Tag Archives: health equity

How healthcare providers can empower voters for a healthier democracy

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It’s Super Tuesday – a day when voters in 15 states and one U.S. territory go to the polls for the presidential primary election. I’ve written in the past about the importance of exercising your right to vote, voting your values, and highlighted some of the non-partisan “get out the vote” organizations.

This time I want to address the intersection of voting and healthcare, but not from a policy perspective. You can probably guess my views on key policies. But rather from an empowering everyone to vote perspective. Whether you vote in the primary or not, much is at stake in the November general election.

Let me start with a very progressive organization, A Healthier Democracy, that I learned about last year when their CEO, Dr. Alister Martin, spoke at the annual NEHIMSS Chapter Conference. According to their website:

A Healthier Democracy builds platforms for collaboration and community organizing at the intersection of health and civic engagement to maximize collective impact on pressing challenges.

They are home to five high-impact national initiatives. There are two initiatives involving voting that I want to highlight – Vot-ER and Patient Voting: Continue reading →

Healthcare as a right in more progressive countries   

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I wasn’t going to write anything this week since my husband and I just returned from an 18-day trip with Road Scholar – The 4 Nordic Capitals. We spent 3-4 days in each – Copenhagen, Oslo, Stockholm, and Helsinki. It was everything I had hoped it would be! But no one hopes for jet lag and feeling like a zombie the first day or two back.

So, on day 2 of re-entry, I was up very early after too short a night’s sleep as my body adjusts to the 7-hour time difference. Why not start writing? I learned so much on the trip and have lots to share in due time. No question that we can learn a lot from these progressive Nordic countries – Denmark, Norway, Sweden, and Finland.

I visited three of these capital cities when we were on a cruise in the Baltic Sea in 2018. But having only 6-8 hours in a port is nothing like immersing yourself for a few days and really learning about the country – their history, political structure, culture, social services, technology, and more.

A day with a Road Scholar tour like this includes a 1-2 hour lecture from the local guide or an outside expert and then guided tours to a variety of sites with usually some free time late afternoon to explore on your own.

Let’s start with how progressive they are. I could start from various angles – a strong focus on sustainability, extensive public transportation infrastructure, free education through the university level, lengthy required maternity/paternity leaves, and of course their healthcare system.

From my lecture notes, here are a few data points I captured on healthcare:

In Finland, healthcare is not completely free but pretty close. Prescriptions are subsidized and you pay a maximum of 700 euro in a year ($769.37 using today’s conversion rate). Think about the people you know in the U.S. who are paying thousands a month for just one critical prescription. Hospitalization is 49 euro a day regardless of what it is for ($53.86 using today’s conversion rate). Think about people in the U.S. who have to declare medical bankruptcy due to hospital bills or deplete their life savings for nursing home care. (A 2015 study by the Kaiser Family Foundation found that medical bills caused 1 million U.S. adults to declare bankruptcy every year and that 26% of Americans aged 18 to 64 struggle to pay medical bills. Medical bankruptcy is almost unheard of outside the U.S.)

In Sweden medical care is free until you are 19 years old and dental care is free until you are 24. For medical care you pay $25 per visit or procedure. After a maximum of $720 per year you don’t pay. (Local guide spoke in dollars vs euros for us).

Yes, people in these countries have high tax rates but their dollars go to services for the entire population. Healthcare is just one example – they truly believe healthcare is a right with every citizen having equal access to services.

More to come on lessons from the Nordic countries in future weeks….

The transformative power of bold leadership in healthcare

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With reproductive rights and LGBTQ+ rights under attack in so many states, it was good to see the Summer 2023 Issue of the Brigham magazine in the mail this week. This issue is titled “Care for Every Body – Embracing Inclusive Medicine”. As a former VP and donor to Brigham and Women’s, I receive the paper copy to read. You can access it online here.

