Press Release  AG Healey Calls for Action to Advance Racial Justice and Equity in Health

BOSTON — A new report released today by Attorney General Maura Healey advances a far-reaching set of recommendations for reducing health inequities that impact communities of color in Massachusetts.

The report – Building Toward Racial Justice and Equity in Health: A Call to Action – highlights longstanding disparities and also addresses the disproportionate toll that the COVID-19 pandemic has taken on the health of Black, Hispanic, and Latinx communities, who have experienced significantly higher infection rates, hospitalization rates, and age-adjusted death rates than other communities, and are more vulnerable to the economic impacts of the virus.

“Our health care system works well for many, but the disparate effects of the pandemic provide a somber reminder that our system fails to equitably serve communities of color,” said AG Healey. “The intent of this report is to advance the urgent work that is needed to address these disparities. We are eager to work with stakeholders from across the state—health care institutions, policymakers, academics, patients, and community-based organizations—to set out an ambitious plan for progress toward racial justice and health equity. COVID-19 has shown us that these actions cannot wait.”

The report calls for action in five domains: data for identifying and addressing health disparities, equitable distribution of health care resources, telehealth as a tool for expanding equitable access to care, health care workforce diversity, and social determinants of health and root causes of health inequities.

AG Healey, along with staff from her office, presented these recommendations during a virtual launch event today that featured reflections from frontline health care providers and health equity leaders: Dr. Simone Wildes (South Shore Hospital), Dr. Altaf Saadi (MGH), Dr. Mothusi Chilume (East Boston Neighborhood Health Center), Monica Lowell (UMass Memorial Health Care), and Dr. Frank Robinson (Baystate Health). Key recommendations from the report include:

Data

• Improving the collection and reporting of data on patient race, ethnicity, and other demographic characteristics to help stakeholders better understand existing disparities and develop strategies to address them.
• Setting and measuring statewide equity benchmarks to demonstrate commitment to advancing health equity and racial justice.

Equitable Distribution of Resources

• Promoting equitable health care provider payment rates to ensure that low-income communities and communities of color have access to the same resources available to any other community in order to meet their health needs.
• Reducing patient cost-sharing during the pandemic for primary care, behavioral health, and prescription drugs for certain chronic conditions so that underserved patients can get the services they need during the COVID-19 emergency.

Telehealth

• Addressing the divide in digital access by increasing the availability of free and low-cost internet plans and devices and making sure that underserved patients are aware of available resources.
• Supporting coverage and payment parity for telehealth services, including telephonic visits, where clinically appropriate, for the next two years.
• Ensuring equitable access for individuals with disabilities and limited English proficiency through standardized provider procedures and accommodation services to minimize existing disparities in clinical care.

Workforce Diversity

• Expanding affordable and inclusive educational opportunities to increase access to health professions.
• Including anti-racist and cultural humility training in medical education, licensure, and certification processes.

Social Determinants of Health

• Prioritizing investments in key social determinants of health—including education, employment, housing, the environment, and violence—in order to address upstream inequities that lead to health disparities.
• Exploring new models to bring together stakeholders who can apply a health equity lens to regional decisions that affect social determinants of health, such as regional health equity authorities.

Today’s report was prepared by Deputy Chief Sandra Wolitzky, Assistant Attorney General Ethan Marks, Health Care Analyst Noam Yossefy, Paralegal Troy Brown, and Mediator Jennifer Morris of the AG’s Health Care Division. The report was informed by the experiences of patients, providers, public health organizations, researchers, and community groups who generously shared their time with AGO staff.

STATEMENTS OF SUPPORT

Don Berwick, President Emeritus and Senior Fellow at the Institute for Healthcare Improvement

“This report, Building Toward Racial Justice and Equity in Health: A Call to Action, could mark, if we act on it, a turning point in the Commonwealth of Massachusetts. We share with the rest of our nation a tragic legacy, centuries long, of disparities in health status and wellbeing that drive from inequities in the underlying generators of illness, injury, and disabilities. This report analyzes the important role of equitable and high-quality health care access and services, of course. But, even more importantly, it draws on massive and incontrovertible evidence that healthy communities depend on the “social determinants of health,” such as supports for early childhood, vibrant educational systems, safe workplaces with income levels sufficient for full lives of thriving, strong care for elders and opportunities for aging people to stay connected and avoid loneliness, and community supports, such as food security, housing security, transportation, recreation, environmental safety, a compassionate system of criminal justice, and more. And, of course, health in our state and our nation will require at last confronting and ending structural racism and any forms of exclusion and disparity based on race, ethnic background, language, gender, and sexual orientation. For our state, this all will require new and ambitious public policies, widespread private sector commitment, and significant redistribution of resources toward those organizations and populations who have been left behind. For example, will we end hunger and homelessness in our wealthy state? Will we move toward a world class system of compassionate and restorative justice, instead of punitive incarceration?  Will we assure every community livable environments and recreation, well-supported schools, universal early childhood and parenting supports, modern transportation, and other conditions for thriving? 

