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 expose 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. The Office of Health Equity within DPH works to address social determinants so everyone can attain their full health potential.
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.
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 our 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 our 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 an action plan with detail on how the agency plans to implement changes to its work to more fully integrate health equity principles and ensure that a health equity lens is applied to all current and future work.
- 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)
- 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)
- 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
The slides presented at the July 22, 2020 HPC Board Meeting describe the HPC's commitment to implementing a framework that will advance health equity..
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 keynote address and the spotlight video are available on the Cost Trends Hearing webpage.
The HPC’s ongoing health equity-focused projects are highlighted below. This list will be updated on a regular basis.
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 Office of Patient Protection works to effectively safeguard health care consumer protections in the Commonwealth, and assists customers in many languages.
Information and tools from initiatives in Massachusetts and across the country.
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.
Massachusetts Legislature Health Equity Task Force. A webcast of the meeting of the Health Equity Task Force to review findings from the September 16, 2020 public hearing and discuss areas of recommendations.
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.