The main articles include:

  • Sex & Gender Glossary – essential terms and definitions for understanding sex, gender, and well-being.
  • Pro-Care. Pro-Patient. – describing how the Department of Obstetrics and Gynecology is working toward reproductive justice for all patients. An alarming data point: If all abortions in the U.S. were to stop, 24% more people would die from pregnancy complications and 39% more non-Hispanic Black people would die.
  • Soul Meets Body – describing how the Center for Transgender Health is breaking barriers and providing state-of-the-art, life changing care for trans and gender diverse people. An alarming data point: 46 states have proposed 491 anti-transgender laws in 2023, more than the previous four years combined.
  • Women ≠ Tiny Men – describing how physician-researchers are working to balance the scales for women’s health.

These articles and the programs described represent bold leadership in healthcare and what we should expect from healthcare providers.

Just as the Winter 2022 Issue titled “Standing Tall for Justice – Cultivating Equity and Inclusion in Medicine” was bold leadership as it covered racial equity in healthcare. And just as Michael Dowling, President and CEO at Northwell Health in New York, regularly shows us what bold leadership means. He doesn’t shy away from controversial issues as he addresses the issue of gun violence and calls for civility and decency in our public discourse.

Dr. Robert Higgins, President, Brigham and Women’s Hospital and EVP, Mass General Brigham comments in the introduction to the Summer 20223 Issue – “While forging the road toward a more inclusive healthcare systems is not an easy or immediately achievable goal, it is a vital commitment we must make. Our sense of humanity depends on it.”

Are you uncomfortable being a bold leader? Do you embrace or shy away from the DEI discussion? The DEI Committee of CHIME is hosting a webinar this Friday, June 30, at 12PM EDT that I highly recommend. It is titled “DE&I in Healthcare 2.0 – Getting Comfortable Being Uncomfortable in a Safe Space Zone”. Please follow this link to register if you want to learn how to stay DEI focused in an anti-DEI climate.

In a recent podcast interview, I was asked about some of the unique challenges and opportunities of being a CIO in the healthcare sector compared to other industries. I commented on how being in healthcare is mission driven and how we can make a difference in people’s lives. Leaders of our nation’s leading healthcare systems being willing to address the difficult issues and care for every person is one of the reasons I am passionate about working in healthcare.

What we do matters.

Related Posts:

Leadership means being bold and taking on the tough issues

Towards a more civil society

When is enough enough?

The healing power of humanity

 

ACP – addressing the digital divide

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“We need to advance health equity in a sustainable way – not with charity care and not performative health equity”, said Dr. Alister Martin, ED physician and CEO of A Healthier Democracy in the closing keynote at the annual NEHIMSS chapter conference last week. One of the many initiatives of A Healthier Democracy is Link Health which focuses on connecting patients to the Affordable Connectivity Program (ACP) to close the digital divide.

Listening to Dr. Martin last Thursday, I decided to use this week’s blog post to amplify this important initiative and help raise awareness among health IT leaders about the ACP and its importance for healthcare. As they say, timing is everything. June 14-22 is the ACP White House Week of Action and June 16 is the ACP Healthcare Day of Action.

Here’s some background on the ACP taken from the Link Health website:

COVID-19 Accelerated A Massive Shift To Telehealth.

The COVID-19 pandemic ushered in widespread acceptance of telehealth and other digital innovations in medicine and dramatically increased the use of telehealth as an intervention to reach patients.  A recent HHS study shows a 63-fold increase in Medicare telehealth utilization and 32-fold increase in behavioral health care through telehealth triggered by the pandemic.

Access To Broadband Internet Is A Social Determinant Of Health.

Despite widespread internet usage in the United States, 15–24% of Americans lack broadband internet connection, a foundational requirement for telehealth and the bevy of other services that underpin the social determinants of health. In fact, access to broadband internet has been considered a “super” social determinant of health (SDoH).

The Affordable Connectivity Program Expands Broadband Access But Needs Help From Healthcare.

The Bipartisan Infrastructure Law created the Affordable Connectivity Program which provides a subsidy of up to $30/month for lower-income households ($75/month for households on tribal lands) on participating internet service plans and a one-time $100 subsidy for a connected device. 51.6 million households are eligible for the ACP, yet only 25% have enrolled. 38 million more households are potentially missing out on money to pay their internet bill. Importantly, only 13% of patients with Medicaid have signed up for the ACP.

