A Health Leader's Perspective on Equity
By Clay Holderman
As protests have moved past Presbyterian Hospital daily, I have reflected on what authentic voice I could possibly add to the long-overdue racial equity conversation. I will never understand the perspective of those targeted by a deeply biased system. But I can offer the health outcome lens on what is surely a deeply unequal society.
Dr. Don Berwick opened the 2018 Institute for Healthcare Improvement annual meeting with a powerful picture of health inequity on two ends of the D-Train in New York City. In the span of 80 blocks, household income drops from $180K per year to $45K per year, and resulting life expectancy drops a full ten years[i]. The demographic of the Upper West Side compared to the South Bronx shows how disproportionately impacted the African American community is compared to their Caucasian fellow New Yorkers.
Dr. Norbert Topf, Chief Medical Quality Officer for Presbyterian Healthcare Services, repeated the study for New Mexico. In a 10-mile bus ride down Louisiana Blvd., we see a similar demographic shift, substituting American Indian and Hispanic for African American. From the Northeast Heights to the International District, crude mortality increases 81%, driven by heart disease (94% higher) and death from cancer (43% higher). Life expectancy decreases 9.8 years across those 10 miles[ii]. These populations live in a food desert with little access to natural foods and difficult access to preventative care. In Presbyterian’s work on Social Determinants of Health, we have found access to reliable transportation as the number one impact on health outcomes.
[i] http://www.ihi.org/resources/Pages/AudioandVideo/Don-Berwick-Forum-Keynotes.aspx
[ii] NM Death Certificate Database, Office of Vital Records and Statistics, New Mexico Department of Health, 2018
