Hastings Center News
Health Equity Summit Recap
The Hastings Center and the Association of American Medical Colleges Center for Health Justice convened a two-day health equity summit called “Righting the Wrongs: Tackling Health Inequities” on January 19 and 20. Co-sponsors included the American Medical Association, the American Nurses Association, the American Board of Internal Medicine Foundation, and the American Hospital Association. Approximately 2,500 people attended remotely.
Day one focused on historical events and decisions that have led to major inequities in health today. It was designed for the general public, health professionals, researchers, and policymakers.
Isabel Wilkerson: Caste in the U.S.
The first keynote speaker was Isabel Wilkerson, winner of the Pulitzer Prize and author of the best-selling books Caste: The Origins of Our Discontents and The Warmth of Other Suns. Wilkerson described the ways in which structural racism in the U.S. is a caste system, an old framework and hierarchy based on skin color and a fundamental cause of disease. “It is our responsibility to correct and repair what was built,” she said.
“How would you apply the caste construct to the structures of American medicine?” asked Hastings Center President Mildred Solomon during an interview and Q&A following the talk. “What can the health care professions do to dismantle caste?”
Wilkerson gave a multifaceted answer, including: “One of the consistent outcomes of empirical studies, time and again, and this is just gut-wrenching to people who look like me, is that too many medical professionals still believe that Black and brown people do not experience pain to the degree that white patients do” and are less likely to receive pain medicine, even if they have end-stage cancer. “This is a complete breakdown not only in medicine; it’s a breakdown in humanity.” Black and brown people are also less likely to have health insurance—even as they are overrepresented as frontline workers at risk of Covid-19 and other illnesses. And, once they enter the health care system, they are less likely to get treatments. “There are life-and-death consequences of the hierarchies.”
Richard Rothstein: Residential Segregation
The second speaker was Richard Rothstein, author of The Color of Law: A Forgotten History of How Our Government Segregated America. He shed light on myths Americans have used to rationalize the profound residential segregation throughout the nation, explaining that Black citizens are not clustered into poorer housing because of personal preference, or even due to lack of financial resources, but as a consequence of flawed housing policies during the 20th century. “This is not de facto segregation,” he said, “but de jure, and it is unconstitutional.” Further, residential segregation in the U.S. is the driver of most other inequities in wealth, education, and health. Black people were blocked from buying homes not only by biased mortgage lenders but by federal housing policy as well. As a result, today housing wealth (accumulated as home equity) by Black homeowners is just 5% of housing wealth accumulated by white homeowners, Rothstein said, which means less money to pass down to children, use to finance college, or pay for health emergencies. Predominantly Black neighborhoods also have more pollution and less access to fresh foods, and they have higher incidence of police abuse and mass incarceration. Rothstein emphasized that residential segregation also segregates our national identity, making it hard for different communities to understand each other, trust each other, and work together. “We, as Americans, have an obligation to fix it,” said Rothstein. “The first civil rights movement accomplished many things, but not this. We need another civil rights movement to redress the segregation that we, all of us, have created.” Rothstein described “plenty of opportunities to make ‘good trouble’.” For example, local civil right movements should press for “remedial funds” to compensate Black home buyers for the lack of intergenerational wealth to use for down payments. “Good local trouble could eventually lead to national policy,” he said.
David Williams: “When One Part of American Hurts, All of America Suffers”
The third speaker was David Williams, a professor at Harvard and an internationally recognized scientist whose TED Talk, “How Racism Makes Us Sick,” has been viewed more than one million times. Williams presented data on segregation as a driver of differences in income and education and how these racial inequities matter for life and health. The gap in life expectancy between Black and white Americans has hardly changed in more than 70 years: in 1950, whites lived eight years longer; in 2020, they lived six years longer. African Americans with a college degree or more education have lower life expectancy than whites with a high school degree. What should be done? Williams had a wide range of recommendations, including increasing the number of people of color who are doctors (a number that has actually declined since 1978), increasing economic development in poor areas to improve housing opportunities, building empathy (“We need to feel the pain that our fellow human beings are facing based on policies that we have developed in this society.”), and building a science base that will guide in developing the political will to address inequities in health. “It’s about all of us,” he said. “When one part of America hurts, all of America suffers.”
Day two was focused on solutions, offering examples of promising strategies that policymakers, researchers, and health care leaders can employ to address inequities through policy, clinical care, medical education, research, and community collaborations.
Daniel Dawes: Political Determinants of Health
The keynote speaker was Daniel Dawes, director of the Satcher Health Leadership Institute at Morehouse School of Medicine and a leader in the movement to advance health equity. He was a key figure in shaping the Mental Health Parity Act and the Affordable Care Act. Dawes said that while progress has been made–the social determinants of health are widely recognized as contributing to health–more needs to be done. “Ensuring that every individual has a fair opportunity to achieve full health potential is a defining challenge of our time,” he said, noting that 83,000 African-Americans die prematurely each year owing to health disparities. Now we have to look at what gives rise to the social determinants of health equity: the political determinants. These are “the systemic processes, distributing resources, administering power. These shape and hinder health equity. They create structural barriers to communities that lack power and privilege.” He cited two disparate manifestations of the political determinants that we hear about in the news every day–racial injustices related to the Covid pandemic and efforts to stall voting rights.
Dawes concluded with the hope that his remarks will be heard as a multipronged call to action: to see racial bias as a cause of inequity, to home in on racial inequities that unfold in front of us, to focus upstream on the political determinants to health. “When extraordinary people come together, magic in health equity happens,” he said. “Let’s make magic together and move the needle of health equity to a place we never dreamed possible.”
Following Dawes’s talk were sessions on health equity policy and practice for physicians, nurses, public health experts, and health educators:
- The Evidence Base for Health Equity: What We Know
- Addressing Health Inequities through Law and Policy
- Finding and Fixing Structural Barriers to Equitable Healthcare in the Clinic
- From Walls to Halls: Changing Health Professions Education to Advance Health Equity
The summit concluded with reflections from Hastings Center President Mildred Solomon and Philip Alberti, Senior Director of Health Equity Research and Policy and Founding Director of the Center for Health Justice of the AAMC. Both expressed optimism that the event would push a health equity agenda forward. Solomon invited participants, attendees, and others with ideas to send them to email@example.com.
Follow the conversation on Twitter at #HealthEquitySummit.
The event was made possible by the generous support of Hastings Center Advisory Council members Frank Trainer and Andrew Adelson.