Background on Health Equity
The HPC’s mission is to advance a more transparent, accountable, and equitable health care system through its independent policy leadership and innovative investment programs. The HPC’s overall goal is better health and better care – at a lower cost – for all residents across the Commonwealth.
The HPC’s 2012 statute explicitly directs the agency to address health care disparities:
“The commission shall establish goals that are intended to reduce health care disparities in racial, ethnic and disabled communities and in doing so shall seek to incorporate the recommendations of the health disparities council and the office of health equity.”
The HPC is committed to addressing these disparities while advancing health equity and promoting social and economic justice.
Imperative for Action
In 2020, the disparate impact of COVID-19 on communities of color and ongoing injustices of police brutality across the country exposed systemic racism and deeply embedded structural inequities.
Health inequities in the Commonwealth have been well documented by the Massachusetts Department of Public Health (DPH), the Center for Health Information and Analysis (CHIA), the Office of the Attorney General, the HPC, and others.
Racial inequities are not unique to the health care system but are reflected in persistent health disparities and increased disease burden for communities of color. In addition to their impact on health and well-being, inequities result in higher health care spending and an imbalanced distribution of resources.
Racism Directly Affects Health Outcomes
The social determinants of health (SDOH) are factors that contribute to an individual’s medical and behavioral health outcomes and to predicting population health (e.g., socioeconomic status, food access, education, and opportunity for employment). While structural inequities and prejudices such as homophobia, ableism, and xenophobia have impacts on SDOH, racism has been proven to also have a direct and harmful impact on health.
Racism both influences social determinants and is an independent factor in health outcomes.
It is pivotal to acknowledge and address the impact of systemic racism as health equity work is implemented.
Source: Boston Public Health Commission’s Racial Justice and Health Equity Initiative; available: http://www.bphc.org/whatwedo/health-equity-social-justice/racial-justice-health-equity-initiative/Documents/RJHEI%202015%20Overview%20FINAL.pdf
Health Equity Principles
- The HPC acknowledges the pervasiveness of health inequities – and the systemic racism that underlies them – and that eliminating inequities is integral to achieving the HPC's mission of better health and better care at a lower cost for all residents of the Commonwealth.
- The HPC will educate itself about the impact of systemic racism and will promote diversity, equity, and inclusion in the workplace in order to more fully cultivate the culture of anti-racism within our agency.
- Advancing health equity in the Commonwealth is a shared responsibility. The HPC will actively seek opportunities to align, partner, and support other state agencies, the health care system, and organizations working for health equity on these goals.
- The HPC’s work will be informed and guided by those with lived experience of inequities.
- The HPC will embed health equity concepts in all aspects of its work and will apply all four of its core strategies to the goal of advancing health equity in the Commonwealth: research and report, convene, watchdog, and partner.
Accountability and Action Plan
Public Commitment to Advancing Health Equity
The HPC is currently finalizing a detailed action plan outlining how the agency intends to implement changes to its work to fully integrate health equity principles and ensure that a health equity lens is applied to all current and future projects.
