How to address health inequities? Eight takeaways from AHA conference

The American Hospital Association recently hosted the Accelerating Health Equity Conference in Kansas City, Missouri. Catholic Health World Associate Editor Valerie Schremp Hahn attended and shares some key takeaways.

1. History shapes attitudes and behavior. The opening keynote speaker was Clint Smith, a journalist and author of How the Word is Passed: A Reckoning with the History of Slavery Across America. He noted that he comes from a family of health care professionals. He spoke of how the institution of slavery continues to shape people's lives today. "America is a place that has provided millions and millions of people with opportunities that their own ancestors could have never imagined: opportunities for upward mobility that fundamentally changed their lives," he said. "And it has also done so at the direct expense of millions and millions of other people who have been intergenerationally subjugated and oppressed. And both of those things are the story of America.

Smith said this legacy is evident in health care. "I think each hospital and each system needs to consider the ways in which, as an institution, they specifically failed to provide care for or provided inadequate care for or refused care, to provide care for different groups of people," he said. "In what ways can we target our services and target our work to specifically address the manifestations of these historical outcomes?"

2. Loneliness can affect health. From 2003 to 2020, time spent alone increased, while time spent on in-person social engagement decreased, according to the U.S. surgeon general. The lack of social connection increases the risk of premature death by an average of 27.5%. This disconnectedness also increases the risk of heart disease, stroke, anxiety, depression, dementia, and susceptibility to viruses and respiratory illness.

"As we have grown in our tech, we have not grown in our touch," said Liz Spinella-Jones, system director for clinical care coordination at CommonSpirit Health. "If anything, we've gotten less interactive."

Spinella-Jones spoke about the surgeon general's National Strategy to Advance Social Connection and the health system's  Lloyd H. Dean Institute for Humankindness & Health Justice. Researchers at the institute want to learn more about the impact social isolation and loneliness have on health and what they can do about it.

"Health justice starts with human kindness," she said. "One of the big things I love about the institute is they're really focusing on the science behind kindness, compassion, empathy and trust."

3. Aging is a fact of life. Ashton Applewhite, an activist and author of This Chair Rocks: A Manifesto Against Ageism, noted that the COVID-19 pandemic brought aging and ageism "out of the corners, into the middle of the room." When people think of vulnerabilities, they think of race, gender, sexual orientation, but often age and ability is missing. That oversight brings ageism and ableism, Applewhite said. There are biases against older people because of the negative messages about the aged, but everyone is either old or "future old," she said.

"We are not going to make the most of these longer lives without confronting ageism and ableism in the world around us, starting with our peers," she said. "We have to accept and ideally embrace the bodies we were born with and the way they change and age over time. We do not have to accept being discriminated against because of it. Let's join forces."

4. Mental health issues should be proactively addressed. There's an increasing demand for mental health care, and an estimated 400,000 more behavioral health professionals are needed to meet the demand over the next five years, said Deryk Van Brunt, a professor at the University of California, Berkeley School of Public Health and CEO of CredibleMind, a digital mental health resource platform. Burnout in hospitals and health care is real, he said, and it is leading to depression and an exodus.

CredibleMind is an online resource where people can take charge of their own mental health: They can learn about burnout, anxiety, mindfulness, and other trending topics; take assessments to learn more about their personality; do a mental health check-in; and find resources for professional help.

Most people with mental distress don't want therapy or medication, Van Brunt said. Other types of early intervention can include exercise, meditation, time in nature, art therapy, and yoga.

CredibleMind has partnered with Providence's Well Being Trust to offer its services to Providence St. Joseph Health's employees and members of the communities the system serves.  Dr. Arpan Waghray, CEO of Providence's Well Being Trust, spoke via pre-recorded video about efforts to address the mental health and well-being of Providence's workforce of 120,000 people.

One program, No One Cares Alone, aims to create content, normalize conversation about mental health and give people access to help if needed.

