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Policy researchers: Looking to other health systems in promoting health equity

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A team of health care policy researchers looked at efforts to promote health equity in eight different countries, and found some potentially useful lessons for leaders in the US health care system trying to do the same.

In a blog post on the Commonwealth Fund’s website in New York City titled “Promoting Health Equity: Learning from Other Countries,” Nason Mane, PhD, and Sandro Galea, MD, MSc in Public Health, Dr. In Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, and the United Kingdom, leaders in these healthcare systems are working to advance health equity and end systemic racism, just as leaders in the US healthcare system are working to do. Maani is the 2019-2020 UK Harness Fellow in Health Care Policy and Practice Fellow of the London School of Hygiene and Tropical Medicine, and Galia is Dean and Professor Robert A. Knox, Boston University School of Public Health.

Putting efforts around health equity in the context of the impact of the global COVID-19 pandemic, Maani and Ghalia write “We looked at how eight high-income countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, and the United Kingdom) are changing the mindsets of leaders Healthcare and professionals, measuring and deconstructing racism in care delivery, and promoting equitable access to care.The eight countries fund health care very differently from the United States and are affected by racism and income inequality in different ways.However, they write, they offer practical lessons and strategies to support marginalized groups To determine how these countries have pursued health equity, we conducted a literature review (see Appendix) and supplemented with interviews with five experts in global health and health equity.This blog post describes promising evidence-based approaches to reducing the health inequalities we have identified and link to the United States and could stimulate further transnational learning.”

Importantly, some of what health care leaders do in other countries appears to be replicable here in the United States, despite the differences between the health care system in the United States and the eight systems that Maani and Galia studied. As they note, “Across these eight countries, we have found that medical associations and schools play critical roles in deconstructing racism, often by identifying and reducing harmful stereotypes. In Canada, a group of medical students documented stereotypes held by other students about Indigenous Canadians or Black population These perceptions included that these patients were less concerned with staying healthy, were responsible for their deteriorating health, and were very different from themselves.Medical societies and schools also track and respond to cases of racism and discriminatory behavior in the workplace and education.In the UK, medical schools have acknowledged that black and minority ethnic groups lack equal access to employment opportunities within the National Health Service (NHS) and are disadvantaged in terms of career advancement, salary, penalties for misconduct, and potential for bullying and harassment,” they reported.

Meanwhile, the researchers wrote, “A second theme that came up in our literature review and interviews is the importance of measuring health disparities in detecting and ultimately reversing racism in care delivery. Researchers in New Zealand have found breast cancer detection and treatment rates among Māori lower than that of non-Māori women, and that the probability of Māori women reaching the five-year breast cancer survival marker is less than half.In France, researchers found that immigrants and their children from sub-Saharan Africa, North Africa, and the French overseas territories were more likely To discriminate when seeking care, and that such experiences tend to make people skip aftercare.And in the UK, black and minority ethnic people were four times more likely to be detained under the Mental Health Act – which allows people to be detained when they are considered to be at risk of direct harm to themselves or to others – more than their white counterparts.. These groups are also more likely to enter mental health services through the criminal justice system than through care primary ‘. and “In Australia, an external assessment tool has been developed to help hospitals measure, monitor and report on institutional racism. It rates preventable hospital admissions rates by race, minority representation in leadership roles, health service funding gaps and has been used to assess all service organizations Health and 16 Hospitals in Queensland, Australia.”

Henceforth, the authors of the article wrote, “

Health inequality reflects broader disparities in access to education, economic benefits, healthy physical environments, and other resources, and health care providers can play a key role in understanding and treating problems. Transnational learning can provide inspiration and examples for improving shared health equity challenges. Our research uncovers a range of international efforts to advance health equity, providing guidance for U.S. health systems that are working to roll back racist practices and policies.”