While COVID-19 “recovery” usually implies a patient’s recuperation from physical symptoms, the recovery of health care systems from systemic fractures exposed by the pandemic is equally pressing. With 7 out of 10 Black Americans reporting unfair treatment by the medical establishment, and the grossly inadequate safety measures provided for immigrants in U.S. Immigration and Customs Enforcement (ICE) facilities, COVID-19 has highlighted the urgent need to restructure health systems to address deep inequalities suffered by marginalized communities in their access to care.
COVID-19 vaccination efforts have further revealed U.S. society’s unreasonable expectation that marginalized communities will disregard this history of systemic exclusion and comply with being included when it fits the health care system’s needs.
Central to helping health systems “recover” from systemic racism and inequity is highlighting the close connection between health and human rights. Physicians for Human Rights (PHR) recently explored this crucial linkage and the important role that health care workers can play in advocating for equitable access to health, as part of our ongoing COVID-19 speaker series.
The discussion, moderated by Ali Khan, MD, MPP, FACP, a practicing general internist and executive medical director at Oak Street Health, featured expert panelists Justin List, MD, MAR, MSc, FACP, assistant vice president of the Office of Ambulatory Care and Population Health at NYC Health + Hospitals, chief quality officer for Gotham Health, and practicing primary care internist at Gotham Health’s Judson Health Center; Saranya Loehrer, MD, MPH, faculty member at the Institute for Healthcare Improvement in Boston and founding partner of the Civic Health Alliance; Katherine Peeler, MD, practicing pediatric critical care physician at Boston Children’s Hospital, instructor of pediatrics, global health and social medicine, and bioethics at Harvard Medical School, medical director of Harvard Medical School’s Asylum Clinic, and PHR medical expert; and Iyah Romm, CEO and co-founder of Cityblock Health, the first tech-driven provider for communities with historically poor access to quality, affordable health care.
Watch the discussion here:
Trust and Accountability in Health Care
In examining the connection between health and human rights, panelists discussed the mistrust that marginalized communities feel toward the U.S. health care system, which has historically excluded – even exploited – people of color. COVID-19 vaccination efforts have further revealed U.S. society’s unreasonable expectation that marginalized communities will disregard this history of systemic exclusion and comply with being included when it fits the health care system’s needs. But rebuilding the trust of these communities requires the health system to re-examine its current understanding of the right to care. “Does a right to care necessarily connote a right to culturally responsive care?” asked Justin List. “Just because you create this right to health care doesn’t mean that health care is going to responsibly address your needs.”
Indeed, the health care system has repeatedly promised more inclusive practices than it delivers, particularly when attempting to rectify past injustices. “If we are going to go to the next step, there needs to be not just an acknowledgement of health as a human right and making sure that we welcome people and give them access, but there is going to be a shift in really looking for reparations for those who we have not given that right to in the past,” said Katherine Peeler. While COVID-19 has highlighted the need for a more equitable health care system, reparation for past inequities in health care provision is critical to building a renewed system centered on fair and equal access to care.
Ceding Power to Create and Restore Equality
Another crucial step in fostering equitable access to health care is the re-examining and rectifying of unequal power structures in the U.S. health system. “Getting proximate and being humble is critical” in earning trust in communities, said Saranya Loehrer. “This relates to our civic engagement and health work, and it is the extent to which many of us in power, in whatever ways we have power, actually need to cede power.”
“Stand up and stand back” is the foundation for a broader balance of power structures in health care.Justin List, MD, MAR, MSc, FACP
During the discussion, panelists shared examples of individual and organizational responsibilities in ceding power as part of restoring, and in some cases creating, equity. Iyah Romm spoke of the need for a structural ceding of power: “One only has to look at the Southern delegation of the AMA’s [American Medical Association] reactions to positions on anti-racism or the perspectives of our hospital institutions on transparency of pricing … to recognize that the entrenched ways of being that are about closure to progress are still fundamentally the norm across the country.” In terms of individual responsibility, List recounted his own decision to step away from a senior leadership role in order to create space for a person who better represented the complexity of identities of people engaging with the health care system. As List advises, seizing the opportunity to “stand up and stand back” is the foundation for a broader balance of power structures in health care.
The right to health encompasses much more than access to health care, particularly for marginalized communities, as it necessitates transparency, accountability, and power parity.
While there is much work to be done, COVID-19 has spawned a range of new tools to help health care workers make their practices more inclusive. For example, combining the efforts of health practitioners and citizen scientists in creating policy and research can facilitate the provision of culturally responsive care. Considering how to increase involvement in health, Romm highlighted the importance of humility in a space where diverse perspectives work together – humility that is essential to inclusive health care and advocacy work. Reflecting on her own experience with broadening contributions to health research, Dr. Peeler shared: “With the aid of PHR teaching me, I have become much better about doing targeted research; understanding what research is going to help a certain person…. asking them what they think of the results when you’re done, even if you don’t like what they have to say about it.”
The right to health encompasses much more than access to health care, particularly for marginalized communities, as it necessitates transparency, accountability, and power parity. Health care systems that have borne the extreme challenges of the pandemic now have the chance to tackle a new one: how to build an improved system founded on equity.