Healthcare Equity in the United States: Addressing Needs for Underserved and At-risk Persons

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Hospitals and associated systems continue to focus their efforts on reducing healthcare disparities through the implementation of various strategies and initiatives aimed at eliminating inequities in access, treatment, outcomes, and overall quality of experience (Williams, J. S., Walker, R. J., & Egede, L. E. (2016). Centers for Disease Control and Prevention has stated that health equity is a condition that corrects historical issues with treatment for all persons (CDC.gov, 2022). While progress has reduced disparities remains a complex issue that has required ongoing specialized attention and effort toward care for all (AHRQ.gov,2021).

Contemporary culture has shifted public views on the acceptance of behavioral variances. That shift, from stigmatizing disenfranchised persons to inclusion, has created awareness for improved care for those at-risk populations (Gopalkrishnan N., 2018). Cognitive dissonance within the minds of caregivers towards counterculture may project a milieu of disproportionate care. Although there may not be an intent to disassociate from the patient, at-risk patients are sensitive to interactions with every person during the term of their care.

While one may assume that improved national care would result from a focus on marginal populations, one may note that revising protocol and policy would need regulatory review by those members having authority (AHA.org, 2023). Creating initiatives that accommodate special interests may require additional resources, revised budgets, or a mix of both. Organizations would rely on their understanding of the community to anticipate where those resources would not negatively impact their operations.

Landry and Erwin (2013) determined that multi-faceted approaches, to resolving issues, historically provided successful outcomes. Their reasoning centered on the propensity of individuals to fulfill their needs (Landry & Erwin; 2013). Studies have indicated that organizations may improve their efforts through education; focused committees; community outreach; improving access to healthcare; and improved reporting processes. Those efforts reflect a growing acceptance of the importance of equity in healthcare delivery to marginalized and at-risk populations (Trent, S., 2021).

Diversity Education for Healthcare Workers

For decades, healthcare organizations and institutions of education have invested in training providers and other caregivers to be culturally competent and sensitive to the diverse needs of their patient populations (AAMC, 2005, January 1). Their intent in doing so was to ensure care delivery is in a way that respects and understands the cultural, linguistic, and social backgrounds of patients (Schouten, B. C., Manthey, L., & Scarvaglieri, C., 2023). Training healthcare providers to be culturally competent is crucial to reducing healthcare disparities and providing quality care to patients from diverse backgrounds (Tulane.edu., 2023). Healthcare equity initiatives establish clear goals and targets for reducing disparities within the healthcare organization, with an intent to align with national or regional health equity objectives.

Medical schools, nursing programs, and healthcare training institutions have integrated cultural competence education into their curriculum (Lopez-Littleton, V., & Blessett, B., 2015). Cultural competence is not a one-time lesson; it is an ongoing process. Healthcare institutions encourage healthcare professionals to engage in lifelong learning and self-reflection to continuously improve their cultural competence. Doing so prepares future healthcare professional providers to stay current with knowledge and best practices in cultural competence. Training programs encourage interdisciplinary collaboration, as teams of professionals often provide healthcare. Learning to work effectively in a culturally diverse team is essential for comprehensive care.

Hospitals may organize workshops, seminars, and interactive training sessions on cultural competence (Gesme, D. H., Towle, E. L., & Wiseman, M., 2010). Workshops and seminars provide education on cultural competence, including an understanding of diverse cultural norms, values, beliefs, and practices that may influence patient care. Organizing training sessions reflects the hospital's commitment to creating an inclusive and culturally competent healthcare environment for both staff and patients. Sessions provide opportunities for healthcare professionals to learn, practice, and apply culturally sensitive communication skills. Cultural competence training emphasizes the importance of being aware of one's own cultural biases and beliefs that may affect their interactions with patients, as well as biases that may exist within patients from diverse backgrounds. Training programs teach healthcare professionals how to communicate effectively with patients from diverse backgrounds, such as understanding nonverbal cues, using interpreters when needed, and employing culturally appropriate communication styles (Bernabeo, E., & Holmboe, E. S., 2013).

