I have been lucky enough in my career so far to visit communities around the United States to support public health efforts. While every community is different, one experience has remained the same: I am an outsider, and often a privileged one at that. Working across so many communities has given me a lot of opportunities to make mistakes, and a lot of chances to correct them.
Whenever I am developing a new health equity project today, I try to follow three core principles to make sure I am approaching my work responsibly:
These core principles act as a guideline, helping me keep my focus on the people at the heart of every health care policy and community health project. I hope others can use these ideas to shape their own approaches to health equity.
The Three Core Principles of Health Equity
1) Listen to the people you are serving
As public health practitioners, listening is one of the most important skills we bring to the table. Under-served communities are used to being ignored or outright abused. The first step to repairing that damage is to listen closely to your patients and other community members. All of the resources in the world will not help a community if the resources are being spent in ways that do not actually address that community’s specific problems.
As Keddem and colleagues described in their article in Medical Care from 2017, listening is an important component of patient engagement, and improved patient engagement may help narrow health disparities. Clinic staff need to actively listen to patients to let them know their health concerns are being taken seriously during visits. Health care teams can listen to patient feedback in structured forums to identify and address gaps in their approach. Directors can listen to their staff when they suggest ways to improve facilities and workflows.
When you show people that you can listen to them with an open mind, they are more likely to feel comfortable enough to share their problems, anxieties, and needs with you. These conversations can guide your practice and help you distribute your services more equitably.
2) Learn everything you can about the community you are working with––especially if you are not from that community
Systemic inequalities affect health outcomes around the world, and seemingly bygone eras still shape society. In the United States, centuries of racial violence created massive and persistent health disparities, and unfortunately, health professionals have been complicit in terrible atrocities. As responsible researchers and practitioners today, it is our job to learn from those mistakes so we never repeat them.
Some of the most important medical breakthroughs came at the expense of communities of color. From the Tuskegee syphilis experiment to gynecological experiments on enslaved women, vulnerable populations have been experimented on without consent. In the 1950’s, clinical trials for birth control were moved from Boston to Puerto Rico. However, questions remain to this day about the ethics of these trials. The Puerto Rican women involved were not told they were trial participants and were not given adequate information about the side effects.
Before you start working in a new community, take the time to understand why the community is under-served in the first place and how you fit into that history. The more you learn about a community, the less harm you will be likely to do, and the better you will be able to meet their needs today.
3) Engage with community members as equals
Inequality creates power dynamics to the benefit of some and to the detriment of others. You may have had a lot of opportunities that the people you are working with did not. Those opportunities may have put you in a position of authority. It is your responsibility to be aware of those dynamics and strive to treat everyone as valued equals, regardless of any existing social inequities.
Doctors in particular can play an important role in creating a more equitable society through patient engagement. As reported by Jaffee and colleagues in a Medical Care article in 2016, transgender individuals experience discrimination in the health care system that is associated with delayed or avoided medical care. The likelihood of experiencing discrimination increases for lower socioeconomic transgender individuals.
Doctors can improve their engagement with vulnerable populations. Respectful engagement with under-served communities can help reduce the likelihood of delayed or avoided care, which in turn can lead to reduced health disparities.
Working toward health equity often means working for and in communities that I am not part of. It can also mean working with under-served communities from a place of relative privilege. While I cannot undo broad systemic injustices alone, I can be aware of them and try to minimize their effects in all of my work.
As public health professionals, we are committed to improving the health care system and making it work for everyone. To achieve that goal, it is worth examining our individual roles in the health care system and continually adjusting our approaches to be more equitable.