- Presentation of the Health Equity Framework and Revised Mission Statement to the HPC’s Board and Advisory Council (Complete; Ongoing Public Updates)
- Dedicated time in public meetings, including the Annual Health Care Cost Trends Hearings, to highlight issues related to health equity and the HPC’s efforts to address them (Complete; Ongoing)
- Public updates on health equity progress in consultation with HPC’s Board, Advisory Council, and staff (Ongoing)
- Integrate race/ethnicity data in APCD through inter-agency and stakeholder collaboration (In Progress)
- Develop metrics to measure progress of health equity integration into research agenda (In Progress)
- Collaboration with other state agencies (In Progress; Ongoing)
- Develop data resources to examine hospital patient demographics (In Progress)
Internal Action Steps
- Development and implementation of operational framework to incorporate health equity principles and lens in all HPC workstreams (In Progress)
- Engagement of experts to provide staff training and promote diversity, equity, and inclusion in order to more fully cultivate the culture of anti-racism within our agency (In Progress; Ongoing)
- Identification and implementation of specific goals to evaluate progress of integrating health equity principles in all HPC workstreams (In Progress)
- Regular internal meetings to review the agency’s health equity efforts and to inform updates to the HPC’s Health Equity Framework (In Progress)
- Recognition of health equity as an integrated workstream, and regular assessment of resources (e.g., staff, training, and funds) to support health equity focus (In Progress)
- Systematic review of HPC employee handbook and internal policies (In Progress)
HPC's Health Equity Work
In July 2021, the HPC released the Health Equity Practice and Style Guide, a practical internal resource developed by and for HPC staff. Its purpose is to promote intentional and consistent use of language and terminology across the agency, to encourage reflection among staff as they communicate about equity within their workstreams, and to provide resources, tools (including preferred terms), and HPC-specific use cases. The Guide was updated in July 2022.
The 2020 Health Care Cost Trends Hearing focused on the impact of the COVID-19 Pandemic in Massachusetts, particularly the disproportionate impact felt by communities of color. The 2021 Health Care Cost Trends Hearing focused on the intersecting challenges of cost containment, affordability, and health equity in Massachusetts, the seriousness and urgency of which have been underscored both by the pandemic and recent spending trends. Materials and presentations from the hearings are available on the Cost Trends Hearing webpage.
On July 22, 2020, the HPC presented a commitment to implementing a framework that will advance health equity.
Regular updates on the HPC’s Health Equity Framework will be provided at public meetings. The most recent update is available here.
The HPC’s ongoing health equity-focused projects are highlighted below. A compendium of recent HPC publications and workstreams that have a focus on equity and disparities is also available. These lists will be updated on a regular basis.
The Birth Equity and Support through the Inclusion of Doula Expertise (BESIDE) Investment Program intends to address inequities in maternal health outcomes and improve the care and patient experience of Black birthing people by increasing access to and the use of doula services.
The MassUP Investment Program funds partnerships between health care providers and community organizations to address a social determinant of health (SDOH).
The Cost-Effective, Coordinated Care for Substance Exposed Newborns and their Caregivers (C4SEN) investment program is a quality improvement to expand access to evidence-based, appropriate addiction treatment. C4SEN seeks to support programs that emphasize cultural relevance, acknowledge the effects of structural racism, and take accountability for improving outcomes for marginalized populations.
The HPC has partnered with MassChallenge HealthTech to host an event series focused on topics related to health equity and innovation. Registration for future events and recordings of past events are available on the MassChallenge website.
The Office of Patient Protection works to effectively safeguard health care consumer protections in the Commonwealth and assists customers in many languages.
Resources
Information and tools from initiatives in Massachusetts and across the country.
Massachusetts Legislature Health Equity Task Force: "A Blueprint for Health Equity." This report was presented to the Massachusetts Legislature in July 2021 and contains recommendations to address historic injustices that led to unequal burden of disease and death during COVID-19 for vulnerable populations.
Massachusetts Attorney General's Office: "Building Toward Racial Justice and Equity in Health: A Call to Action." This report from the Attorney General’s Office highlights longstanding disparities and the disproportionate toll that the COVID-19 pandemic has taken on communities of color in Massachusetts.
Massachusetts COVID-19 Health Equity Advisory Group. The primary function of the advisory group was to generate a series of recommendations for the Commissioner of the Massachusetts Department of Public Health on how the COVID-19 pandemic response could be informed by a health equity lens to ensure equitable access to resources and services, and prevent inequities and disproportionate negative outcomes.
Racial Justice and Health Equity Framework, Boston Public Health Commission. BPHC’s Health Equity Framework for understanding health inequities shows how racism and other systems of oppression (homophobia, ableism, transphobia, sexism, and xenophobia) have an independent influence on all the social determinants of health and can have a direct impact on health outcomes.