Opinion: What happened to health equity?

By Leni Preston

The writer is an independent health policy expert. She lives in Bethesda.

Merdie Nzanga recently reported in Maryland Matters that, “… health care advocates are lining up a list of priorities for the upcoming General Assembly session… ” One is the ongoing effort to obtain funding for the Prescription Drug Affordability Board. The rest of the legislative agenda focuses on the efforts to ensure that all Marylanders, including undocumented immigrants, have easily accessible and affordable health insurance.

Without doubt these are laudable goals. However, it is well know that simply having an insurance card is not enough.  To get the actual care they need, individuals require accurate information and resources to both navigate the system and use the services provided by the card. To address this, our state enacted a law that names the University of Maryland’s Horowitz Center for Health Literacy as the state’s Consumer Health Information Hub. The first of its kind in the country, this is an important achievement. However, it is not enough.

The state must ensure that there is equitable access to all health care services and that they meet an individual’s personal needs. In other words, we must address the issue of health equity. Without that, our families, friends and neighbors will not have the tools they need to lead the healthy and fulfilling lives they are entitled to.

The COVID-19 pandemic pulled back a curtain to reveal what health policymakers have known for years — our health care system is riddled with inequities, These damage, if not take, the lives of untold members of our communities. In 2020 the General Assembly took steps to address this with the establishment of the Maryland Commission on Health Equity. Its purpose is to address the underlying causes, including systemic racism, that have created the unfair system we have today.

For the past year I have served as a member of the commission’s Policy Committee. Despite the good intentions of committee members, progress under the leadership of Governor Hogan’s Department of Health has been painfully slow.

Now there is cause for optimism with our newly elected Governor Moore and Lieutenant Governor Miller. They have made clear their commitment to addressing the issues head on. With that in mind, I hope that they, and the Health Care Executive Policy Committee will seriously consider recommendations put forward by the Policy Committee in its report to the legislature. Some of those stem from analyses undertaken by the Best Practices Work Group and many  are based upon initiatives already in place in states that are well ahead of Maryland in the area of health equity.

Among the recommendations to highlight are those to:

1. Establish the Governor’s Council on Racial Equity and Health Justice. This sub-cabinet group would highlight the close relationship between the issues and create a meaningful and integrative structure that can address them in a strategic, comprehensive and transparent manner;
2. Address data collection and use to include: (a) Standardized data that must be consistently collected across all relevant departments and other areas of the health care system. A minimum requirement would be the inclusion of: race, ethnicity, language, gender identity, sex, sexual orientation, disability status and factors that influence the social determinants of health; and (b) data made available in an interactive and publicly accessible dashboard. This would support development of substantive and realistic strategies and advance public confidence while promoting consumer and community engagement. Connecticut is among the states that is implementing a useful model.
3. Require inclusion of a health equity analysis in: (a) implementation of a Health in All Policies approach across all departments; (b) development of all departmental budgets; and (c) all relevant proposed legislation.

The latter two recommendations are just two examples of why the Governor’s Council will be required to design and implement “whole government” strategies for a racial equity and health justice agenda. As the legislation establishing the Health Equity Commission stated, “more than 100 studies have linked racism to worse health outcomes, … and … racism exacerbates health disparities.” To address what are systemic challenges, it will be vital to take an aggressive and forward-thinking approach.

Our new administration and the 2023 General Assembly, with both old and new health policy leaders, are well positioned to achieve this. I hope they, and the advocates working to secure health insurance cards for all, will seize the opportunity to, once again, make Maryland a health policy leader. Marylanders expect and deserve nothing less.

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