In fact, although COVID-19 has rung a loud alarm on equity, the fact base for this report, so impressively documented in its extraordinary reference list, is not new. The dimensions, causes, and some of the remedies for health disparities have been recorded and known for many decades.  Sadly, for so many, we have spent far more time and energy studying and lamenting these problems than solving them. This is a choice now: will our Commonwealth - all of us - not just read this ambitious report, but act at last - to save lives, restore store health, and show in our behaviors and investments the compassion, solidarity, and justice that will make us all, without exception, as healthy as we can be - all of us?  Yes? Or no?”

Sandro Galea, Dean of Boston University School of Public Health

“The most important story to emerge from COVID-19 is the need to have health equity front and center in the public conversation, and to take tangible steps to promote health equity. This report stands to do just that. It is an important marker of the centrality of the issue, and offers concrete potential solutions that are achievable and can make a difference.”

Carlene Pavlos, Executive Director, Massachusetts Public Health Association

“We are grateful for the Attorney General’s focus on health equity and for the clear and transparent presentation of data showing the deep racial inequities in health outcomes that have only been amplified by this pandemic. The dual public health crises of COVID-19 and structural racism demand a response that focuses on addressing the root causes of inequity and improving the social determinants of health for communities of color. We stand ready to partner with the Attorney General in addressing the recommendations highlighted in this report.”

Michael Curry, Deputy CEO and General Counsel of the Massachusetts League of Community Health Centers

“This report makes substantive and important contributions to our Commonwealth’s conversation on health equity. Its broad focus provides an additional framework for addressing the medical, social and economic disparities that continue to thwart health and success in communities of color.” 

Steve Walsh, President and CEO of the Massachusetts Hospital Association

“We applaud Attorney General Healey for her continued focus on health equity and for the important work her office is doing to create structural change in the commonwealth. For too many residents, systemic racism and socioeconomic status have been barriers to quality healthcare. Our providers remain committed to being an active part of the solution. The Attorney General has always been a fierce advocate for our patients, and we stand with her in our shared mission to deliver the accessible, equitable care they deserve.”

Frank Robinson, Vice President of Public Health at Baystate Health

“The set of solutions in the AG's Health Equity Report, if matched with enabling policies, programs, and resources will create a watershed moment, a turning point in healthcare, for the equitable distribution of resources and elimination of disparities facing Black and indigenous and people of color and lead to significantly addressing upstream social and economic determinants of health.”

Dr. Altaf Saadi, General Academic Neurologist at Mass General Hospital, Associate Director at MGH Asylum Clinic, Instructor of Neurology at Harvard Medical School

“The pandemic has amplified existing health disparities, but it doesn’t need to become one of its defining features. This report is a very important step in offering solutions to combat these disparities, to ensure all Massachusetts residents have access to quality health care. With hundreds of thousands infected, and thousands dead, it is more critical than ever to address these disparities in the Commonwealth moving forward.”

Monica Escobar Lowell, Vice President of Community Health Transformation and Community Benefits at UMass Memorial Health Care

“This is a much needed new and impactful guide to develop innovative approaches to achieve health equity during these turbulent times.”

Audrey Shelto, President of Blue Cross Blue Shield of Massachusetts Foundation

“The report from the AG’s Office points to the Commonwealth’s historical successes in addressing health care coverage, quality and costs through ‘shared responsibility’. We applaud the call for that same collaboration, sense of urgency and commitment to resolving totally unacceptable and longstanding health inequities. The BCBSMA Foundation is eager to join with the AGO and others in being part of the solution.”

Andrew Dreyfus, President and CEO for Blue Cross Blue Shield of Massachusetts

“At Blue Cross Blue Shield of Massachusetts, we view racism as a public health crisis. The COVID-19 pandemic and the extraordinary events of the past several months have prompted a dramatic reawakening to structural racism and laid bare the deep racial and ethnic disparities that exist in health care. We applaud the Attorney General for bringing focus and urgency to this important work, and we look forward to working with her office and other key stakeholders on addressing these issues and creating a better, more equitable future."

