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Health Equity & Justice in America

The freedom to live a healthy life is an essential part of the American promise. Thanks to incredible breakthroughs in medical treatment and care that freedom has been extended to more and more Americans. Diseases that were once death sentences have become manageable conditions.

Yet millions of Americans today still find their health determined by who they are or where they live. The impact of systemic discrimination impacts how much we earn, the neighborhoods and homes we live in, the schools we attend, the food we eat, and the jobs we have access to. Each of these factors affects the health of Americans more than what happens at a doctor’s office or hospital.

The freedom to live a healthy life is an essential part of the American promise.

This systemic discrimination takes the form of a doctor who takes a Black person’s pain symptoms less seriously, or a health clinic staffed by providers lacking training on how to appropriately care for a transgender person. It manifests in a hospital system that breaks ground only in a predominantly white neighborhood, and in a public health department that fails to translate important information into Chinese and Arabic despite a need in the community. Discrimination shows up in health facilities that are not accessible to people with disabilities. It takes place in states like Georgia and Texas, where governments play politics with people’s lives by refusing to expand Medicaid.

As a result, a Black man living in a rural community today can expect to live seven years less than a white man living in a city. An Asian American is more likely to die from certain types of cancer than a person who belongs to any other racial or ethnic group.National Institute on Minority Health and Health Disparities. “The Center for Asian Health Engages Communities in Research to Reduce Asian American Health Disparities.” 2016. A Latino is 20 percent more likely to develop diabetes than someone who is not Latino.Center for Disease Control and Prevention. “Hispanics/Latinos and Type 2 Diabetes.” September 15, 2019. A lesbian is more than twice as likely to have mental illness than her straight peers.National Alliance on Mental Illness. “LGBTQ.” A person with a disability is almost four times more likely to have heart disease than a person without a disability.Center for Disease Control and Prevention. “Persons with a Disability as an Unrecognized Health Disparity Population.” October 28, 2019. And a Native or Black woman is over two times more likely to die from pregnancy-related complications than a white woman.Center for Disease Control and Prevention. “Racial and Ethnic Disparities Continue in Pregnancy-Related Deaths.” September 5, 2019.

Health Equity Rollout Animation

In Pete’s administration, achieving health equity will be a strategic priority: during his first 100 days in office, he will direct the federal government to develop a National Health Equity Strategy. He will designate and invest in Health Equity Zones to empower communities to combat their most pressing disparities and transform our under-resourced public health system, enabling public health departments to become champions of equity in their communities. His administration will both invest in training our health workforce to combat racism and bias when treating patients, and support more underrepresented groups entering the sector to achieve equitable representation.

Pete understands that health policies alone will not be enough to achieve health equity. Income, housing, education, food, access to clean water, and safety all have a profound impact on our health. That’s why Pete’s administration will adopt a “Health in All Policies” approach to embed health considerations into decision-making across federal agencies.

The impact of systemic discrimination affects the health of Americans more than what happens at a doctor’s office or hospital.

This plan should be viewed in concert with Pete’s other health policies, which will also help close inequities. His Medicare for All Who Want It plan achieves universal coverage, which disproportionately benefits people with low incomes, people of color, and those living in rural communities. His Healing and Belonging in America plan destigmatizes and decriminalizes mental illness and addiction, which will drastically improve mental health outcomes for LGBTQ+ people, veterans, and people of color. Pete’s Women’s Agenda for the 21st Century will end the maternal mortality crisis—which primarily affects Black, Native, and rural women—while his plan for LGBTQ+ Americans commits to ending the HIV/AIDS epidemic by 2030, which disproportionately affects gay and bisexual Black and Latino men, and transgender women.

This plan for health equity is just the beginning. It is a policy framework that empowers communities to collaborate with the federal government to eliminate systemic health disparities. We cannot replace discriminatory policies with neutral ones and expect the playing field to level itself. We must intentionally work to create an era of inclusion in health.

Make Health Equity a National Priority

Pete believes that everyone has a right to equitable health. Yet far too many people are denied these rights simply because of who or where they are—including people of color, people who are incarcerated, LGBTQ+, disabled, veterans, older, or living in rural communities. When Pete is President, achieving health equity will be a national imperative.

Launch a task force to develop a National Health Equity Strategy.

  • Launch a National Health Equity Strategy Task Force in the first 100 days to develop a National Health Equity Strategy; outline steps to make health equity part of all federal agencies’ missions; and establish a roadmap for centering the lives of underrepresented groups in our health care system.
  • Appoint a Secretary of Health and Human Services (HHS) committed to achieving health equity.
  • Revitalize the Office of Civil Rights in HHS to ensure that legal frameworks exist to challenge health inequities, protect communities’ health and human rights, and ensure agencies explicitly consider the racial and demographic impact of their decisions.
Health Equity Overview Graphic

Designate and invest in Health Equity Zones and empower communities to address health disparities.

