This week, our country honors the importance of public health in our communities. Taking place April 3-9, National Public Health Week 2023 focuses on “Centering and Celebrating Cultures in Health,” highlighting how the connection to our community and culture impacts our health and well-being.
Unfortunately, profound racial and ethnic disparities in healthcare have long been the norm in the United States. According to the Commonwealth Fund, “decades of policy choices made by federal, state, and local leaders have led to structural economic suppression, unequal educational access, and residential segregation, all of which have contributed in their own ways to worse health outcomes for many people of color.1” The disparity was more clearly manifested due to the challenges presented by the COVID-19 pandemic.2
So, how do we improve public health so no one is left behind?
Since public health is rooted in population health, we must pay particular attention to marginalized populations who historically have not had the representation, access, or power that more traditional groups have. Marginalized communities are more likely to be those excluded or neglected from mainstream social, economic, educational, and/or cultural life. Examples of these populations include those excluded due to race, gender identity, sexual orientation, age, physical ability, language, and/or immigration status.
At ForHealth Consulting at UMass Chan Medical School, we work hard to address the needs of marginalized communities through our clinical expertise and health policy research. These types of projects play equally important parts in reducing health disparities by improving access and health outcomes for marginalized communities and people.
Clinical Services: Addressing More than Just Care
In a 2018 American Academy of Family Physicians survey, patients were asked what they needed to improve their health. They expressed a desire to eliminate the racism and systematic injustice that permeates their daily lives and influences their experiences with health care, outcomes, and life expectancy.3
Social and economic determinants of health include language, income, transportation, wealth, education, employment, neighborhood conditions, and social policies. Limited or no access to these types of resources can severely affect the quality of health care. Approximately one in ten working adults in the United States has limited English-language proficiency,4 and roughly 15% of American adults age 18+ (more than 37.5 million people) have some difficulty hearing.5 The Massachusetts Medical Interpreter Training program, based in ForHealth Consulting, helps break through the language barrier. Medical interpreters’ unique clinical training, cultural sensitivity, and language fluency – the result of this training program – help build trust between the patient and their family and their physicians or care team.
Since 2018, ForHealth Consulting has worked with one state’s network of 12 federally qualified health centers—centers that serve medically underserved areas or populations— that engaged our survey research experts to conduct its annual measurement of the patient experience. This model addresses social and economic determinants of health and has been associated with effective chronic disease management, cost savings, and improved quality of care. Our customized reports provide actionable information to help the practices further improve the patient experience.
Health Policy Research: Getting Everyone to the Table
Engaging underrepresented communities in health services and health policy research is critical. Without doing this, our research findings will not fully represent the population. To achieve health equity, we must be purposeful in understanding all people’s needs and experiences. We should work to eliminate or minimize systemic bias by including people from marginalized communities in the study sample and inviting them to research studies. Sometimes it means extra resources and time devoted to reaching these populations when data about them are limited or missing. We should remember the credo: “Nothing about us without us.”
At ForHealth Consulting, our qualitative research and evaluation team uses a participatory approach to engage multiple stakeholders in study design and execution. We engage community members to lead focus group discussions, as established relationships and trust can spur more honest and open conversations. Our quantitative team also uses imputation and other methods to fill in the gaps of race and ethnicity information where these population characteristics are often missing.
We are intentional and inclusive to ensure our studies include the diverse people and communities, which necessitates being intentional meeting people where they are. We always provide appropriate accommodations to allow people to join the study (e.g., use of translators, flexibility in scheduling interviews or focus groups during the evening or daytime). We make sure to include individuals from minority groups, rural communities, communities of color, and other underserved communities.
Public health is the science of protecting and improving the health of people and their communities. Today, more than ever, it is vitally important for us to ensure that all people and communities receive the optimal level of care centered on their unique needs – making healthcare more equitable, effective, and accessible.
3 https://www.ncbi.nlm.nih.gov/books/NBK571814/
4 https://pubmed.ncbi.nlm.nih.gov/29461136/
5 https://www.cms.gov/files/document/audio-sensory-disabilities-brochure-508c.pdf