Opinion: What happened to health equity?

Photo by Ariel Skelley/Image Bank/Getty Images.

By Leni Preston

The author is an independent health policy expert. She lives in Bethesda.

Merdie Nzanga recently reported in Maryland Matters that “…health care advocates are making a list of priorities for the upcoming General Assembly session…” One is the ongoing effort to secure funding for the Prescription Drug Affordability Board. The remainder of the legislative agenda focuses on efforts to ensure that all Marylanders, including undocumented immigrants, have easily accessible and affordable health insurance.

Undoubtedly, these are laudable goals. However, it is well known that just having an insurance card is not enough. In order to receive the care that is actually needed, individuals need accurate information and resources to both navigate the system and use the services provided by the card. To counteract this, our state passed legislation designating the University of Maryland’s Horowitz Center for Health Literacy as the state’s Consumer Health Information Hub. As the first of its kind in the country, this is a major achievement. However, it is not enough.

The state must ensure that there is equal access to all health services Services and that they meet a person’s personal needs. In other words, we need to address the issue of health equity. Without it, our families, friends and neighbors will not have the tools they need to live the healthy and fulfilling lives they are entitled to.

The COVID-19 pandemic has pulled back a curtain to reveal what health leaders have known for years – our health care system is riddled with injustices that are damaging, if not destroying, the lives of countless members of our communities. In 2020, the General Assembly took steps to address this with the establishment of the Maryland Commission on Health Equity. Its purpose is to address the underlying causes, including systemic racism, that created the unfair system we have today.

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For the past year I have served as a member of the Policy Committee of the Commission. Despite the good intentions of committee members, progress under the leadership of Gov. Hogan’s Department of Health has been painfully slow.

Now there is reason for optimism from our newly elected Governor Moore and Lieutenant Governor Miller. They have made clear their commitment to addressing the issues head-on. With that in mind, I hope that you and the Health Care Executive Policy Committee will give serious consideration to the recommendations made by the Policy Committee in its report to the Legislature. Some of these come from analysis conducted by the Best Practices Work Group, and many are based on initiatives already in place in states that are far ahead of Maryland in health equity.

Highlights of the recommendations include:

  1. Establish the Board of Governors up Racial Justice and Health Justice. This sub-cabinet group would highlight the close relationship between the issues and create a meaningful and inclusive structure that can approach them strategically, comprehensively and transparently;
  2. address Data collection and use include: (a) Standardized data which must be collected consistently across all relevant departments and other areas of healthcare. A minimum requirement would be the inclusion of: race, ethnicity, language, gender identity, sex, sexual orientation, disability status and factors affecting the social determinants of health; and (b) data contained in an interactive and publicly accessible dashboard. This would support the development of substantive and realistic strategies and increase public confidence while fostering consumer and community engagement. Connecticut is among the states implementing a useful model.
  3. Require Initiation of a health equity analysis in: (a) implementation of a “Health in All Policies” approach in all departments; (b) development of all departmental budgets; and (c) any relevant legislative proposals.
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The latter two recommendations are just two examples of why the Board of Governors must develop and implement “state-of-government” strategies for a racial equity and health equity agenda. As the legislation establishing the Health Equity Commission noted, “More than 100 studies have linked racism to poorer health outcomes, … and … racism exacerbates health inequalities.” To address the systemic challenges, an aggressive and proactive approach is crucial approach to follow.

Our new government and the 2023 General Assembly, with old and new health leaders, are well positioned to make this happen. I hope that they and the advocates who work to secure health insurance cards for everyone will take the opportunity to once again make Maryland a leader in public health. Marylanders expect and deserve nothing less.

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