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By LISA EISENHAUER

A membership-driven initiative being led by CHA is addressing systemic racism and its effects, both within Catholic health care and throughout the communities that Catholic health ministries serve by taking steps to end health and social disparities. The effort includes ensuring that testing and treatments for COVID-19 are available and accessible in minority communities and advocating for better schools, safe housing, economic opportunity and criminal justice reform.

Saint Agnes Health Institute staff set off to knock on doors in Baltimore in August to promote participation in the census, which determines how much federal assistance communities receive. Saint Agnes Hospital, part of Ascension, started the institute in 2018 to partner with the community to promote wellness and disease prevention.

The initiative, Confronting Racism by Achieving Health Equity, was rolled out to the public on Feb. 4 with the pledged support of 23 of the nation's largest Catholic health care systems. The systems together employ nearly a half million people across 46 states and the District of Columbia and care for almost 4 million patients annually.

Sr. Mary

Sr. Mary Haddad, RSM, CHA president and chief executive officer, said during a press briefing announcing the initiative that Catholic health ministries' efforts to end racism go back to their founding by congregations of women religious who cared for the poor and vulnerable. Those congregations led efforts to integrate care for patients of color in the last century and lent their voices on behalf of justice during the civil rights movement.

"But over the past year, we have been confronted with the fact that any strides that have been made against racism have simply not been enough," Sr. Mary said. "COVID-19 and the police killings of George Floyd and others impel the Catholic health ministry to address the devastating impact that racism has on the health and well-being of individuals and communities."

Dean

'Seize this moment'
Lloyd H. Dean, chief executive officer of CommonSpirit Health, said at the briefing that Catholic health care providers see systemic racism as a threat that impacts their ability to improve the health of the communities they serve. He pointed to statistics that show Black, Hispanic and Native Americans are almost four times more likely to be hospitalized for COVID and almost three times more likely to die of the virus than white Americans.

He said that while efforts have been made in the past to address racial disparities in health outcomes, they have failed because they have been episodic. Catholic health care systems comprise the largest nonprofit sector in health care in the U.S. and collectively they can make strides and join with others who share their vision for strong equitable health and mental health care. Now is the time, Dean said emphatically.

Staff of Our Lady of the Lake Regional Medical Center in Baton Rouge, Louisiana, take a knee in support of racial equality in June. The hospital is part of the Franciscan Missionaries of Our Lady Health System.

"Shame on us if we do not seize this moment as a nation and as a society to make measurable, demonstrable and systemic changes," Dean said.

The initiative has four focus areas for Catholic health systems. The first is to commit to ensure that testing for COVID is available and accessible in minority communities and that new treatments are distributed and used equitably as they become available. Signatories to the pledge also commit to prioritize vaccinations for those at higher risk — seniors and communities of color, including Native American communities.

Change from within
The second focus area is enacting change across health systems. Dean said one way that CommonSpirit Health is working to address root causes of health inequities is by partnering with the Morehouse School of Medicine in a 10-year, $100 million initiative to develop and train more culturally competent providers and doctors of color. Receiving care from a physician of the same culture builds the trust of patients and can lead to better health management and health outcomes, he said. Morehouse is one of only four medical schools at historically Black colleges.

Catholic health systems are examining how their organizations recruit, hire, promote and retain employees; how they conduct business operations, including visible diversity and inclusivity at the decision, leadership and governance levels; and how they incentivize and hold leaders accountable.

Sadau

Ernie Sadau, president and chief executive officer of CHRISTUS Health, said in his remarks at the briefing, "visible diversity and inclusion" are critical. He noted that the system's board makeup is 45% minority and 40% women. In Mexico, a CHRISTUS Health leadership program increased the percentage of female executives to 45% from 10% in just a few years.

"We have evidence that our work is changing things for our associates, for our patients, for our communities that we serve," Sadau said. "CHRISTUS is changing from the inside out and we're proof that change is possible."

The third focus area is advocating for improved health outcomes for minority communities and populations. Members will promote and improve the delivery of culturally competent care and oppose policies that worsen or perpetuate economic and social inequities, including when it comes to such issues as education, housing and criminal justice reform.

Building trust
The fourth leg of the pledge is to strengthen trust with minority communities. Signatories vow to foster, strengthen and sustain authentic relationships based on mutually agreed goals to better understand the unique needs of their communities.

Duperval-Brownlee

Dr. Tamarah Duperval-Brownlee, senior vice president and chief community impact officer with Ascension, said her system is keenly aware that trust, honesty and transparency are keys to giving communities the best possible care.

"Our Catholic ministry is called to take an active and intentional role to improve care and address what matters most to those we serve in many ways," Duperval-Brownlee said.