Another form of training has been through cultural assessments where healthcare professionals conduct cultural assessments to better understand a patient's cultural background, beliefs, and preferences. This information helps in tailoring care plans to meet individual patient needs. Cultural competence in care plans, ensuring that patients receive care that is culturally appropriate and respectful. This may include dietary considerations, family dynamics, and healthcare decision-making practices.

Patient-centered training emphasizes the importance of building trust and rapport with patients prior to diagnosis, when appropriate. Doing so allows most patients to feel understood and respected, they are more likely to engage in their healthcare and follow recommended treatments. Cultural competence training often highlights the role of cultural factors in health disparities. Senior leaders encourage healthcare providers to address disparities and work toward equitable healthcare delivery to provide positive perspectives to their patients.

Cultural competence aligns with the principles of patient-centered care, where patients are active participants in their healthcare decisions, and their values and preferences (Kwame, A., & Petrucka, P. M., 2021). Hospitals gather feedback from healthcare providers and patients to evaluate the effectiveness of cultural competence training programs and make necessary improvements. There should be little variance between education and application as one may not understand the success of training without interaction that provides meaningful feedback.

Training is a critical component of providing equitable healthcare services and reducing disparities in care. By equipping healthcare providers with the skills to navigate cultural differences and communicate effectively, hospitals can improve patient satisfaction, adherence to treatment plans, and overall health outcomes for individuals from diverse backgrounds. It focuses on equipping healthcare providers and professionals with the knowledge, skills, and attitudes necessary to effectively interact with and care for patients from diverse cultural backgrounds. The goal of this training is to improve healthcare outcomes, reduce health disparities, and enhance the overall quality of patient care.

Training programs begin by helping healthcare providers understand that culture encompasses a wide range of factors, including race, ethnicity, nationality, religion, language, gender, sexual orientation, socioeconomic status, and more. Participants learn to recognize and respect the diversity of their patient population. Healthcare professionals should reflect on their own cultural backgrounds, biases, and beliefs. Self-awareness is essential to understanding how one's own cultural perspective may influence interactions with patients from diverse backgrounds.

Cultural competence training often emphasizes the concept of cultural humility, which involves recognizing that one can never fully understand or know everything about another person's culture. Healthcare providers learn to approach patients with a humble attitude, acknowledging their own limitations in cultural knowledge. Training helps healthcare providers develop effective communication skills when collaborating with patients who have limited English proficiency or speak a different language. This may involve using interpreters or language assistance services.

Healthcare professionals learn to respect and accommodate patients' cultural beliefs, practices, and preferences within the boundaries of medical ethics and safety. This includes understanding the role of spirituality and religion in healthcare decisions.

Training equips healthcare providers with cross-cultural skills, such as the ability to assess and adapt their communication and care practices to meet the unique needs of patients from various cultural backgrounds. Providers develop care plans that are culturally sensitive and consider a patient's cultural context, values, and preferences. This includes considering dietary restrictions, family dynamics, and alternative healing practices. Training often emphasizes the role that cultural factors can play in health disparities. Healthcare providers should actively work to reduce disparities by providing equitable care to all patients.

Cultural competence is not a one-time training event but an ongoing process. Cultural competence and sensitivity training are essential for healthcare providers and institutions to ensure that patients receive respectful, patient-centered, and effective care regardless of their cultural background. It contributes to improved patient-provider communication, trust, and overall healthcare outcomes while helping to reduce healthcare disparities that may exist among distinct cultural and ethnic groups.

Health Equity Committees

Hospitals have established health equity committees and initiatives focused on identifying and addressing disparities within their patient populations. Those committees often work to collect data, set targets, and implement strategies to reduce disparities (Thompson, H. M., Clement, A. M., et. al., 2022). Health Equity Committees and Initiatives are organized efforts within healthcare organizations and institutions to address and reduce health disparities among different patient populations. Those initiatives focus on promoting health equity by identifying, understanding, and mitigating the barriers that lead to unequal access to healthcare and disparate health outcomes among various demographic groups.