Steve Grossman, CEO, Initiative for a Competitive Inner City

“The Initiative for a Competitive Inner City (ICIC) is proud to support the Attorney General’s far-reaching and innovative action plan to improve wellness outcomes in communities that suffer from the ravages of concentrated poverty. The pandemic has exacerbated the vulnerability of these communities and made more urgent than ever their economic revitalization as essential to achieving racial justice and equity.

Matt Selig, Executive Director, Health Law Advocates

“We applaud Attorney General Healey for issuing this comprehensive report on Racial Justice and Equity in Health in Massachusetts. The report and its recommendations address issues of the highest importance for our entire state. As the report notes, ‘stakeholders should come together to address the systemic health inequities facing people of color.’ Health Law Advocates is eager to be part of that urgent work with Attorney General Healey and others.”

Amy Rosenthal, Executive Director of Health Care For All

“Attorney General Healey’s Call to Action on Health Equity is a forward-thinking plan to address the health disparities that have always been present but have been laid bare and exacerbated by the COVID-19 pandemic. By providing a blueprint on issues from the digital divide and telehealth to the need to invest in upstream social determinants of health, this report responds to many of the needs that Health Care For All hears about from consumers across the state. It is especially pressing and heartening to see that recommendations on health care affordability and the importance of reducing cost-sharing for prescription drugs and other critical services are included as part of her framework for addressing health equity.”

Myechia Minter-Jordan, New Commonwealth Fund Member, President and CEO of DentaQuest Partnership for Oral Health Advancement

“As a member of the New Commonwealth Fund, I am encouraged by the commitment of the Attorney General to lift up an important examination of systemic racism and its impact on health equity. Our Fund members look forward to continued collaboration with the Office of the Attorney General on this critical issue.”

Phillipe Copeland, Clinical Assistant Professor, Boston University School of Social Work

“During these times of dual pandemics, systemic racism and COVID-19, the AGO's recommendations are a welcome contribution to the struggle to defeat both. I particularly appreciate the attention paid to fighting on multiple fronts, from data collection, to workforce diversity, to resource distribution.”

Dr. David A. Rosman, President of the Massachusetts Medical Society

“The Massachusetts Medical Society applauds the work done by the Attorney General’s Office in producing this helpful report on health equity in Massachusetts. The recommendations offered by the AGO have amplified the lived experience of health care professionals and patients within our Commonwealth. While this pandemic persists, it continually exacerbates the magnitude of health disparities in Massachusetts. It is, perhaps now more than ever, critically urgent to take meaningful strides toward health equity by implementing concrete proposals based on real experience. The AGO proposes sensible recommendations that are built from the ground up and are based on a solid foundation.

Specifically, the Medical Society is strongly supportive of the AGO recommendations regarding telehealth as a means to promote access to health care. These recommendations seek to provide parity in coverage and reimbursement for clinically appropriate telehealth services, including audio only services, in order to best promote the use of telehealth by working to bridge the digital divide and ensure accessibility for patients with disabilities. Additionally, the Medical Society lauds the focus on workforce diversity as one manner of mitigating disparities in health care. The institution of medicine has long failed to represent its patient population within its own workforce. It is well past time to develop policies that expand access to medical education for those seeking to enter the workforce and that promote equitable development of health care workforce diversity and capacity.

Furthermore, the physicians of the Massachusetts Medical Society are guided by longstanding and unwavering policies, including a shared ethical responsibility, to take actions necessary to eliminate disparities in health care caused by all forms of racism and shaped by social determinants of health. Accordingly, the Medical Society is encouraged by the AGO’s efforts to address the root causes of health disparities.

This pandemic has cast a glaring spotlight on many forms of inequities, as patients from our most underserved communities are disproportionately affected by COVID-19, but systemic racism as a cause of illness and premature death for people of color is not novel. These inequities are generational, shameful and, quite frankly, an embarrassment to the health care community. We applaud the work of the AGO in producing this report and support the recommendations therein that will improve access to quality health care in Massachusetts.

The Medical Society looks forward to continuing our commitment to ensuring that all residents of the Commonwealth have the opportunity to enjoy the highest attainable standard of health in all its dimensions, including health care, and we stand ready to assist in implementing the recommendations put forth by the AGO in this thoughtful report.”

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