Link Health is partnering with the White House, Civic Nation, and leading healthcare organizations on the ACP Week of Action to leverage the health sector to connect patients to the ACP and close the digital divide. There are resources at this site if you are ready to be part of the action and amplify the message through your organization and in your community. Continue reading →

Healthcare for all: ensuring inclusivity in LGBTQ+ patient care

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June is Pride Month. In recent years, LGBTQ+ rights have come under attack. All this after the landmark Supreme Court decision in 2015 supporting marriage equality. These attacks are taking many forms – “Don’t Say Gay” bills in state legislatures, bans on drag queen story hours, protests and intimidation at events, bomb threats at children’s hospitals providing gender affirming care, and more.

A March 7, 2023, piece in the Boston Globe by Renee Graham, “Understanding the intersectionality of hate”, begins by highlighting the number of bills pending in state legislatures. “The American Civil Liberties Union is tracking more than 380 anti-LGBTQ bills in nearly three dozen state legislatures, ranging from bans on gender-affirming care for trans youth to prohibiting classroom discussions about LGBTQ people or issues”.

In the face of these attacks and threats, and anti-LGBTQ+ legislation, allyship is more important than ever. Who doesn’t have a gay family member, friend, or colleague? Allyship is showing up and speaking up. There are many ways to do this as individuals and organizations, especially during Pride Month.

In 2015 I wrote a post titled “Marriage equality, it’s personal”.  I talked about the experience of my aunt when her longtime partner was hospitalized in her final days and how my aunt was treated. That was 1990. We’ve come a long way in healthcare but need to continue these efforts given the strong anti-LGBTQ+ sentiments.

I’m proud to have worked at Boston Children’s Hospital in recent years. Despite bomb threats due to their gender affirming care program, they are not deterred from their ongoing commitment to providing comprehensive and affirming treatment for LGBTQ+ patients and families. They have been awarded the Healthcare Equality Index’s (HEI) Leadership Status every year since 2015. They provide LGBTQ+ patient and family centered care in four key areas: patient non-discrimination, equal visitation, employment non-discrimination, and training in LGBTQ+ patient and family centered care.

The HEI is the national LGBTQ+ benchmarking tool that evaluates healthcare facilities’ policies and practices related to the equity and inclusion of their LGBTQ+ patients, visitors, and employees. Nearly 500 healthcare facilities achieved the top score of 100 in 2022 and earned the LGBTQ+ Healthcare Equality Leader designation.

My 2015 blog also referenced this HEI designation. I was working at Michigan Medicine then and they too were recognized with HEI Leadership Status. I closed that blog hoping that in the coming years, thousands more healthcare organizations would receive this same designation. There is progress, but more is needed.

Resources:

National LGBTQIA+ Health Education Center – Ten Strategies for Creating Inclusive Health Care Environments for LGBTQIA+ People

Human Rights Campaign Foundation – Transgender-Affirming Hospital Policies

#EmbraceEquity

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Today is International Women’s Day (IWD) and March is Women’s History Month. The International Women’s Day 2023 campaign theme is #EmbraceEquity. As their website says, “The aim of the IWD 2023 #EmbraceEquity campaign theme is to get the world talking about Why equal opportunities aren’t enough. People start from different places, so true inclusion and belonging require equitable action. International Women’s Day is a global day celebrating the social, economic, cultural, and political achievements of women. The day also marks a call to action for accelerating women’s equality.”

Yes, we have much progress to celebrate but sad to say that in 2023, there is still so much more to do. Especially with our current political climate and Diversity, Equity and Inclusion (DEI) programs being under attack in some states. Take Florida for example where the governor announced in February that he intends to ban state universities from spending money on diversity, equity and inclusion initiatives, calling them discriminatory.