Health Equity Committees typically consist of a diverse group of healthcare professionals, including physicians, nurses, administrators, social workers, and community representatives, ensuring a well-rounded perspective on healthcare disparities (Wakefield, M., Williams, D. R., & Le Menestrel, S., 2021). Those committees gather and analyze data related to patient demographics, health outcomes, and healthcare utilization to identify disparities and target interventions effectively [Figure 1]. They work to identify disparities in healthcare access, quality, and outcomes among different racial, ethnic, socioeconomic, and geographic groups. They also consider disparities related to gender, sexual orientation, disability, and other factors.

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Health Equity Committees may advocate for policy changes within the healthcare organization or at the broader policy level to eliminate structural and systemic barriers to healthcare access and quality. Committees oversee and support quality improvement projects that target disparities in care, ensuring that patients from all backgrounds receive the highest quality of care. Ongoing monitoring and evaluation of initiatives are critical to assess progress and make necessary adjustments. This includes regularly reporting on outcomes and sharing results with stakeholders.

Committees may also promote research projects that focus on healthcare disparities, contributing to a better understanding of the root causes and potential solutions. Patients and their families are often actively involved in Health Equity Initiatives to provide input, share their experiences, and participate in decision-making processes. Overall, Health Equity Committees and Initiatives play a vital role in advancing health equity within healthcare organizations. By addressing disparities and promoting inclusivity in healthcare delivery, these initiatives aim to ensure that all individuals, regardless of their background or circumstances, have equal opportunities to access high-quality healthcare services and achieve better health outcomes. Health Equity Committees provide a resource for engagement with a local community to better understand the unique challenges and needs of underserved populations. This helps in tailoring interventions and programs to address specific community issues.

Community Outreach and Education

Vulnerable populations often face stigmatization and discrimination within the healthcare system, which can lead to mistrust and reluctance to seek care. Hospitals engage in community outreach programs to educate underserved populations about health issues, preventive care, and the importance of regular healthcare visits. Those efforts aim to improve health literacy and promote early intervention. Collaboration with community organizations, local governments, and other stakeholders is often essential to address social determinants of health and create lasting improvements in health equity.

Community outreach and education are essential components of public health and healthcare efforts aimed at improving the well-being of communities, increasing health awareness, and preventing and managing health conditions (Trent, S., 2021). The approach to those topics involves healthcare organizations, government agencies, nonprofits, and community groups working together to engage with local populations and provide them with information, resources, and support.

Before developing outreach and education programs, a thorough needs assessment should reveal an understanding of specific health needs, challenges, and cultural factors of the target community to provide content and delivery methods for the programs [Figure 2]. Healthcare organizations and public health agencies identify sub-culture communities that might be at greater risk for specific health issues or disparities and could include underserved populations, minorities, low-income communities, or areas with high rates of specific diseases. Outreach and education programs should be culturally competent, meaning they are sensitive to the cultural, linguistic, and social norms of the community served. Cultural competence ensures that messaging and interventions are relevant and respectful.

Healthcare professionals and educators conduct workshops, seminars, and informational sessions in community centers, schools, churches, and other local venues. Sessions cover topics such as disease prevention, healthy lifestyles, nutrition, and the importance of regular healthcare check-ups. Community outreach aims to improve health literacy by providing understandable, evidence-based information that empowers individuals to make informed decisions about their health.

Outreach programs often include information about available healthcare services, including how to access primary care, specialty care, and preventative services. This helps individuals navigate the healthcare system more effectively. Providing information about immunizations, screenings, and early detection of diseases can help prevent the onset of health conditions or catch them at an early, more treatable stage (Toscos, T., Carpenter, M., Flanagan, M., Kunjan, K., & Doebbeling, B. N., 2018). Outreach efforts encourage healthy behaviors and lifestyle choices, such as exercise, nutrition, smoking cessation, and alcohol moderation.

