Policy Researchers: Look to Other Health Systems in Advancing Health Equity

A team of health policy researchers looked at efforts to promote health equity in eight different countries and found some potentially helpful lessons for US health system leaders trying to do the same.

In a blog published on the New York City-based Commonwealth Fund’s website, titled “Advancing Health Equity: Learning from Other Countries,” Nason Maani, Ph.D., and Sandro Galea, MD, MPH, DrPH reviewed experiences in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway and the United Kingdom, as these health system leaders are working to advance health equity and end systemic racism, just as US health system leaders are working to do so. Maani is a 2019-2020 UK Harness Fellow in Health Care Policy and Practice Research Fellow at the London School of Hygiene and Tropical Medicine, and Galea is Dean and Robert A. Knox Professor at Boston University School of Public Health.

Placing health equity efforts in the context of the impact of the global COVID-19 pandemic, Maani and Galea write: “We looked at how eight high-income countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway , and the UK) have sought to change the mindset of healthcare leaders and professionals, measure and tackle racism in healthcare and promote equal access to healthcare. The eight countries fund health care very differently from the US and are affected by racism and income inequality in different ways. Nonetheless,” they write, “they offer lessons and practical strategies to support historically marginalized groups and reduce health inequalities Global Health and Health Equity. This blog post describes promising, evidence-based approaches to reducing the health inequalities we have identified that are relevant to the US and could inspire further cross-country learning.”

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Importantly, some of what leading health care providers are doing in other countries appears to be replicable here in the US, despite the differences between the US health care system and the eight systems studied by Maani and Galea. They note: “Across these eight countries, we found that medical associations and schools play a crucial role in dismantling racism, often by identifying and reducing harmful stereotypes. In Canada, a group of medical students documented stereotypes that other students had about Canada’s First Nations or Black population. These included the perception that these patients were less interested in staying healthy, were to blame for their poorer health, and were vastly different from themselves. Medical associations and schools also monitor and respond to incidents of racism and discriminatory behavior in the educational and work environment. In the UK, medical colleges have recognized that black and minority ethnic groups do not have equal access to career opportunities within the National Health Service (NHS) and have been discriminated against in terms of career progression, salary, sanctions for misconduct and bullying and harassment,” they report.

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Meanwhile, the researchers write: “A second theme that emerged in our literature review and interviews was the importance of measuring health care disparities in order to uncover and ultimately reverse racism in health care. Researchers in New Zealand found that breast cancer screening and treatment rates are lower among Māori women than non-Māori women, and Māori women are less than half as likely to reach the five-year breast cancer survival mark. In France, researchers found that immigrants and their children from sub-Saharan Africa, North Africa and the French Overseas Territories were more likely to experience discrimination when seeking care, and that such experiences led people to skip subsequent care. And in the UK, black and minority ethnic people were four times more likely to be imprisoned under the Mental Health Act – which allows people to be imprisoned if they are deemed at risk of imminent harm to themselves or others – than their white counterparts. These groups are also more likely to enter mental health services through the criminal justice system than through primary care.” And: “In Australia, an external assessment tool has been developed to help hospitals measure, monitor and report on institutional racism. It assesses avoidable hospitalization rates by race, minority representation in leadership positions and healthcare funding gaps and was used to rank all 16 hospital and healthcare organizations in Queensland, Australia.”

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The authors of the article continue to write: “

Health inequalities reflect broader inequalities in access to education, economic benefits, healthy physical environments, and other resources, and health care providers can play a central role in understanding and addressing the issues. Transnational learning can provide inspiration and examples for improving common health equity challenges. Our research uncovered a range of international efforts to advance health equity and provided roadmaps for U.S. health systems working to reverse racist practices and policies.”

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