Ten years have passed since the water crisis in Flint, Michigan, noted Khalid Osman, PhD, assistant professor of civil and environmental engineering. He said one way to effect equity in water infrastructure design and management is help the primary stakeholders — community members — understand what’s in their water by sharing data with them. Government officials may believe the public can’t contribute to decision-making processes about water and sanitation infrastructure because they don’t understand it, Osman said. “But the reality is they are interacting with their water every single day. They’re interacting with their sanitation systems every single day. And they have a keen understanding of it. We are just not valuing it in … our decision-making processes.” `
Stephen Luby, MD, the Lucy Becker Professor in Medicine whose research focuses on health in middle- and low-income countries such as Bangladesh, said academia has done a good job of defining environmental problems and inequities, but “there has been much less attention to solution-oriented research.” He pointed to advances in solar cells, which he said are 400 times less expensive now than when they were first developed, as a good example of solution-based research. Similarly, he cited developments in battery technology as helping government efforts to transition away from fossil fuels. “There are huge ways that we can make a better environment and a healthier world,” he said.
A racial-equity collaborative
Omar Lateef, DO, has made implementing solutions to health inequities the hallmark of his leadership as president and CEO of Rush University Medical Center in Chicago.
Health systems must become deeply involved in the communities they’re serving to shrink health disparities, he said. “You can’t show up, get a form filled out for a grant and then disappear three years later,” he said. “You want to tie yourself to the community. You have to get all in and build trust, build relationships.”
This is the type of effort Lateef leads at Rush. Even before taking the helm of the medical center in 2019, he engaged in major efforts as its chief medical officer to enact a holistic, equity-based system of health care by establishing partnerships with local businesses and community leaders.
The goal was to shrink the life-expectancy gaps between the more affluent parts of Chicago, such as Streeterville, where the city’s famous shopping district is located, and areas like Near West Side. If you’re born in Streeterville, you can expect to live an average of 15 to 17 years longer than if you’re born on the Near West Side, Lateef said.
Lateef and his colleagues enacted a plan to improve the health of the community by hiring locally, investing locally, buying supplies from local businesses and supplying local volunteers. “If in everything that we do as a health care institution, we do to improve the community at large, we’ll improve those social determinants of health,” he said. “That means if you hire locally and you give jobs and you give financial stability to your community, you’ll save lives. … We have to use businesses anyway. Why not fund our own neighborhoods?”
In 2017, Rush led this charge and teamed up with five other health systems to create an anchor network called West Side United, which, Lateef said, has become “a national model for how a community could get together and solve inequity.”
Improving health care and outcomes
Public health insurance works, but it’s not enough, said Alyce Adams, PhD, professor of health policy and of epidemiology and population health, speaking as a member of a panel about tackling health disparities. “Patients still face out-of-pocket costs that are beyond their means,” Adams said. “They have access, but they can’t afford it.” Health care systems need to be prepared to monitor and address those gaps as “proactive health systems that are focused on affordability,” she said.
Lisa Chamberlain, MD, PhD, professor of pediatrics, said that universal preschool is a key tool for reducing health disparities. As a physician who has cared for children for more than two decades, Chamberlain said has observed that many of the 5-year-olds she examined during well-child visits were not ready for kindergarten, even though their parents were responsible and hard-working.
Chamberlain began consulting with researchers at the Stanford School of Education to develop interventions that could help kids become better prepared for kindergarten. She noted that studies started in the early 1970s found that children randomized to “high-quality preschool now have higher rates of high school graduation, higher income, lower heart attack rates.”
“It’s a lifetime investment that starts in these powerful 0 to 5 years,” she added. “I really believe that as a community — if we start to do transdisciplinary work, come up with innovative solution-based research that can help change these trajectories — there are incredible opportunities.”
Michelle Williams, ScD, professor of epidemiology and population health, who moderated the panel, said she found it puzzling that the social and political will to create equitable health care hasn’t coalesced “when we know intuitively that we all thrive if we don’t leave people behind.” In preparing for the symposium, Williams said she thought about Toni Morrison’s The Origin of Others and how people tend to “other-ize” their fellow humans who are poor, homeless or developmentally disabled. “Our tendency to do that othering attenuates our chance to galvanize the social and political will to bring interventions to scale,” she said.
Maisha Winn, PhD, the Excellence in Learning Graduate School of Education Professor, said that finding common ground is critical. “It doesn’t mean that everybody agrees on the solution,” Winn said. “It doesn’t even mean that everyone’s sort of at the same place. But fundamentally, if you can start on common ground and decide what the process is for getting there, you have a higher likelihood of success of getting policy.”
She said that othering is a way for people to simplify complex issues. Reflecting on the killing of UnitedHealthcare CEO Brian Thompson in December, she said she was horrified to hear people justify the killing and assert that insurance companies are the enemy and that “now maybe they’ll listen.”
“I think, ‘Oh, my God, you don’t understand how complex this is,’” Winn said. “If every single insurance company decided, ‘I’m going to cover everything there is,’ that’s not going to solve the problem because it’s so much more complicated than that.”
Educating people about the social determinants of health as well as why the health care ecosystem developed as it did is vital, she said. “We get what we pay for. We get what we put in.”