Taking Action: Become a Health Equity Leader

Date: April 17, 2024

Category: Office of Behavioral Health Equity

In a 1955 speech, Dr. Martin Luther King Jr. famously declared that of all forms of inequality, injustice in health is the most "shocking and inhumane." Yet racial and ethnic health inequities remain pervasive across all state health systems* (PDF | 3.5 MB). Fortunately, with hard work and the passage of time, health equity progress does take root and grow. Indeed, there are significant advances to achieving health equity for African Americans and other marginalized populations. But the hard work continues, and we must build upon these advancements.

For example, in September 2023 the Centers for Medicare & Medicaid Services (CMS) announced a new voluntary, state total cost of care (TCOC) model: the States Advancing All-Payer Health Equity Approaches and Development Model ("States Advancing AHEAD" or "AHEAD" Model (PDF | 231 KB)). CMS' goal in the AHEAD Model is to collaborate with states to curb health care cost growth, improve population health, and advance health equity by reducing disparities in health outcomes. The AHEAD (PDF | 231 KB) Model design includes several health equity components and will be a collaborative effort among CMS, states, hospitals, and primary care practices. Some health equity components of the model include states to convene individuals and organizations with a wide range of perspectives to inform model activities and build partnerships between the state, providers, payers, and the community to support model goals. For example, all participating states will be required to develop a Statewide Health Equity Plan to define and guide Model activities aimed at reducing disparities and improving population health. Additionally, participating hospitals will also be required to create hospital health equity plans that align with statewide priorities and activities. AHEAD builds upon the work of existing Innovation Center state-based models, including the Vermont All-Payer Accountable Care Organization (VT ACO) Model, the Maryland Total Cost of Care Model (MD TCOC), and the Pennsylvania Rural Health Model (PARHM).

The medical community is also identifying and implementing solutions to address disparities. As one approach, the National Institutes of Health (NIH) initiated an ad hoc committee appointed by the National Academies of Sciences, Engineering, and Medicine (the National Academies) to examine the current state of racial and ethnic health care disparities in the United States through a series of public workshops. The published report, Unequal Treatment Revisited: The Current State of Racial and Ethnic Disparities in Health Care: Proceedings of a Workshop (2024)** highlights the major drivers of health care inequities and includes recommendations to advance health equity. Additionally, a first-ever survey conducted of state medical associations, national medical specialty societies, and county medical organizations about health equity found several critical, promising findings, as published in the AMA Health Equity in Organized Medicine 2023 Survey Report: Insights, Solutions, and Resources to Take Action*** (PDF | 4.1 MB).

Some of the key equity actions undertaken by associations and medical societies include:

• 72 percent took actions to prioritize equity, including aligning performance incentives to organizational equity goals and assessing the organization's budget to support advancement of health equity.
• 47 percent took actions to advance health by advocating to eliminate harmful, race-based clinical algorithms**** (PDF | 408 KB) and decision-making tools that incorrectly use race as a proxy for genetic or biological ancestry.
• 29 percent took actions focused on promoting a thriving community, including addressing root causes of health inequities by leveraging organizational assets and strengths to address social determinants of health.

And in the behavioral health ecosystem, the Substance Abuse and Mental Health Services Administration (SAMHSA) is advancing health equity on a variety of fronts. Per its Black Youth Suicide Prevention Initiative and its annual Black History Month celebration, experts share best practices on integrating health equity practices for African Americans. Further, the Asian American and Native Hawaiian Pacific Islander Behavioral Health Center of Excellence (CoE) promotes culturally and linguistically appropriate behavioral health information and practices; has established a steering committee to identify emerging issues; and provide training, technical assistance, and consultation to practitioners and community organizations. In 2023, SAMHSA funded a Center of Excellence to advance the behavioral health equity of Hispanic/Latino communities. The Hispanic/Latino CoE serves as a resource to mental health and substance use providers, primary care providers, community-based and faith-based organizations, research institutions, Hispanic and Latino-Serving Institutions of higher education, peer and recovery support service providers, state, regional, local, and federal entities, other systems that address behavioral health issues experienced by Hispanic and Latino individuals (e.g. education, criminal justice, and social services), and the general public, including Hispanic and Latino individuals, families and communities and those with lived experience. SAMHSA also supports three specific CoEs for Behavioral Health Disparities. The CoEs develop and disseminate training and technical assistance for practitioners to address the disparities in behavioral healthcare in the African American, LGBTQ+, and the aging populations. Since their inception, all three funded CoEs have collectively provided training and technical assistance to approximately 35,200 individuals and 3,500 local and state organizations nationwide.

SAMHSA's National Network to Eliminate Disparities in Behavioral Health (NNED), operated by SAMHSA's Office of Behavioral Health Equity, is a network of more than 1,500 community-based organizations addressing the mental health and substance use needs of underserved communities. To address disparities in behavioral health care, the NNED was formed with support from SAMHSA, the National Institutes of Health/National Institute on Minority Health and Health Disparities, and The Annie E. Casey Foundation. The NNED invites community-based organizations or agencies, and individuals addressing mental health or substance use disparities, with a strong focus on diverse and underserved communities, to become NNED Members.

There has never been a better time in behavioral health to be a health equity leader. The work of earlier generations of leaders provides the foundation for the creative and data driven equity initiatives and programs that are successful today. Advancing equity requires action - always has, always will.

*The Commonwealth Fund's report entitled MIRROR, MIRROR 2021 Reflecting Poorly: Health Care in the U.S. Compared to Other High-Income Countries is included because of its comparisons in the performance of health care systems of 11 high-income countries, including the United States.
** This workshop series is part of an ongoing consensus study examining the current state of racial and ethnic health care disparities in the U.S., building on the 2003 Institute of Medicine consensus report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.
***The Health Equity in Organized Medicine Survey (HEIOM) published by the American Medical Association provides insight into actions organized medicine is taking to advance health equity.
****The peer-reviewed article from the American Medical Association Journal of Ethics is an example of efforts to reduce harmful effects of race-based clinical algorithms

Resources

Asian American, Native Hawaiian, and Pacific Islander Behavioral Health Center of Excellence (CoE)
The purpose of this CoE is to advance the behavioral health equity of AA, NH, and PI communities. The AANHPI-CoE develops and disseminates culturally informed, evidence-based behavioral health information and provides technical assistance and training on issues related to addressing behavioral health disparities in AA, NH, and PI communities.

African American Behavioral Health Center for Excellence (CoE)
The African American Behavioral Health Center of Excellence is a national Center funded by the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, located within the National Center for Primary Care, Morehouse School of Medicine.

Hispanic/Latino Behavioral Health Center of Excellence (CoE)
The Hispanic/Latino Behavioral Health Center of Excellence is led by the Institute of Research, Education, and Services in Addiction at the Universidad Central del Caribe School of Medicine and is funded by the Substance Abuse and Mental Health Services Administration.

National Network to Eliminate Disparities in Behavioral Health (NNED)
NNED is a network of community-based organizations focused on the mental health and substance use issues of diverse and underserved communities.

Promoting Health Equity (PDF | 4.7 MB)
A Resource to Help Communities Address Social Determinants of Health
This workbook is for public health practitioners and partners interested in addressing social determinants of health in order to promote health and achieve health equity

SAMHSA: Office of Behavioral Health Equity (OBHE)
OBHE advances behavioral health equity by reducing disparities in racial, ethnic, LGBTQI+, and other under-resourced communities across the country by improving access to quality services and supports that enables all to thrive, participate, and contribute to healthier communities.