Radical Moves to Increase Health Equity

When I took the reins at Jefferson Health, I was struck by the disconnect between the mission of the academic medical center and the extreme poverty and health disparities in Philadelphia. The city had no less than five academic hospitals with advanced capabilities, yet Philadelphia was ranked in the bottom 10% among 50 metropolitan areas for the health statistics of minority residents.

Jefferson’s Collaborative for Health Equity works closely with communities to improve their health and reduce health disparities. Using donated funds, including those raised by Jefferson’s annual galas, the Collaborative is increasing access to healthcare, addressing hunger and food insecurity, training people for jobs, building new green spaces, helping residents achieve and maintain financial security, and addressing trauma in all its forms by providing support services for individuals and families.

Another equity-focused program I helped launch is Closing the Gap, a $3 million collaboration with Novartis. This initiative focuses on five zip codes that are home to about 200,000 Philadelphians at high risk of cardiovascular disease. Novartis chose to work with Jefferson because we put our money and mission (“We improve lives”) on the line to deal with the city’s underperformance in population health. One key indicator of that underperformance was the enormous gaps in cardiovascular disease rates between Philadelphia’s wealthiest and poorest residents.

Closing the Gap is expanding healthcare infrastructure in the affected areas and connecting people to the care they need. In addition, the program provides financial assistance to local community organizations. Moreover, it has mounted a screening and community health worker program to ensure that individuals are assessed for cardiovascular risk factors, are connected with programs to reduce their risk and receive the resources needed to optimize health, including nutritious meals, transportation and specialty care.

The Jefferson-Temple partnership exemplifies one of the three main tenets of healthcare at any address: radical collaboration, radical communication and radical concentration on health disparities. Radical collaboration means that healthcare competitors should work together to meet the whole community’s social needs. Such partnerships might be funded by taking some of the government money that academic medical centers get to research health inequities or population health management and putting it into action-oriented initiatives among several “competitors” willing to work together to eradicate the epidemic of health inequity.

The second tenet is radical communication. Instead of buying 30-second commercials or paying for billboards that tout their supposed excellence, hospitals should put that money into community outreach. In Jefferson’s health equity programs, we went out to where the people were to learn about their problems and help improve their access to healthcare. That meant sending nurses and community health workers out to homes, churches and nail salons.

Radical communication also requires that health systems communicate with people in their own language, through representatives they can identify with and in places where they normally get their information. When Jefferson rolled out COVID-19 vaccinations, for example, we had African American community health workers go to the Black churches, and Latino folks went to the Latino churches. For more than 100 straight weeks, I was on Sonny Hill’s In the Living Room sports radio show with Robert Perkel, MD, (a premier Jefferson family physician) in a segment called “The Doctors Are in the House.” In that two-year period, we had a major impact on vaccine hesitancy among that population. I remember one text from a listener: “We are not vaccinated because we usually don’t trust people like you, but you seem sincere so I have decided to get my family vaccinated. It takes a lot for us to trust, so please keep it real!” Those Sunday mornings, we tried to live up to Beyonce’s lyrics in “Radio”: “It never lets me down.”

The final tenet, radical concentration on health disparities, means among other things that health system CEOs should be paid partly on the basis of what they are doing to attack those inequities.

Health inequities have been with us for a long time, and they’re not likely to disappear in the near future. To eliminate them, we must rebuild our society in ways that eliminate systemic racism and discrimination and that reduce the income inequality that is closely linked with health disparities. In the meantime, health systems are uniquely situated to work with community resources to minimize the impact of these disparities and produce better health for everybody.

This is not an easy problem to solve. The goal of this chapter is to have us live into Lady Gaga’s challenge in “Born This Way.” While “God makes no mistakes,” we should all have an equal chance to live a healthy life. Our health should not be based on Where You Live. Tracy Chapman used that album to challenge us to “Change,” asking “What chain reaction/What cause and effect/Makes you turn around”? True healthcare transformation will not occur until we no longer are bound by Curtis Mayfield’s “Choice of Colors.” More than 50 years ago, the Impressions sang,

? A better day is coming, for you and for me

? With just a little bit more education

? And love for our nation

? Would make a better society

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So, maybe at your next hospital board meeting, a medley of “Born This Way,” “Change,” and “Choice of Colors,” with a smattering of “We Are Not Helpless” by Stephen Stills, might spark a different conversation around population health and equity!

Editor’s Note: This content has been excerpted from the book Feelin' Alright: How the Message in the Music Can Make Healthcare Healthier . It has been edited for length.

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