people – in 2019, life expectancy for the non-Hispanic White population was 78.9 compared to 75.3 for the Black population and 73.1 for the American Indian and Alaska Native populations,” the news release said.

When they are not being ignored, the committee emphasized American Indian and Alaska Native populations have the worst measures for health. As a remedy, Congress should authorize funding of the Indian Health Service at parity with other health care programs. The House of Representatives should re-establish its Indian Affairs Committee, and the director of the Indian Health Service should be raised to the level of an assistant secretary, according to the report recommendations.

“Health inequities also have consequences for the economy, national security, and businesses,” according to the committee. Although there are national effects, community involvement is crucial to eliminating inequity from health policies.

“Including community voices in the policy process is of paramount importance to the nation’s path to health equity,” committee co-Chair Daniel Polsky said in the news release. Polsky is Bloomberg Distinguished Professor of Health Economics and Policy in the Bloomberg School of Public Health and the Carey Business School at Johns Hopkins University. “Our recommendations call for steps from the executive and legislative branches to increase transparency and boost community representation.”

The committee noted improved coordination among federal agencies, along with more accurate data, also are essential for future efforts to weed out inequities and promote health for all.

As for health, that includes physical and mental well-being. Over the years, both have been harmed among minoritized communities by inequitable distribution of social determinants of health, such as economic stability, health care access and quality, education, social and community contexts, and features of neighborhoods and built environments, according to highlights of the report.