5. Inquiries should be done with empathy. There's a human behind every data point health care providers collect or question they ask.

"How can we truly get to the heart of what's going on with the patient and then restore them back to the community better than we found them?" asked Kala Guidry, program director of health equity data management and analytics for CHRISTUS Health. She explained that empathic inquiry is a conversational approach to social needs screening that promotes partnership, affirmation and patient engagement.

CHRISTUS uses a model called IDEAL, which invites caregivers to: internally reflect on their bias; frame their approach with CHRISTUS' core value of dignity; engage with open-ended questions to understand the patient's challenges and cultural beliefs or practices; ask directed questions, focusing on needs; and leverage clinical, community and spiritual resources to close gaps and promote quality care.

"In the health care industry, we are bombarded with statistics and numbers every day," she said. "But each one of those numbers are individuals — they're humans who have individual needs and lives, and loves, and hurts."

She added that it's a careful balancing act to ensure that artificial intelligence and technology do not underplay empathy-driven and human-centered conversations.

6. Conversations about diversity can be messy, complicated and nuanced. A troupe based at Minneapolis' Pillsbury House Theatre acted out several scenarios about diversity and equity as part of their Breaking Ice program, prompting a standing ovation from the audience. The often humorous, sometimes uncomfortable interactions focused on themes of racism, ageism, ableism, well-being, and caring for patients while being aware and inclusive of their cultural values, beliefs and practices.

Dr. Alan Verrill, CEO of AdventHealth Shawnee Mission, introduced the group and challenged others in the room to understand their own organizational history and to "create spaces that are much more equitable, both for the workforce and for the patients you serve."

7. Integrating social determinants of health screenings into the digital health record can help patients. Dr. Tonya Jagneaux, the chief medical analytics officer for Franciscan Missionaries of Our Lady Health System, talked about the challenges of integrating social determinants of health screening into the electronic health record. She said health systems must ask themselves: Who will own the screening, and is it part of the daily workflow? What if the patient can't answer the questions — will there be follow–up?

She pointed out anyone can be vulnerable. When a hurricane or tornado hits, people who were otherwise doing well may face several crises overnight: food insecurity, transportation insecurity, homelessness, social isolation, and financial insecurity.

Jagneaux encouraged the use of scripts to help providers broach sensitive topics and ask questions in a culturally sensitive way.

She noted that it's awkward to screen without offering ways to help. She said it's important to include solutions for patients into screening systems. Having these solutions encourages providers to do the screenings. FMOLHS has a social determinants of health "pharmacy" that allows providers to connect patients with resources or have patients look for them on their own.

8. There are ways to help a community improvement plan succeed. Plan listening sessions to find out what the community needs and to reach special populations, said Ashley Carroll, division director of healthy communities and community benefit for CHI Health, part of CommonSpirit Health. While the mission of Catholic health care includes advancing social justice, she said, "that does not just happen in the four walls of a hospital or a clinic, right? That requires getting out into the community and intentional collaboration with others."

In Omaha, Nebraska, CHI Health shared data with other health systems on their common patients, said Carroll. The system helped establish a health and housing coalition that launched a medical respite pilot program for people experiencing homelessness. It set up a Pathways Community HUB to train public health workers to identify at-risk people and connect those in need with services. They partnered with the Latino Center of the Midlands, a community center, to provide student internships in health care careers.

Cynthia Ricks-Maccotan, community integration program manager for Virginia Mason Franciscan Health, also part of CommonSpirit Health, talked about building relationships between groups. She said nothing can happen "if we don't trust (one another), if we can't communicate, we don't have a relationship."

She said the system partnered with a group called Latino Civic Alliance in Washington state to address violence among youth, and figured out gang violence prevention best practices, hired interpreters, and paid for materials in Spanish. In a certain corridor, there was a 50% reduction in gang violence calls within three months. "Win, win, people," she said. "We were building that relationship. So what did we do? Our community benefit agreement says we need to listen."