I continue to participate in CHIME’s Diversity, Equity and Inclusion committee as we start another year of programming for all CHIME members. As leaders, raising awareness and finding ways to take positive and meaningful action for our employees and our patients is what this work is about. This Friday as part of the DE&I Dialogues series, we will host a live webinar entitled, “Why DE&I: Defining Health Disparity, Inequity, and Inequality”. The webinar will cover why DE&I is important in your healthcare organization and how it impacts patient care. Featured speakers are Andrea Daugherty, CIO at Dell Medical School at the University of Texas at Austin, Cletis Earle, SVP and CIO at Penn State Health, and Dr. Eric Quinones, Chief Healthcare Advisor at World Wide Technology. You can register here for the March 10, 12PM ET webinar. I hope you will join us this Friday and for future DE&I Dialogues as we continue to learn and work together in 2023.

Related Posts:

International Women’s Day all year long

Women’s History Month, not exactly a Hallmark care event!

One year later – an increased focus on diversity equity and inclusion

 

A step backwards

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“The decision whether or not to bear a child is central to a woman’s life, to her wellbeing and dignity. It’s a decision she must make for herself”. Ruth Bader Ginsburg

I was both angry and sad last Friday when the Supreme Court ruling was announced. There is no question that we are going backwards. My granddaughters will have less rights than me.

How did we get here? The Supreme Court ruling overturning Roe v Wade should come as no surprise. I’m not just talking about the leaked opinion in May. I’m talking about the state level restrictions that have been enacted over the past decade leading to Friday’s ruling.

A piece in the New York Times on June 25, “How Did Roe Fall? Before a Decisive Ruling, a Powerful Red Wave”, by Kate Zernike laid it out clearly starting back with the 2010 elections. The fact that 1380 state level restrictions were enacted in the 50 years since Roe v Wade was decided and that 46% of them were since 2011 tells the story. It is a long article but worth reading.

Aside from understanding the recent history covered in this article, the takeaway is clear – your vote matters. It matters at every level from local elections to the national election for president. While more Americans voted in 2020 than in any other presidential election in 120 years, 80 million people didn’t vote. Local candidates and state legislators win elections oftentimes with only a small percentage of voters bothering to vote.

The health equity issues of this ruling are significant. The ruling puts the health and safety of women at risk with a disproportionate impact on women of color and the financially disadvantaged. Many leaders have recognized this in their statements of support for reproductive rights and the actions they are taking to provide services. Continue reading →

2022 or the 1950s? 

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February started with news that was both disturbing and disappointing to see in 2022. But unfortunately, not a surprise considering the long history of racism and white supremacy in this country. News programs the first few days of Black History Month covered bomb threats at many HBCU campuses, the Florida Anti-Woke Act, book banning, a neo-Nazi group protesting in front of Brigham and Women’s Hospital in Boston, and another police shooting of a young black man, Amir Locke, in Minneapolis.

It makes one wonder if this is 2022 or the 1950s. Are we moving forward or backward?

When I touch on political subjects in my blog posts, I try to weave a healthcare perspective into it. The best I can do given these discouraging news stories is to reinforce that it takes each one of us to make change and create the kind of world we want to live in, work in and raise our families in.

As Rev. Dr. Martin Luther King, Jr. said, “The arc of the moral universe is long, but it bends towards justice”. Yes, but only if we pull it towards justice. So, what can you or I do to pull it?

I applaud Boston Children’s Hospital where I served as interim CIO last year for requiring “Bystander to Upstander” training for all employees as part of the health system’s commitment to diversity, equity, and inclusion. This program raised awareness of microaggressions in everyday life and provided simple tools for each of us to use to move from being a bystander when we see and hear something to being willing to call it out.

I applaud the CHIME Diversity and Inclusion committee which I am a member of for their continued work to raise awareness amongst CHIME and CHIME Foundation members and AEHIS, AEHIA and AEHIT members. The newest offering, “DEI Dialogues”, kicks off this Friday 2/25 from 12-1PM ET. DEI Dialogues will be a dynamic series of virtual conversations around identity, belonging, equity and inclusion with a different lens of focus each month. The focus of the first one is Black History Month. Cletis Earle, SVP and CIO at Penn State Health, and Dr. Andrea Hendricks, Senior Executive Director & Chief Diversity, Equity, and Inclusion Officer at Cerner, will moderate the discussion. For more information on CHIME Diversity and Inclusion and to register for the first DEI Dialogues, click here.