Outreach workers often connect individuals with local resources, such as food assistance programs, housing services, mental health support, and social services, addressing social determinants of health. In times of public health emergencies or crises (e.g., disease outbreaks or natural disasters), community outreach and education efforts can provide vital information and support to affected communities. Building trust and relationships within the community is crucial for successful outreach. Community members may be involved in program planning and implementation, ensuring that initiatives are culturally relevant and meet local needs.

Continuous evaluation of outreach and education programs is essential to assess their impact and make necessary adjustments for improvement. Feedback from the community should update the program's purpose so as to reflect current needs. Community outreach and education play a vital role in promoting public health, reducing health disparities, and fostering healthier communities. By empowering individuals with knowledge and connecting them to resources, these initiatives contribute to better health outcomes and improved quality of life for residents in underserved or at-risk communities.

Improving Access to Healthcare

Hospitals have expanded their services to underserved communities by opening clinics and healthcare centers in areas with limited access to healthcare facilities. This can help reduce barriers to care, such as transportation and proximity to healthcare services. Access to care in healthcare refers to an individual's ability to obtain timely, affordable, and appropriate healthcare services when needed. Access to care is a critical component of a well-functioning healthcare system, as it directly impacts health outcomes and overall well-being. Barriers to access can result in delayed or inadequate care, worsened health conditions, and health disparities.

Geographic access refers to the physical proximity of healthcare facilities and providers to where people live or work. Rural areas may face challenges in terms of distance and transportation.

Financial barriers include the cost of healthcare services, insurance coverage, and out-of-pocket expenses. Lack of insurance or underinsurance can lead to significant financial barriers. Health insurance is a critical factor in access to care. Those without insurance or with limited coverage may delay or forgo necessary healthcare due to cost concerns. Not all healthcare providers accept Medicaid or Medicare, which can limit access for beneficiaries of these government insurance programs.

The availability of healthcare providers, including primary care physicians, specialists, and other healthcare professionals, can impact access. Shortages of healthcare providers in certain areas can limit access. Timely access to care means being able to receive healthcare services when needed, without excessive waiting times. Long waiting lists for appointments or procedures can delay necessary care. Lack of reliable transportation can hinder access to healthcare, especially in rural or low-income communities. Transportation services or telehealth options can help mitigate this barrier.

Access to healthcare beyond regular office hours, such as evenings and weekends, is important for addressing urgent medical needs and preventing unnecessary emergency room visits. Illnesses and injuries can occur at any time, including outside of regular office hours. Extended hours at urgent care centers, emergency rooms, and primary care clinics are essential for addressing life-threatening or serious conditions promptly.

Offering healthcare services during evenings and weekends accommodates the schedules of patients who may work during the day, have caregiving responsibilities, or face other time constraints. This convenience encourages individuals to seek care when needed. Extended hours can also be valuable for routine healthcare needs, such as vaccinations, screenings, and follow-up appointments. Making these services available during nontraditional hours helps individuals prioritize preventive care.

Access to urgent care centers or after-hours clinics can reduce unnecessary visits to the emergency room for non-emergent issues. This helps manage healthcare costs and ensures that emergency departments can focus on critical cases. Vulnerable populations, such as low-income individuals or those without reliable transportation, may find it more convenient to seek care during evening or weekend hours. This can help reduce disparities in access to care.

Extended hours at primary care clinics or specialized clinics enable patients to receive continuity of care for chronic conditions or ongoing treatment plans. This can help manage chronic diseases and prevent complications. Availability of dental and mental health services during extended hours can be especially critical, as dental emergencies and mental health crises can occur at any time. Access to healthcare during extended hours can help reduce wait times for appointments, making it easier for patients to receive care in a timely manner.

Hospitals and healthcare systems that offer extended hours demonstrate a commitment to the health and well-being of the community. This can foster trust and engagement among residents. It is important for healthcare organizations to assess the needs of their patient populations and consider offering extended hours as part of their service delivery. While it may require additional resources and staffing, the benefits in terms of patient satisfaction, timely care, and improved health outcomes can be substantial. Additionally, as telehealth and digital health technologies continue to evolve, they offer innovative solutions for expanding access to care beyond traditional office hours.