She said Ascension is building trust within the communities it serves in several ways, including by tracking health disparities, addressing and removing socioeconomic barriers to better health, ensuring representation of those communities in health care teams, investing in sustainable structures and resources to ensure that health care advances are available equitably and don't compound disparities, and by applying "cultural humility" so as to listen better and understand issues affecting the health and well-being of people who've been marginalized.

Accountability and commitment
Sr. Mary said the initiative will produce measurable outcomes. "We will be putting measures in place that will be able to track the progress, not only to hold ourselves accountable but also to look at ways that we can continue to improve."

In offering inspiration for the effort, Sr. Mary cites a quote from Pope Francis: "We cannot tolerate or turn a blind eye to racism and exclusion in any form and yet claim to defend the sacredness of every human life."

More information about this initiative can be found at WeAreCalled.org.

Time is right to take the lead, say those behind CHA's equity pledge

For Dr. Rhonda Medows, it was a "trifecta of harm and tragedy" that prompted her to urge CHA and its members to take the lead in confronting racism and health disparities.

Medows

That trifecta was the coronavirus pandemic, the economic downturn caused by a nationwide lockdown, and the racial injustice and hate crimes that gave rise to a national outcry.

"Altogether it made it clear in my mind that this was not something that we could sit by the wayside on, that we had to be a powerful voice to advocate on behalf of people in general and in particular people of color who were being so enormously harmed," says Medows, the president of population health management for Providence St. Joseph Health. She is chair-elect of CHA and leader of its advocacy and public policy committee.

Robinson

Medows and fellow board member Darryl Robinson, senior executive vice president and chief human resources officer at CommonSpirit Health, were among the leading early proponents behind CHA's Confronting Racism by Achieving Health Equity pledge. The CHA Board of Trustees approved the pledge in July. Providence St. Joseph Health, CommonSpirit and 21 other large Catholic health systems have signed on.

Time to double down
Robinson sees the vow to work to end racism, health inequities and social injustice as an expansion of the diversity, sustainability and philanthropy efforts already underway at CHA member organizations as well as at CommonSpirit. "I just think that our collective legacies underscore that we have actively been involved in this work in so many ways, it was really more of an extension of what we are already doing," he says. "The other thing I think is that we are part of the broader society and we're all major employers, and if not us, then who will do that work?"

While many systems have long embraced diversity and community outreach as part of their mission, Robinson says he hopes that joining the CHA-led effort will prompt them to redouble that work. "It encourages people to, if you're in a community that is having difficulties, extend your reach further into them," he says. "If you are focused on people of color, which is great, but there are other individuals who are within your communities who are also struggling, extend yourself into those parts of your population as well."

Medows says she wants the pledge to move health systems to act. "What I'm hoping it accomplishes is that we move beyond stating that we are not racist and stating we are in support of loving our brother and being inclusive and valuing diversity, to actual action, action that has a measurable impact," she says.

'Woke' nation
The time is right for this type of commitment not only because of the disproportionate toll of COVID-19 on communities of color and the rage sparked by the police killings of George Floyd and others, Medows says, but also because the national discussion around those tragedies has made the broader public aware that minority and vulnerable communities do not get equal treatment. She noted, for example, the fact that Black, Hispanic and Native Americans have had much higher hospitalization and death rates from COVID than white Americans has been spotlighted in the media and decried by civic leaders.

"I think, as my son would say, people got woke and stayed that way and actually learned and listened," she says. "It's really hard to know something and just simply ignore it after that."

To change the nation's course and end its inequities, Medows says three things need to be addressed: the social determinants of health, those elements such as housing and good nutrition that impact a person's life and well-being; the racism and implicit bias that affects the quality of care for patients; and the access to and quality and type of health care people are given. All of those are focuses of the pledge.

Her request of care providers who want to personalize the effort would be to do a self-assessment and ask themselves what do they know and what do they need to learn about the communities they are caring for, to ask the people in those communities what they are concerned about and to listen closely to the answers, and to be patient and willing to go back again and again to hear what patients and communities want and need.

"People deserve the dignity and respect of a conversation, of information sharing and the ability for people to listen to what they have concerns about and what questions they may have," Medows says.

'We have to do better'
Robinson views the equity pledge as part of a much wider movement needed to improve the prospects of the next generations. He says the effort must go beyond health care to address the broader needs of distressed communities. When there are limited employment opportunities, affordable housing and health care access, people are forced to make difficult choices, he says. "Members of challenged communities must have the capability to fully compete in an equal and equitable manner. That does not exist today."

For individual care providers, he hopes that committing to equity will prompt them to search for deeper meaning in their careers. For health systems, he hopes the pledge prompts them to open opportunities to a wider cross section of workers from within their communities.

"We have to do better, as a nation, as member organizations, as individuals," he says. "We have to do better, and we can."

— LISA EISENHAUER