February 23, 2024

Greater Health Equity Will Change the Course of Black History

Ericka King Betts, PhD, Director of Health Equity for Ohio, Humana

In my field of health equity, we know a lot about the “what” — stark statistics showing the many ways people of color and other marginalized groups have poorer health outcomes than the U.S. population overall. When I make presentations about health equity, people ask lots of questions about those numbers. But making significant progress on health equity — changing those numbers — requires us to go further and delve into the “why.”

Understanding the factors behind health disparities is the only way to eliminate them. As we take time during Black History Month for extra reflection on both the trials and the triumphs of the past, my greatest hope is that the health-equity work we do today will change the future history for marginalized Americans, including Black Americans, for the better.

Dr. Kemi Doll, a gynecologic oncologist with the University of Washington, no doubt is familiar with some of the most heartbreaking race-based health inequities: Black women are more likely than white women to die of breast cancer and three times as likely to die in childbirth of a pregnancy-related cause. And while the rate of endometrial cancer is slightly lower for Black women than for white women, Black women with the disease are 90% more likely to die. Dr. Doll made a damning observation about this: “The narrative was basically, ‘There’s something wrong with African Americans’ bodies.’ There was just so little investigation into why.”

I’m glad more research is happening now, and I’m proud of the role Humana Healthy Horizons and our counterparts in other Ohio Medicaid managed care plans are playing in using that information to change statistics and improve lives.

Many of the reasons for health inequity lie in systemic issues like redlining. Because of redlining, more Black people live in neighborhoods with poor access to health-care services as well as substandard housing and unsafe environments. Because of lower-quality public schools in Black communities and racial gaps in hiring and compensation, Black people are more likely to be in low-paying jobs without health insurance.

Humana Healthy Horizons invests in organizations that serve our members on a local level and address the most urgent wellbeing needs facing our communities. Through these partnerships, we help drive positive outcomes in a number of areas, including: maternal health, substance use disorder recovery, job training, food and housing insecurity and more. We’ve partnered with the Mid-Ohio Food Collective, Greater Cleveland Food Bank, and the Foodbank, Inc. in Dayton to bring healthy, nourishing food to underserved communities.

Another area where we provide crucial support is maternal health. Our partnership with Volunteers of America (VOA) has supported the opening of a Family-Focused Recovery (FFR) center in Columbus. The center provides recovery support services for pregnant and postpartum women with opioid use disorders, allowing mothers to recover with their families. VOA’s FFR programs are among the few in the country that combine intensive addiction treatment services with wraparound family support to address underlying social determinants of health that often impede recovery.

Unfortunately, other reasons for inequitable health outcomes have to do with the very professionals trusted to provide care. Medical education too often gives too little attention to equity and fails to overcome the cultural biases, conscious or unconscious, that we all bring to our work. A 2016 study published in Proceedings of the National Academy of Sciences found that, of more than 500 medical students and residents interviewed, more than half held at least one false belief about biological differences between Black and white patients. Among the most persistent and harmful of those is the myth that Black people have higher pain tolerance, leading to inadequate pain management for Black patients.

At Humana, we work on cultural humility with our employees throughout the year and it’s part of the information resources we give all our providers, and we encourage all our employees to volunteer in ways that address health equity concerns.

Unwinding centuries of systemic racism is a long-term priority with a timeline that is hard to predict. But there’s a lot we can do here and now to address cultural bias among individuals, and we at Humana are deeply engaged in that work. We have a robust training program around implicit bias and cultural humility, which the National Institutes of Health defines as “a process of self-reflection and discovery in order to build honest and trustworthy relationships.” To me, it’s also the willingness and openness to learn from someone who is different — approaching conversations with a heart to listen and understand, rather than making assumptions.

And in the communities where our members live, we work to tear down the barriers to healthy living. I’m proud to serve alongside the health-equity directors of other Medicaid managed care plans on the steering committee that oversees the Ohio Department of Medicaid’s Community Reinvestment initiative, through which we all work collaboratively to build the capacity of communities to become healthier places to live.

Eliminating health inequities means changing facts on the ground and changing the hearts and minds of healthcare professionals to give them the cultural competence equitable care requires. It’s difficult but rewarding work and it gives me hope that, in future Februarys, those who follow us will look on this time as one that changed Black history for the better.