Vulnerable populations, such as the homeless, marginalized persons, and individuals with disabilities, often face additional barriers related to shelter, social services, and specialized care. These barriers can compound existing health disparities and make it challenging for these individuals to receive the care and support they need. Homeless individuals face the immediate challenge of not having a stable place to live. This instability makes it difficult for them to maintain regular healthcare appointments and access preventive care. Homeless individuals often lack access to necessities such as food, clean water, sanitation facilities, and hygiene resources. These conditions can lead to various health problems and exacerbate existing health issues.

Unhoused persons grapple with mental health issues and substance use disorders, making it harder for them to seek and receive appropriate healthcare. Stigma and discrimination can also discourage them from seeking help. Marginalized individuals, including those living in impoverished neighborhoods, may face difficulties accessing reliable transportation to healthcare facilities. This can result in missed appointments and delayed care.

A sizable portion of marginalized populations may lack health insurance coverage, limiting their access to primary and specialty care, and expanding insurance coverage can improve access to essential healthcare services (Baicker, K., Chandra, A., & Shepard, M., 2023). People with disabilities may encounter communication barriers when healthcare facilities do not provide accommodation for individuals with hearing, visual, or cognitive impairments. Accessible information and communication aids are essential for ensuring equitable care.

Access to social services that address housing, food insecurity, and mental health support is critical for vulnerable populations (Ragavan, M. I., Marcil, L. E., & Garg, A., 2020). Insufficient access to those services can perpetuate health disparities. Efforts to address those barriers often involve a multidisciplinary approach, with collaboration between healthcare organizations, social services agencies, advocacy groups, and government entities. Initiatives to expand access to housing, food security, mental health services, and substance use treatment can complement healthcare interventions and improve the overall well-being of vulnerable populations (Gottlieb, L., Fichtenberg, C., Alderwick, H., & Adler, N., 2019). Additionally, promoting cultural competence and disability-inclusive practices within healthcare settings can help reduce disparities and ensure that these populations receive the care and support they deserve.

Expansion of telehealth has improved access to care for individuals, particularly during the COVID-19 pandemic. COVID-19 pandemic accelerated the adoption of telehealth, making it easier for patients, particularly those in rural or underserved areas, to access healthcare services remotely. Telehealth can help bridge geographical disparities in access to care. However, access to digital technology and a reliable internet connection can be barriers for others. The expansion of telehealth services has also increased access to care during nontraditional hours. Patients can consult with healthcare providers remotely, reducing the need for in-person visits and providing flexibility in scheduling appointments.

Political Factors

Government policies and regulations, such as scope-of-practice laws and certificate-of-need requirements, can affect the availability and accessibility of healthcare services. Efforts to improve access to care include expanding insurance coverage, increasing the number of healthcare providers, addressing transportation challenges, promoting telehealth, and implementing policies that reduce financial barriers. Healthcare organizations and policymakers play a crucial role in identifying and addressing barriers to ensure that all individuals have equitable access to the healthcare services they need. Access to care is a fundamental component of achieving better health outcomes and reducing health disparities in society.

Leaders in healthcare institutions often conduct research to better understand the root causes of healthcare disparities and develop evidence-based interventions to address them. They are increasingly recognizing the importance of reporting social determinants of health, such as housing, education, and income, which have a significant impact on health outcomes. They are collecting and analyzing demographic data to identify disparities and track progress in reducing them.

Transparent reporting of this data can hold healthcare organizations accountable and drive improvement efforts. Collecting and analyzing demographic data is an essential component of efforts to identify and address healthcare disparities within hospitals and healthcare systems. That data-driven approach helps healthcare organizations gain insights into the disparities that exist among their patient populations, enabling them to develop targeted interventions and track progress over time. By analyzing that data, healthcare organizations can identify disparities in healthcare access, treatment, and outcomes among different demographic groups.

