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- Healthcare inequities can lead to extra costs for racial and ethnic minorities.
- Some health systems are embedding health-equity programs in their business strategies.
- Partnerships with community health organizations are key.
- This article is part of "Big Trends in Healthcare," a series exploring the top trends shaping the future of the industry.
While Keneica Moore didn't anticipate problems with her sixth pregnancy, she's grateful she attended a doula-led support group focused on addressing healthcare disparities experienced by pregnant Black women.
"The most significant takeaway was that it is acceptable to stand up for yourself," Moore, 39, said. Thanks to the support group, she said, she had the confidence to decline an epidural during childbirth because of her scoliosis. "Black women's voices are frequently disregarded when it comes to their health," she said.
The support group Moore attended is a pilot program offered through Mobilizing African American Mothers through Empowerment, in collaboration with Duke Health, that aims to improve Black maternal health. According to the Centers for Disease Control and Prevention, Black women are three times as likely to die from a pregnancy-related cause as white women.
MAAME doulas taught women relaxation techniques, breathing exercises, and self-advocacy skills, with the goal of empowering them to talk to their doctors about their care. "We created this group with a lot of intention because we realized many of the gaps in social support are not being addressed," said Dr. Sarahn Wheeler, who serves as vice chair for equity, diversity, and inclusion for the obstetrics and gynecology department at Duke Health.
Wheeler, who's also an associate professor of obstetrics and gynecology and director of Duke's Prematurity Prevention Program, said that within the US healthcare system, more people are becoming aware of differences in the quality of care offered to certain patients, especially Black patients and other patients of color. "However, dismantling and reorganizing systems is not a quick process," she said.
A healthcare system that doesn't address inequities can take a toll on patients. Some hospitals are dedicating resources to programs that focus on community outreach and partnerships, recognizing that these disparities can lead to poor patient outcomes and added healthcare costs for patients.
The cost of health inequity
A 2023 report by the National Institute on Minority Health and Health Disparities found that racial and ethnic health disparities cost the US economy $451 billion in 2018, a 41% increase since 2014. The report said health inequities led to increased costs associated with premature death, loss of work productivity, and excess medical spending.
A separate analysis conducted by the Deloitte Health Equity Institute found that inequities cost about $320 billion in annual healthcare spending, a figure that could grow to $1 trillion by 2040 if nothing is done to address the problem. The institute found that health inequity contributed to late diagnoses and complications from high-cost conditions such as diabetes, asthma, and cardiovascular disease.
"Our analysis is likely a floor given we focused on gender, socioeconomic, and racial and ethnic inequities," said Dr. Jay Bhatt, a managing director of the institute and the Deloitte Center for Health Solutions.
Bhatt said health equity was becoming less of a side project and more of a core factor in strategy operations that affect how hospitals and health systems think about their businesses — for example, they're embedding equity programs in quality and safety strategies and initiatives.
"When you lean into health equity, you can create value, better outcomes, and lower costs," he said. "Health equity is not just a moral imperative, it's an economic imperative."
Strategies for improving health equity
Bhatt said that creating effective health-equity programs requires health systems to focus on community outreach to build and sustain trust.
In addition to MAAME, Duke Health works with Born in Durham, Healthy For Life, a joint effort with the county's public-health department and a coalition of community health organizations and advocacy groups, focused on perinatal equity and reduction of maternal and infant morbidity and mortality.
Wheeler described the group as a gathering place to discuss and address the needs of the local community. Duke Health also collaborates with the Diaper Bank of North Carolina, which aims to ensure families with babies and children living in poverty have enough diapers.
Together, health systems and their community partners, which can include nonprofit health organizations, health advocacy groups, and places of worship, can better address social determinants of health, or the nonmedical factors that affect health, such as the environment in which people live, work, and play. A lack of access to affordable fresh food and an inability to get to appointments safely are common barriers to good health, Bhatt said.
Other social determinants of health that Wheeler sees in the clinic are a lack of childcare, income insecurity, and language barriers. A lack of social support is especially problematic. "It's heartbreaking to walk into a room with a 19-year-old who has a very complex pregnancy and they're there by themselves," Wheeler said. She added that research, such as her work on preventing preterm birth, is often an integral part of understanding and reducing barriers to care.
Bhatt said health systems can push for health equity by creating diverse care teams. "One of the steps to building trust with patients is by employing clinicians and care teams who have shared experiences with and demonstrate empathy to the communities they treat and serve," Bhatt said. Hospital boards and leadership should also reflect the demographics of the community they serve.
"If you lean into health equity," Bhatt said, "there is opportunity to improve outcomes, build consumer loyalty and trust, and create economic value."