Formal declarations may be new, but racism is not. Here are 3 ways to start to tackle structural inequity.

By Rachel Woods, Darby Sullivan, and Andrew Mohama

Racism has been a public health crisis for a long time. And while we applaud the New York City Board of Health for officially declaring it as so, what follows after this declaration is what actually matters.

Over the last few months, we've seen plenty of new commitments to health equity across the industry. But how many of these commitments are making a true and sustainable impact? Some commitments often aim at advancing equity with efforts that are merely passion projects—relatively one-off programs or investments dedicated to pet issues based on the personal interests of small but mighty teams—not true organizational transformation. Other commitments rely on partnerships that don't go far enough. The only way to make a dent in the massive challenge of racism in health care is to push for large structural change, because yes, racism is systemic.

In the absence of top-down change from policymakers, the onus rests on the shoulders of health care leaders to use whatever leverage they have to push the industry—and each other—toward this structural change.

Three requirements on the journey towards addressing structural inequity

1. Embed health equity into everything you do

   Let's make sure we are on the same page here: relying on disjointed efforts or one-off equity educational sessions will not move the needle. Equity is not something that folks should be able to opt-into learning or thinking about. Racism is a crisis, so make sure your actions address that level of severity. To do that, equity efforts should be engrained into the very roots of your organization, including in leadership roles, hiring practices, and funding decisions. Every department, team, and individual should be held accountable to equity goals that align with their work. For example, as our colleague Micha'le Simmons recently said: 'If your mission as a health care organization is to deliver patient-centered, high-quality care, we cannot deliver on this mission unless we address racism.'

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3. At the same time, dedicate specific resources toward the sole goal of combatting racism

   Racism, like all inequities, are deeply complex issues. There will be some elements of your equity strategy that don't naturally fit into the mandate of existing departments or teams—or that cut across multiple at the same time. To tackle special equity goals and coordinate across the organization, create a dedicated team with sufficient resources. This often looks like creating a C-suite role, equipping them with the necessary staff and funding, and holding them accountable for tangible progress.

   However, there is a potential bottleneck here: many health care leaders believe in the moral case for advancing health equity, but they struggle to secure these dedicated resources from senior executives without proving reduced costs or improved revenue as a result. Demonstrating a financial return can take years and varies on the organization's position in the industry. To bolster the value proposition, review five ways that health equity supports business priorities beyond financial ROI here.

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5. Embrace the power of partnerships

6. Even with the most equitable and strategic approach, no one single organization or section of the industry can accomplish structural change alone. We need key stakeholders to work together, and this even means collaboration among competitors. To forge successful partnerships across the industry (including competitors), the following steps are critical:

   • Ensure your own house is in order first;
   • Select the right partners who align with your goals and can help you fill gaps; and,
   • Determine how accountability for progress will work between you and partners.

   We discuss each of these components in depth here.

Parting thoughts

New York City may be one of the first cities to formally declare racism a public health crisis, but this doesn't mean your community is exempt from the legacies of structural racism. Don't wait for a formal declaration—act now.

For a curated list of our podcast episodes on racism and health equity, click here. In this list, you will find episodes featuring CEOs who tore up their old mission statements, SVPs who discuss women and women of color representation in leadership roles, and experts from Advisory Board who share research-backed insights on equity.