Demographic data analysis can help hospitals better understand the root causes of healthcare disparities (Woolf, S. H., 2017). It allows them to examine factors such as social determinants of health, socioeconomic disparities, and systemic issues that contribute to inequities in healthcare. Armed with data that highlight disparities, hospitals can design and implement targeted interventions and initiatives. These interventions may include culturally sensitive care programs, community outreach efforts, and policies aimed at reducing disparities in specific areas, such as maternal health or chronic disease management.

After implementing interventions, hospitals continue to collect and analyze demographic data to assess their effectiveness. This ongoing evaluation helps healthcare organizations determine whether disparities are decreasing and whether additional strategies may require improvement. Hospitals often report their demographic data and findings to regulatory agencies, accrediting bodies, and the public. This transparency holds healthcare organizations accountable for addressing disparities and encourages continuous improvement (Thorlby, R., Jorgensen, S., Siegel, B., & Ayanian, J. Z., 2011). Demographic data analysis performed by the committee may fit into quality improvement initiatives within healthcare organizations. It helps identify disparities that may affect the quality of care delivered and allows for targeted quality improvement efforts.

Hospitals use demographic data to promote equity in clinical decision-making. This includes addressing biases in treatment protocols and ensuring that healthcare providers are aware of potential disparities in diagnostic and treatment outcomes. Demographic data can inform patient-centered care approaches by helping healthcare providers better understand the unique needs and preferences of patients from diverse backgrounds.

Demographic data in research projects aimed at uncovering the causes of healthcare disparities and developing innovative solutions to reduce them. Healthcare organizations create health disparities dashboards or reporting systems that provide real-time data on disparities, making it easier to track progress and take timely action.

Collecting and analyzing demographic data is a crucial step in the journey toward health equity. It allows hospitals to tailor their strategies and interventions to the specific needs of their patient populations, working to reduce disparities and improve the overall quality of healthcare for all individuals, regardless of their background or circumstances.

While organizations have made strides in addressing healthcare disparities, it is essential to recognize that disparities are deeply rooted in systemic issues, including socioeconomic inequalities and structural racism (Bailey, Z. D., Krieger, N., Agénor, M., Graves, J., Linos, N., & Bassett, M. T., 2017). Achieving healthcare equity requires collaboration across healthcare organizations, policymakers, and communities to address these underlying factors. Hospitals play a crucial role in this effort, but a comprehensive approach is necessary to make lasting improvements in healthcare disparities.

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References

AAMC (2005, January 1). Cultural Competence Education. AAMC.org. Retrieved October 7, 2023, from https://www.aamc.org/media/20856/download

American Hospital Association (2023, January 1). Reducing Health Care Disparities. Retrieved October 7, 2023, from https://www.aha.org/reducing-healthcare-disparities/diversity/governance-and-leadershipdiversity/home#:~:text=This%20includes%20helping%20to%20improve%20measurement%20to%20identify,have%20successfully%20helped%20to%20reduce%20or%20eliminate%20disparities

Agency for Healthcare Research and Quality (2021, December 1). 2021 National Healthcare Quality and Disparities Report. National Library of Medicine. Retrieved October 7, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK578532/

Baicker, K., Chandra, A., & Shepard, M. (2023). Achieving Universal Health Insurance Coverage in the United States: Addressing Market Failures or Providing a Social Floor?. Journal of Economic Perspectives, 37(2), 99-122.

Bailey, Z. D., Krieger, N., Agénor, M., Graves, J., Linos, N., & Bassett, M. T. (2017). Structural racism and health inequities in the USA: evidence and interventions. The lancet, 389(10077), 1453-1463.

Bernabeo, E., & Holmboe, E. S. (2013). Patients, providers, and systems need to acquire a specific set of competencies to achieve truly patient-centered care. Health Affairs, 32(2), 250-258.