  • Designate communities with significant health disparities as Health Equity Zones. These communities will receive federal funding to end their most pressing health disparities, with a programmatic budget of $5 billion over 10 years.
  • Health Equity Zones will establish multi-sector coalitions focused on health equity, which could include local housing authorities, food banks, environmental protection organizations, local NAACP chapters, health care systems, economic development agencies, and safe transportation groups.

Reorient Our Health Care & Public Health Systems Toward Prioritizing Health Equity

Our national health care and public health systems do not equitably serve all communities. For example, people of color and members of other minority groups have been—through both negligence and intention—excluded from these systems. This remains the case even today. The Hyde Amendment, for example, primarily denies women of color access to essential reproductive health care services. Several states have sought to enact Medicaid work requirements, which will disproportionately deprive women with children and people with disabilities from accessing health care.Bailey, Anna, and Judith Solomon. “Taking away Medicaid for not meeting work requirements harms women.” July 6, 2018. We are long overdue in transforming our health care and public health systems not toward neutrality, but toward anti-racism, -misogyny, -homophobia, -ableism, and -xenophobia.

Empower public health departments as Chief Health Strategists for their communities and increase their funding through a Public Health Infrastructure Fund.

  • Empower local public health departments to become Chief Health Strategists for their communities by giving them greater resources to identify the root causes of local health inequities across sectors, including housing, transportation, and criminal justice.
  • Create a Public Health Infrastructure Fund, a mandatory funding stream to support state and local health departments, starting at a $500 million governmental contribution and ramping up annually until the gap of $4 billion a year between current spending and existing needs is met.

Incentivize health systems to make achieving health equity a strategic priority and establish health equity quality standards.

  • Establish health equity standards in federal health insurance programs such as Medicare, Medicaid, and the public plan. As part of the National Health Equity Strategy, the federal government will develop equity plans for Medicaid and the public plan, setting aggressive goals for closing access outcomes gaps.
  • Require federal health-related programs to collect and monitor data from health organizations—such as hospitals and nursing homes—stratified by demographic characteristics, and attach financial incentives to achieving equity measures.
  • Encourage health systems to invest in addressing the social determinants of health in their communities.
Health Equity Diabetes Graphic

Train our health workforce to both combat racism and bias when treating patients, and address the exclusion of underrepresented groups in the health workforce.

  • Train more health practitioners to identify and reduce bias by expanding incentives for the adoption of evidence-based programs shown to reduce disparities in health outcomes.
  • Create grant programs for Historically Black Colleges and Universities, Tribal Colleges, and Hispanic-Serving Institutions to recruit underrepresented groups into health professions, including by increasing scholarships and financial assistance.
  • Require that Medicare and Medicaid consider diversity when developing provider networks, and ensure that clinicians are adequately prepared to serve the patient populations in their network.

Increase funding for research to close health inequities.

  • Invest in finding cures for diseases that disproportionately affect minority populations, particularly for HIV, triple negative breast cancer, and sickle cell disease.
  • Increase grants available to behavioral and social science researchers to help us better understand the causes of and solutions to health inequities, such as the disproportionate burden of diabetes among certain minority populations.
  • Mandate that all federally-funded research trials on people include populations that reflect our country, with the highest ethical standards to ensure individuals are providing genuine informed consent.
Health Equity HIV Graphic

Adopt a "Health in All Policies" Approach

Most of our health outcomes are determined by what happens outside a clinic or hospital: by where we can live, what we can eat, and what jobs we have access to. For example, Black patients are more likely to receive care in low volume health centers and therefore have higher surgical mortality rates;Epstein, Andrew J., et al. “Racial and Ethnic Differences in the Use of High-Volume Hospitals and Surgeons.” JAMA Network. February 2010. cities like New York are so inaccessible to people with disabilities that it has been described as a “nightmare” for them;Smith, S.E. “New York City is a Nightmare for Disabled People.” VICE News. July 17, 2018. and across rural America, half of counties lack access to obstetrics services, exacerbating the maternal mortality crisis.Kozhimannil, Katy, and Austin Frakt. “Rural America’s disappearing maternity care.” Washington Post. November 8, 2017.

Given these structural barriers, how can one stay healthy? Pete strongly believes that a health equity lens must be applied across federal policies and programs. Just as he supports building the capacity of state and local health departments to take a Health in All Policies approach, Pete will adopt an unprecedented health equity approach across the federal government. He will:

Create Offices of Health Equity and Justice in all relevant federal agencies.

Health Equity Maternal Mortality Graphic

Develop and test innovative delivery and payment models to reduce health inequities by taking into account the social determinants of health.

Advance health equity at the state and local levels through a “Health in All Policies” approach.

Pete is determined to usher in a new era for health in America. One that recognizes that our policies must target systemic disparities in our health system. One that understands what happens in our lives outside the clinic is more important to our health and well-being than what happens in a hospital or doctor’s office. And one that makes achieving health equity—where everyone has a fair opportunity to be as healthy as they can be—a national imperative.

We must intentionally work to create an era of inclusion in health. If you’re with us, text ACCESS to 25859.

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