In a 1955 speech, Dr. Martin Luther King Jr. famously declared that of all forms of inequality, health injustice is the most “shocking and inhumane.” However, racial and ethnic health disparities remain pervasive across the board state health systems* (PDF | 3.5 MB). Fortunately, with hard work and the passage of time, the progress of health equity takes root and grows. Indeed, there have been significant advances in achieving health equity for African Americans and other marginalized populations. But the hard work continues, and we must build on these advances.
For example, in September 2023 the Centers for Medicare & Medicaid Services (CMS) announced a new voluntary, statewide total cost of care (TCOC) model: the states Advancing All-Payer Health Equity Approaches and Model Development (“States move forward” or “AHEAD” model (PDF | 231 KB)). CMS’ goal in the AHEAD model is to work with states to contain rising health care costs, improve population health, and promote health equity by reducing disparities in health outcomes. The FORWARD (PDF | 231 KB) The design of the model includes many health equity components and will be a collaborative effort between CMS, states, hospitals, and primary care practices. Some health equity components of the model include states to convene individuals and organizations with a wide range of perspectives to inform model activities and create partnerships between the state, providers, payers, and the community to support the goals. of the model. For example, all participating states will be required to develop a state health equity plan to define and guide Model activities aimed at reducing disparities and improving population health. In addition, participating hospitals should also create hospital health equity plans that align with statewide priorities and activities. AHEAD builds on the work of existing state-based Innovation Center models, including Vermont All-Payer Accountable Care Organization (VT ACO) Model.The Maryland Total Cost of Care Model (MD TCOC)and Pennsylvania Rural Health Model (PARHM).
The medical community is also identifying and implementing solutions to address disparities. As one approach, the National Institutes of Health (NIH) initiated an ad hoc committee appointed by the National Academies of Sciences, Engineering, and Medicine (the National Academies) to examine the current state of racial and ethnic disparities in health care in the United States through a series of public workshops. The published report, Unequal Treatment Revisited: The Current Status of Racial and Ethnic Disparities in Health Care: Proceedings of a Workshop (2024)** highlights the main drivers of health care disparities and includes recommendations for promoting health equity. Additionally, a first-of-its-kind survey of state medical societies, national medical specialty societies, and county medical organizations on health equity found several critical, promising findings, as published in AMA Health Equity in Organized Medicine 2023 Research Report: Insights, Solutions and Resources to Take Action*** (PDF | 4.1 MB).
Some of the key justice actions undertaken by associations and medical societies include:
- 72 percent took action to prioritize equity, including aligning performance incentives with organizational equity goals and evaluating the organization’s budget to support the advancement of health equity.
- 47 percent took action to promote health by supporting the elimination of harmful, Match-Based Clinical Algorithms**** (PDF | 408 KB) and decision-making tools that incorrectly use race as a proxy for genetic or biological ancestry.
- 29 percent took actions focused on promoting a thriving community, including addressing the root causes of health disparities by leveraging organizational strengths and strengths to address the social determinants of health.
And in the behavioral health ecosystem, the Substance Abuse and Mental Health Services Administration (SAMHSA) is advancing health equity on several fronts. In line with the Black Youth Suicide Prevention Initiative and the annual celebration of Black History Month, experts share best practices for incorporating health equity practices for African Americans. Further, the Pacific Islander and Native Hawaiian Behavioral Center of Excellence (CoE) promotes culturally and linguistically appropriate behavioral health information and practices. has established a steering committee to identify emerging issues; and provides training, technical assistance and consultation to professionals and community organizations. In 2023, SAMHSA funded a Center of Excellence to advance health behavior equity in Hispanic/Latino communities. The Hispanic/Latino CoE serves as a resource to mental health and substance use providers, primary care providers, community and faith-based organizations, research institutions, Hispanic and Latino-serving institutions of higher education, peer support and rehabilitation service providers, state, regional, local, and federal entities, others systems that address behavioral health issues facing Hispanics and Latinos (eg, education, criminal justice, and social services) and the general public, including Hispanic and Latino individuals, families and communities, and people of lived experience. SAMHSA also supports three specific CoEs on Behavioral Health Disparities. CoEs develop and distribute training and technical assistance for practitioners to address disparities in behavioral health care in African American, LGBTQ+and aging populations. Since their inception, all three funded CoEs have collectively provided training and technical assistance to approximately 35,200 individuals and 3,500 local and state organizations nationwide.
of SAMHSA National Network to Eliminate Behavioral Health Disparities (NNED), operated by SAMHSA’s Office of Behavioral Health Equity, is a network of more than 1,500 community organizations that address the mental health and substance use needs of underserved communities. To address disparities in behavioral health care, NNED was created with the support of SAMHSA, the National Institutes of Health/National Institute on Minority Health and Health Disparitiesand The Annie E. Casey Foundation. NNED invites community-based organizations or agencies and individuals facing mental health or substance use disparities, with a particular focus on diverse and underserved communities, to become NNEDs Members.
There’s never been a better time in behavioral health to be a health justice leader. The work of previous generations of leaders provides the foundation for the creative initiatives and data-driven equity programs that are successful today. Advancing equality requires action – always will, always will.
*The Commonwealth Fund report entitled MIRROR, MIRROR 2021 Reflecting Poorly: US Health Care Compared to Other High-Income Countries included because of its comparisons of the performance of the health care systems of 11 high-income countries, including the United States.
** This workshop series is part of an ongoing consensus study examining the current status of racial and ethnic disparities in US health care, based on the 2003 Institute of Medicine consensus report, Unequal Treatment: Addressing Racial and Ethnic inequalities in health care.
***The Health Equity Survey in Organized Medicine (HEIOM) published by the American Medical Association provides information on the actions organized medicine is taking to promote health equity.
****The article is peer-reviewed by the American Medical Association Journal of Ethics is an example of efforts to reduce the harmful effects of race-based clinical algorithms
Resources
Asian American, Hawaiian, and Pacific Islander Health Center of Excellence (CoE)
The purpose of this CoE is to advance health behavior equity in the AA, NH, and PI communities. AANHPI-CoE develops and disseminates culturally informed, evidence-based health behavior information and provides technical assistance and training on issues related to addressing health behavior disparities in AA, NH, and PI communities.
African American Behavioral Health Center of Excellence (CoE)
The Center of Excellence for African American Behavioral Health is a national center funded by the US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, located at the National Center for Primary Care, Morehouse School of Medicine.
Hispanic/Latino Behavioral Health Center of Excellence (CoE)
The Hispanic/Latino Behavioral Health Center of Excellence is directed by the Addiction Research, Education and Services Institute at the Universidad Central del Caribe School of Medicine and funded by the Substance Abuse and Mental Health Services Administration.
National Network to Eliminate Behavioral Health Disparities (NNED)
NNED is a network of community-based organizations focused on the mental health and substance use issues of diverse and underserved communities.
Advancing health equity (PDF | 4.7 MB)
A resource to help communities address the social determinants of health
This workbook is intended for public health professionals and partners interested in addressing the social determinants of health in order to promote health and achieve health equity
SAMHSA: Office of Behavioral Health Equity (OBHE)
OBHE promotes health behavior equity by reducing disparities in racial, ethnic, LGBTQI+ and other under-resourced communities across the country, improving access to quality services and supports that enable all to thrive, participate and contribute to healthier communities.