Gesme, D. H., Towle, E. L., & Wiseman, M. (2010). Essentials of staff development and why you should care. Journal of oncology practice, 6(2), 104–106. https://doi.org/10.1200/JOP.091089

Gopalkrishnan N. (2018). Cultural Diversity and Mental Health: Considerations for Policy and Practice. Frontiers in public health, 6, 179. https://doi.org/10.3389/fpubh.2018.00179

Gottlieb, L., Fichtenberg, C., Alderwick, H., & Adler, N. (2019). Social determinants of health: what’sa healthcare system to do?. Journal of Healthcare Management, 64(4), 243-257.

Kwame, A., & Petrucka, P. M. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. BMC nursing, 20(1), 1-10.

Landry, A., & Erwin, C. (2015). PERSPECTIVES ON MULTIDISCIPLINARY TEAM PROCESSES AMONG HEALTHCARE EXECUTIVES: PROCESSES THAT FACILITATE TEAM EFFECTIVENESS. Journal of Health and Human Services Administration, 38(3), 350-380. Retrieved from https://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F1770508390%3Faccountid%3D27965

Lopez-Littleton, V., & Blessett, B. (2015). A Framework for Integrating Cultural Competency Into the Curriculum of Public Administration Programs. Journal of Public Affairs Education, 21(4), 557–574. https://www.jstor.org/stable/24615545

Ndugga, N., & Artiga, S. (2023, April 21). Disparities in health and health care: 5 key questions and answers. Kaiser Family Foundation. https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-5-key-question-and-answers/

NYU Lagone Health (2023, January 1). Section for Health Equity. Med.nyu.edu. Retrieved October 8, 2023, from https://med.nyu.edu/departments-institutes/population-health/divisions-sections-centers/health-behavior/section-health-equity

Office of Health Equity (2022, July 1). What is Health Equity? Centers for Disease Control and Prevention. Retrieved October 7, 2023, from https://www.cdc.gov/healthequity/whatis/index.html

Ragavan, M. I., Marcil, L. E., & Garg, A. (2020). Climate change as a social determinant of health. Pediatrics, 145(5).

Schouten, B. C., Manthey, L., & Scarvaglieri, C. (2023). Teaching intercultural communication skills in healthcare to improve care for culturally and linguistically diverse patients. Patient education and counseling, 115, 107890. https://doi.org/10.1016/j.pec.2023.107890

Thompson, H. M., Clement, A. M., Ortiz, R., Preston, T. M., Quantrell, A. L. W., Enfield, M., ... & Milburn, N. (2022). Community engagement to improve access to healthcare: a comparative case study to advance implementation science for transgender health equity. International Journal for Equity in Health, 21(1), 104.

Thorlby, R., Jorgensen, S., Siegel, B., & Ayanian, J. Z. (2011). How health care organizations are using data on patients’ race and ethnicity to improve quality of care. The Milbank Quarterly, 89(2), 226-255.

Toscos, T., Carpenter, M., Flanagan, M., Kunjan, K., & Doebbeling, B. N. (2018). Identifying successful practices to overcome access to care challenges in community health centers: a “positive deviance” approach. Health services research and managerial epidemiology, 5, 2333392817743406.

Trent, S. (2021). How to Facilitate Inclusive Community Outreach and Engagement. National Library of Medicine. Retrieved October 7, 2023, from https://icma.org/articles/pm-magazine/how-facilitate-inclusive-community-outreach-and-engagement

Tulane University (2021, May 1). How to Improve Cultural Competence in Health Care. Tulane.edu. Retrieved October 7, 2023, from https://publichealth.tulane.edu/blog/cultural-competence-in-health-care/

Wakefield, M., Williams, D. R., & Le Menestrel, S. (2021). The future of nursing 2020-2030: Charting a path to achieve health equity. National Academy of Sciences.

Williams, J. S., Walker, R. J., & Egede, L. E. (2016). Achieving Equity in an Evolving Healthcare System: Opportunities and Challenges. The American journal of the medical sciences, 351(1), 33–43. https://doi.org/10.1016/j.amjms.2015.10.012

Woolf, S. H. (2017). Progress in achieving health equity requires attention to root causes. Health Affairs, 36(6), 984-991.