A Q&A with Ann Benjamin Frederick, MD

Penn State Hershey Medical Center and Penn State University College of Medicine, MD, N. Benjamin Frederick, who attended one of the sessions, explained that there is a difference between default decision-making and equitable decision-making, which is important for people from disadvantaged populations. In 2023 Health Equity Summit, “Health Equity Decision-Making.”

talks with fredrik The American Journal of Managed Care ,AJMC) The summit discussed the key themes of its session as well as the need for further investigation on key areas of research within health equity and how short- and long-term policies and practices should be designed to advance equity.

AJMC: At this year’s Health Equity Summit, you are leading the discussion on health equity decision-making. Can you speak first on some of the major topics that you will be presenting during your session?

Frederick: The main topics are related to distinguishing between default decision making and equitable decision making, and some of the key principles that characterize equitable decision making.

The needs of historically disadvantaged groups are not taken into account in default decision making. It is generally the approach to decision-making that generally produces solutions that work for people who are similar in important ways to the decision-makers themselves. Since historically disadvantaged groups are typically not part of the decision-making process, these default decisions create gaps or additional barriers or burdens for socially vulnerable groups. This results in unintentional harm, which shows up in the form of measurable health disparities.

There are several key principles governing health equity decision-making:

  • Make a Commitment to Health Equity
  • Identify vulnerable groups in advance
  • Design and build with vulnerable groups
  • Invest in health equity, allocate resources proportionate to needs

AJMC: Numerous health care stakeholders including payers, providers, industry and health benefit consultants will attend the meeting. Integration of health equity initiatives will require multidisciplinary action and aligned objectives What do you hope each audience member will gain from your session as it relates to addressing health disparities prevalent in their respective communities?

Frederick: The pursuit of health equity requires change at the individual level, in the systems and structures of each organization, and in society. Health disparities are often thought to arise through nefarious means, but disparities also arise through benign decisions that do not take historically vulnerable or disadvantaged populations into account.

The key take-home point is that pursuing health equity begins with a change in the culture of our organizations, and a willingness to critique our routine decisions in light of health equity principles.

AJMC: Health disparities have persisted for decades but the amount of research on their impact is limited. In identifying these community-level health disparities, what data trends are noteworthy?

Frederick: Health disparities are not inevitable by definition. Health disparities can occur and need to be addressed. We’re seeing a lot of good work being done that is narrowing health disparities in some areas, like maternal mortality rates in some states. Organizations are taking data seriously and learning to intervene within their contexts.

We are on the cusp of a revolution in data collection and analysis that is beginning to prioritize health equity in a meaningful way. Health equity work requires a complex science approach.

AJMCWhat are some key areas within health equity that need further investigation?

Frederick: As more and more data is collected, we find that the number of possible variables contributing to disparities can be dizzying. We need to develop a mindset that does not seek single bullet solutions, but embraces a multivariate analysis and multisectoral solutions. Because this science is so new, we also need the patience and persistence to implement interventions given the evidence presented to us and see what works and what doesn’t.

On a practical level, I think we could benefit from a scholarly vehicle for medical education similar to MedEdPortal, which serves as a searchable and open repository for peer-reviewed health equity interventions.

AJMC: Initiatives aimed at addressing health disparities are largely in their infancy and the effects of these actions will likely not be felt for generations to come. How should short- and long-term policies and practices be designed to advance equity, considering issues of quality, cost, and access that affect health outcomes?

Frederick: A long-term approach is needed for grantees and policy makers to research and implement solutions, perhaps similar to what NASA has developed with its space travel efforts. With space travel, NASA developed a plan that has several steps to achieve the goal. While the health equity task is not that straightforward, it would benefit from some ambitious goals that align key actors.

Look to the work of the Millennium Development Goals, and now the Sustainable Development Goals, for efforts to align around health and wellness initiatives on a larger, global scale. Perhaps a similar effort could be had around health disparities.

Finally, don’t dismiss small-scale efforts. Every effort towards health equity is important, if for no other reason than it is one person’s effort to right a wrong, and it should encourage each of us.

AJMCWhat is one disparity in health care that you think doesn’t get the attention it deserves?

Frederick: Easy: use of interpreters. So high quality health care is based on effective communication. Failure to use an interpreter should be a never-ending event in health care. Interpreters also often serve as cultural liaisons, which again, is an important form of interpersonal communication that can generate errors, mistakes, missteps, and ultimately subpar care, which is then measured at the population level as inequality. goes.

AJMC: Is there anything else you want to add to your session at the 2023 Health Equity Summit?

Frederick: The topic of health equity is very broad. A framework that has helped me get my head around both contributors to inequalities and intervention levels is self, systems, structures, and society. Similar to the socio-ecological model, each level interacts with and influences the others. I find myself mapping their comments along this spectrum when people talk about health equity, and it helps me get very giddy.


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