Health Equity for All Kids Is a Challenging Yet Attainable Goal | Health News

It’s often said that children are the future, but for some kids, achieving a healthy adulthood is harder than it is for others. That’s due to a number of variables, perhaps the most pernicious of which is a social environment that features structural racism, implicit and explicit bias, and other factors that create inequitable access to health care and disparities for kids in some racial, ethnic and socioeconomic groups. These experiences early in life are not short-lived: They can have long-term health consequences.

Moderated by Dr. Jean Raphael, section head for academic general pediatrics and associate vice chair for community health at Baylor College of Medicine and Texas Children’s Hospital in Houston, the panel noted that there’s a lot more to health care than simply treating disease. Understanding and addressing the social determinants of health that may be contributing to a child’s overall well-being and ability to access care is critically important to offering the supportive services kids truly need.

Dr. Maria Trent, professor of American health, pediatrics and nursing at Johns Hopkins University in Baltimore, said that in studying the problem of inequity and racism on children’s health, “what we see is that children, when they grow up in environments where racism is prevalent, their experiences really have direct impacts on how they see themselves and how they operate in the world.”

And this has lasting impacts on health over the entire lifetime, said Trent, who co-authored a 2019 policy statement for the American Academy of Pediatrics calling racism a “socially transmitted disease.” Said Trent during the webinar: “Long-term, children who witness this kind of behavior, really carry it with them into adulthood.”

Combating Racism in Child Health

Improving data collection about race and social determinants of health is one way to begin improving some of the structural barriers that prevent children from realizing optimal health, said Dr. Nia Heard-Garris, a pediatrician and physician-investigator at Ann & Robert H. Lurie Children’s Hospital of Chicago.

Creating more precise “data on race, ethnicity, gender identity, sexual orientation – the multiple identities that children and families carry,” is important for fully understanding differences between groups, she said.

Often, when a disparity is noted, the fallback is to attribute such to genetics or a biomedical cause. “But really,” Heard-Garris said, “what we know is that there are important social contributors like racism, like these structural barriers” that fuel these problems. It’s not always genetics or individual health behaviors that are “preventing children from realizing their most optimal health.”

Gaining a deeper appreciation of “the complexity of each individual” is an important component of ongoing research in this area, Raphael noted. Indeed, Trent said that “how you see yourself and how you feel – what you see your identity as – oftentimes may not be the driver of how you access care and your health outcomes.”

It’s a complex topic for sure, but one that many children’s hospitals are committed to working through. Making meaningful change toward health equity is an all-hands-on-deck effort, noted Dr. John Cowden, a general academic pediatrician and health equity integration project leader with Children’s Mercy Kansas City.

“If you have just an office or a center, and even a number of dedicated staff (focused on improving health equity), it’s easy for people to assume they’re the ones who will take care of all the things that need to be taken care of,” he said. “An analogy that we use is safety. In safety work, it would not be reasonable for me to say that ‘safety is not my work as a pediatrician; that’s the safety officer’s work.'”

Instead, as with safety, responsibility for improving access to care and eliminating disparities is everyone’s business. The work of improving diversity, equity and inclusion “needs to be in all of our regular work, and those are the tools that we need to keep developing together,” he said.

Dr. Allison Empey, assistant professor of pediatrics at Oregon Health & Science University and chair of the AAP’s Committee on Native American Child Health, agreed that addressing inequity “really has to be integrated” into all aspects of hospital work – from hiring practices to patient care, even right down to the hospital environment itself.

“One thing that we’re doing is we’re walking around the hospital and taking a look all together and seeing what sort of things visually are on our walls that may or may not make people feel comfortable being there,” Empey said. That’s just one small example of the work being done at her hospital, she noted.

Opening up patient charts for review by the patients themselves, a stipulation in the 21st Century Cures Act, is another means of helping clinicians focus on the patient first, Trent said. This change allows patients more access to their own health data, but even more importantly, it encourages clinicians to consider how they’re talking about the patient to other clinicians.

Managing implicit and explicit bias is another strategy some hospitals are adopting to help staff better understand how their interactions with patients could influence outcomes. Training and educational efforts to address these issues are underway at many hospitals across the country.

Toppling a legacy of institutional and structural racism is a more challenging endeavor, but one that can be achieved through persistent, ongoing efforts, the panelists said. “Groups of people are not monoliths,” Heard-Garris explained, noting that addressing the long legacy of institutionalized racism and how it can impact each individual differently should be a primary area of focus. “I would want us to focus on thinking again about intersectionality, thinking about structural racism and examining policies.”

Doing all of this hard work isn’t just a moral obligation, Heard-Garris said. There’s also a business imperative for it. “In our circles, ‘business’ may be considered a dirty word, but also, I think we do need to understand that there’s a business case for this work.”

Cowden added that the work, whenever possible, should leverage the power of human experiences and stories to make inroads versus just fixating on the numbers in the charts for disparities. Sometimes “a single story can show us disparity in a more powerful way than a chart,” he said.

Partnerships for Better Children’s Health

In the second part of the webinar, in a conversation with Kathy Higgins, chief executive officer of the Alliance for a Healthier Generation, Higgins noted that the integrated, collaborative approach to addressing inequities in children’s health needs to extend beyond hospitals and health systems to schools and communities, too.

From school nutritionists to teachers, guidance counselors, families and community leaders, everyone has a role to play in helping children live their healthiest lives. Partnership across all these domains leading to policy change can help, Higgins said.

“The need is so great and the demand is so great that we really need to be committing more than some resources,” Higgins said. “And it may feel transformational to what things used to be, but transformational change will absolutely require a greater amount of resources and collaboration.”

Higgins noted that the pandemic has ” put a spotlight” on problems that existed long before the COVID-19 pandemic was declared and added urgency to addressing these issues.

“COVID has certainly exacerbated situations and conditions that already existed.” COVID-19 did not create the disparities we’re dealing with, but it has made them even more obvious, she added. “What we recognize is that while we’re all in the same storm, we’re all in different boats.”