Striving for Equity

Health Organizations Must Act, Urge Equity Experts

SAN DIEGO—If health systems provide quality care only to those with privileged access, can it be considered quality care at all? Speakers for the ACR Convergence 2023 session Addressing Social Determinants of Health: A Journey Toward Health Equity challenged their audience to consider this question and provided expert guidance concerning the implementation of health equity measures in medical organizations.

What Are Social Determinants of Health?

Dr. Rose-Smith

“We all will achieve health equity when each individual has the opportunity to have and acquire their best health without barriers, such as race, ethnicity, income and gender identity,” said Jillian Rose-Smith, PhD, MPH, LCSW. Dr. Rose-Smith is the vice president and chief health equity officer of the Hospital for Special Surgery’s Department of Social Work in New York City, where she provides operational leadership for access to care and other DEI projects. For health equity to be achieved, “we’ll need to do more than talk and think about health equity. … We’ve been having this conversation for three-and-a-half decades,” and still haven’t rectified the massive, well-documented disparities in care.

Dr. Rose-Smith defined social determinants of health as “conditions in the environments where people live, work, play and worship that can impact the health, functioning and quality of life.” These factors account for 80–90% of adverse health outcomes, she said.¹

According to Dr. Rose-Smith, the top social factors that influence musculoskeletal health are access to care, transportation, health insurance coverage, race and ethnicity and health literacy. Navigating these challenges may prevent patients from following the care plans provided by their doctors. “They’re thinking, ‘How can I feed my family? How can I get transportation? How can I get childcare?’ And they’re not thinking about, ‘How am I going to get the medication that you just prescribed?’” said Dr. Rose-Smith. Housing instability, food insecurity, safety, limited access to care, racism and trauma all contribute to what Dr. Rose-Smith identifies as toxic poverty stress and are detrimental to physical health.

In 2017, the National Quality Forum (NQF) published the Road Map to Health Equity guideline.² The NQF provided instructions to hospitals and health plans on how to prioritize equity, as well as guidance for clinicians, who can connect individual patients with community support services. It also called on policymakers to incentivize equity measures. According to Dr. Rose-Smith, this resource led to conversations, but not a lot of direct change.