A team of healthcare policy researchers has looked at efforts to advance health equity in eight different nations, and found some potentially helpful lessons for leaders in the U.S. healthcare system who are attempting to do the same.
In a blog published to the website of the New York City-based Commonwealth Fund and entitled “Advancing Health Equity: Learning from Other Countries,” Nason Maani, Ph.D., and Sandro Galea, M.D., M.P.H., DrPH, looked at experiences in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, and the United Kingdom, as leaders in those healthcare systems work to advance health equity and end systemic racism, just as U.S. healthcare system leaders are working to do. Maani is the 2019-2020 U.K. Harness Fellow in Health Care Policy and Practice research Fellow London School of Hygiene and Tropical Medicine, and Galea is the Dean and Robert A. Knox Professor, Boston University School of Public Health.
Putting efforts around health equity into the context of the impact of the global COVID-19 pandemic, Maani and Galea write that “We looked at how eight high-income countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, and the United Kingdom) have sought to change the mindsets of health care leaders and professionals, measure and dismantle racism in care delivery, and promote equitable access to care. The eight countries finance health care very differently than the U.S. and are affected by racism and income inequality in varying ways. Nevertheless,” they write, “they offer lessons and practical strategies for supporting historically marginalized groups and reducing health inequalities.To identify how these countries have pursued health equity, we conducted a literature review (see the appendix) supplemented by interviews with five experts in global health and health equity. This blog post describes promising, evidence-based approaches to reducing health inequalities we identified that are relevant to the U.S. and could spur further cross-national learning.”
Importantly, some of what healthcare leaders in other countries are doing, appears to be replicable here in the U.S., despite the differences between the U.S. healthcare system and the eight systems studied by Maani and Galea. As they note, “Across these eight countries, we found that medical associations and schools play critical roles in dismantling racism, often by identifying and reducing harmful stereotypes. In Canada, a group of medical students documented stereotypes that other students held of Canadian Aboriginal or Black populations. These included perceptions that these patients were less interested in remaining healthy, were to blame for their poorer health, and were vastly different from themselves. Medical associations and schools also track and respond to instances of racism and discriminatory conduct in educational and work settings. In the U.K., medical colleges have acknowledged that Black and minority ethnic groups lack equal access to career opportunities within the National Health Service (NHS) and have been disadvantaged in terms of career progression, salary, sanctions for misconduct, and likelihood of experiencing bullying and harassment,” they report.
Meanwhile, the researchers write, “A second theme that emerged in our literature review and interviews was the importance of measuring health care disparities to detect and ultimately undo racism in care delivery. Researchers in New Zealand found that breast cancer screening and treatment rates are lower among Māori than non-Māori women, and that Māori women are less than half as likely to reach the five-year breast cancer survival mark. In France, researchers found immigrants and their children from Sub-Saharan Africa, North Africa, and French overseas territories were more likely to experience discrimination when seeking care, and that such experiences tended to make people skip subsequent care. And in the U.K., people from Black and minority ethnic groups were four times more likely to be detained under the Mental Health Act — which allows people to be detained when they are considered at risk of immediate harm to themselves or other — than their white counterparts. These groups are also more likely to enter mental health services through the criminal justice system than through primary care.” And, “In Australia, an external assessment tool was developed to help hospitals measure, monitor, and report on institutional racism. It assesses rates of preventable hospital admissions by race, the representation of minorities in leadership roles, and health services funding gaps, and was used to evaluate all 16 hospital and health services organizations in Queensland, Australia.”
Moving forward, the article’s authors write, “
Health inequities reflect broader disparities in access to education, economic advantages, healthy physical environments, and other resources, and health care providers can play a central role in understanding and addressing the problems. Cross-national learning can offer inspiration and examples for improving common health equity challenges. Our research uncovered a range of international efforts to advance health equity, offering guideposts for U.S. health systems working to undo racist practices and policies.”