When it comes to understanding our own biases and working to end racism, we are each on our own journey of self-awareness and action. Together we can be the change and move forward not backward.

Resources and Related Posts:

Here’s the story behind Black History Month – and why it’s celebrated in February

How Sharing Our Stories Builds Inclusion

One year later – an increased focus on diversity, equity and inclusion

At the intersection of racism and healthcare

One year later – an increased focus on diversity, equity and inclusion

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A year ago this week a small number of Minneapolis residents witnessed the death of George Floyd. Within days, the world knew what had happened and responded. There were mass protests in cities across the country and the world.

It was a time to reflect as companies across the country looked internally at their own practices and culture. Many started programs focused on Equity, Diversity, and Inclusion (EDI). Those with programs already in place revisited and strengthened them. At Boston Children’s Hospital where I am currently serving as interim CIO, they reaffirmed their commitment. This past week, Dr. Kevin Churchwell, President and CEO, sent a note to all staff outlining some of the work that has been done in the past year in support of their six core EDI commitments with the subject: “One Year after George Floyd’s death, our work continues…..”

The core commitments are:

Goal 1: We will be truly inclusive.

Goal 2: Our team will be as diverse as the patients and families we care for.

Goal 3: We will eliminate racism from our processes, practices, and guidelines.

Goal 4: We will continue to educate ourselves to be an inclusive working environment.

Goal 5: We will work to eliminate health disparities in our community and across the nation.

Goal 6: We will develop and use metrics to continually improve our performance in equity, diversity, and inclusivity.

As Dr. Churchwell said in his message, “George Floyd’s name became a rallying cry for millions and yet another compelling reason to discuss tensions around racism and social injustice. One man’s life became a symbol of so many lives lost needlessly. Disparities and inequities long considered to be “part of the system” became impossible to ignore. Here at Boston Children’s, we took a hard look at ourselves, and we realized that we need to be part of the solution to these important issues.”

Many of you or your CIO may be members of CHIME. In 2020, I joined the CHIME Diversity and Inclusion Committee which was established in early 2019. Continue reading →

The year we meet again

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This is one of those weeks where I throw out what I was writing to mark an historic moment. It has been one year since the worldwide pandemic was declared. We all remember that week. It was a week when suddenly everything we knew as normal changed.

But a year later, this same March week feels like a hopeful turning point. The CDC has released guidelines on what fully vaccinated people can do. Congress has passed the American Rescue Plan and President Biden has signed it. The President is projecting we will reach 100 million vaccine doses in arms by his 60th day in office (next week) compared to his original goal of 100 million in the first 100 days. And he has directed the states to make the vaccine available to all adults by May 1 while the federal government mobilizes thousands of vaccinators and launches a new website to help people find the vaccine site closest to them.

I wrote last week that my husband and I have received our first dose. Our “magic date” as I call it is April 10 (though I know it is about science, not magic!). That is the day after our 45th wedding anniversary. That is when we will be fully vaccinated – two weeks after our second dose appointment on March 27. Like everyone who has missed spending time with their families we are looking forward to breaking bread together again. My husband and I are talking about which of our favorite restaurants we will go to for an inside meal for the first time in over a year.  And we are making plans to go somewhere for a long weekend.

I have shed tears many times this past year as I saw story after story of healthcare workers struggling to deal with overflowing ICUs and families describing the loved ones who they lost to COVID. This week I had tears reading the story of a young EMT in my town who transported many COVID patients to the hospital every day in March, then got COVID himself in April and nearly died. After many months of recovery, he is now back on the job. I had tears listening to the COVID-19 briefing on Monday. My emotions were a combination of sadness and anger as I listened to the experts unfiltered and thought about all the lies and misinformation and ignoring of science that we lived with the past year. We know the pandemic didn’t have to take the toll on this country that it did. Continue reading →