Health Equity Is On The Table. We’ve Been Waiting For You. Please, Take Your Seat.

Updated: May 25, 2021

By Jessica Bonham-Werling

Introduction: Welcome to a series of weekly articles that together forms a body of evidence conclusively demonstrating why and how the private sector should and can be significantly involved in social justice reform. Please join us for "Health Equity Is On the Table."

The health of a population can be measured in many ways; however, the CDC and other health agencies use three specific metrics to evaluate a population’s dynamic state of physical, mental, and social well-being. These are infant mortality, age-adjusted death rates, and life expectancy. You might guess where this is going, so let’s cut to the chase. Compared to other wealthy nations and despite soaring healthcare spending, the United States ranks near the bottom, if not the bottom, in each of these measures.

One has to wonder why this occurring in the land of milk and honey. Are we simply a gluttonous nation failing to make responsible decisions about our health? Honestly, this is what I thought was happening until fairly recently. I was also certain that the key to changing the course was educating people on healthy eating and exercise while also discouraging unhealthy tobacco, alcohol, and drug habits. It turns out I was wrong (really wrong), despite my 15-year career in healthcare. What creates health has little to do with making healthy decisions, and everything to do with having the opportunity to make healthy decisions. Our poor health status is driven by the significant health disparities that exist because we as a country have failed to give everyone the opportunity to make decisions that support good health outcomes. I’ve come to realize just how ridiculous it sounds to stress a new walking routine, for example, to an individual who does not have access to a safe space to walk, or an avocado toast recipe for someone whose only accessible food outlet is a gas station.

I spent all these years in healthcare and I couldn’t see the picture that was right in front of my eyes; I totally missed the forest for the trees. How did I miss that Black Americans are more likely to die at early ages from all causes? How did I miss that Black Americans:

  • are 30% more likely to die from heart disease than white Americans;

  • have the highest mortality rate of any racial group for most major cancers;

  • are 60% more likely to be diagnosed with diabetes and twice as likely to die from diabetes than white Americans;

  • are 50% more likely to have a stroke and 60% more likely to die from a stroke than white Americans;

  • have 2.3 times the infant mortality rate as non-Hispanic whites?

Until recently, structural racism in medicine led to textbooks that held these discrepancies to be due to genetic differences. However, when the data is examined, it is evident that these differences have both nothing and everything to do with the color of a person’s skin. Once I started reading, I couldn’t help but dig in and try to understand why. I assembled an investigative team of change leaders at the Gordian Knot Society. We did the research for you, and we hope you will join us as we look at answering that question. Our research and writing team consists of:

It is critical to understand that these disparities are not biological. We remind you that in our February 1st post, we highlighted the growing body of evidence that your ZIP code is the single largest predictor of your health - it informs the physical, social, economic, and service living conditions that ultimately dictate whether or not you have the opportunity to make healthy decisions. These living conditions are referred to by public health specialists as the “social determinants of health,” often abbreviated as SDOH. Extreme variations in SDOH can lead to dramatic health inequities such as those described in the data above. Many Black, brown, and Asian people live in neighborhoods that are afflicted with SDOH that have been shown to support poor health outcomes. For example, 45% of poor black children live in neighborhoods with concentrated poverty, while only 12% of poor white children live in similar neighborhoods. Racist policies like redlining that segregated Black and brown people into neighborhoods with poor conditions and ongoing structural racism has made it difficult, if not impossible, for people living in poverty to improve their conditions, and ultimately their health.

Back to the question at hand. How did I miss this? Until eighteen months ago, I was focused on healthcare, but as a part of corporate America. When I shifted into academia, it was like a hidden world became illuminated. Academia, the government, philanthropic, and advocacy organizations have been at the table working on health equity for almost fifty years. Researchers first took note of health inequities in small studies in the 1980s, and then larger studies confirming these findings began emerging in 1990. The establishment of a specific goal for eliminating health disparities made its first appearance in the federal government space with the introduction of Health and Human Services’ “Healthy People 2000” initiative, released in 1990. State and local health departments have also taken a leadership role in promoting health equity, particularly in the last decade. Major philanthropic and advocacy organizations joined the fight in the mid-nineties and early 2000s with dramatic initiatives to address disparities.

All this work has been going on for decades, but the private sector has only been marginally engaged at best. Why? The full answer is complex, but ignorance and privilege play a huge role. If I can spend fifteen years in healthcare without ever once having to contemplate racism, SDOH, or their role in health disparities, we can assume many can honestly claim a similar experience.

CEOs could blissfully claim ignorance through about May of 2020, but that is no longer a valid excuse. You’d have to live in a cave to claim ignorance these days; COVID-19 and George Floyd’s murder have brought these issues forward in a way that they can no longer be overlooked or ignored. It is a sad statistic that the most vulnerable communities in the United States accounted for the majority of both COVID-19 cases and deaths throughout the pandemic. There is no longer any plausible deniability of how SDOH impacts health outcomes, so what are we going to do about it?

Now is the time for the private sector to come to the health equity table and take charge of their seat which has been collecting dust. Corporate entities have incredible power that, when used effectively, could result in real and lasting change. We saw the discriminatory “bathroom bill” overturned in North Carolina after businesses boycotted the state, and stay tuned for what happens next in Georgia after their legislation limiting voting has been opposed by the MLB, Delta, Coca Cola, and others.

Let’s not get too excited about a few organizations waking up to the importance of social justice. While many businesses are becoming more aware of how they can make a positive impact, the majority are not going to come to the table simply because of social pressure. In our March 29th post, we highlighted the “dangerous beast” that unrestrained capitalism has become, and explored Friedmans’ doctrine that the sole responsibility of business is to maximize profits for its shareholders, not to create social well-being. The Gordian Knot Society has this crazy notion that a business can actually achieve both - maximize both profits and social well-being. Healthy communities ultimately lead to increased productivity, a more efficient workforce, and less expenditure on sickness, but that is really just the tip of the iceberg.

Over the course of the next several weeks, we will release serialized installments of a white paper highlighting what businesses can do and the real, tangible benefits that can be achieved. Come with us as we explore how business can exercise their power by pulling operational, marketing, product, supply chain, and human resources levers to positively impact the living conditions in the communities where they operate and sell, including the:

  • Physical environment

  • Economic and work environment

  • Social environment

  • Service environment

Social justice is everyone’s business. However, it’s not just “the right thing to do,” we’re going to show you how it really is the right thing to do for your bottom line, too.

Next: Part 1, first published May 10th, 2021

Photo collage elements courtesy of Evangeline Shaw on Unsplash and ClipArtMax

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