On the second day of HIMSS23, April 18, being held at McCormick Place Convention Center in Chicago, in an education session entitled “Advancing Social Justice and Equity in Health Technology,” Aletha Maybank, M.D., M.P.H., chief equity officer, American Medical Association (AMA) and Bobby Mukkamala, M.D., an otolaryngologist and member of AMA’s Board of Trustees, AMA, highlighted how innovation has the power to advance health equity.
Mukkamala gave a brief overview of the 176-year-old Chicago-based AMA and its House of Delegates (HOD)—the Congress of Medicine—that represents 190 state and medical specialty organizations in the U.S. The HOD establishes policy to guide the practice of medicine and influences policy decisions about medical practice and patient safety at state and federal levels.
Next, he described AMA’s current strategic focus regarding health equity. AMA’s focus includes:
- Chronic disease: Confronting public health crises and eliminating health inequities
- Professional development: Recreating training, education, and learning by promoting innovation to take on challenges in healthcare
- Removing obstacles: Encouraging physician-patient relationships more than paperwork and promoting technology as an asset vs. a burden
Maybank then questioned, “What is health equity?” She then outlined that health equity is having an assuring the conditions, resources, opportunities, and power to achieve optimal health. She added that achieving health equity includes valuing all individuals and populations equally, recognizing and rectifying historical injustices, and providing resources according to need.
“We need to value all people equally,” she commented. “When we look at data, we don’t value all people equally and we have outcomes that demonstrate that. That’s hard to swallow, because we want to believe we do but our system and structure does not allow us to.”
Mukkamala then went over AMA’s policy on technology. One example he gave was telehealth during the COVID-19 pandemic. “Virtual care took on an increasing role in taking care of patients during the pandemic and virtual care technology needs to have equitable polices.” He added that access to broadband has been a concern, as a major social determinant of health (SDOH), as well as digital literacy.
He then outlined how AMA approaches innovation. The organization keeps three questions in mind:
- Does the innovation do what it is supposed to do?
- Does insurance cover its use?
- Who is going to be accountable if something goes wrong with it?
Maybank commented, “Another layer to this [the AMA’s approach to innovation], is, where does equity fit in? Really, it fits into all of it. Who’s benefiting from it being created? Who’s not benefiting? Who’s being harmed? What are the unintended consequences? These are questions that need to be asked for this particular framework.”
After the death of George Floyd in 2020, Maybank added, the AMA passed anti-racism policies including naming and acting on racism as a public health threat, ridding our healthcare system of racial essentialism, supporting the elimination of race as a proxy for ancestry, genetics, biology, medical education, research, and clinical practice.
She then said that the gap in health innovations depends on the following inputs to create equitable outputs including funding, resources, opportunities, types of funders, and drivers and external influence. Mukkamala then said, “Despite decades of increasing investments in health innovation, the U.S. continues to experience worse health outcomes than other high-income nations and persistent inequity.”
“The exclusion of the majority of the U.S. population from health innovation resourcing prevents meaningful progress in national health improvement,” he added.
Maybank then explained that white households are more likely to hold all assets (checking accounts, equity in vehicles, equity in homes, retirement assets, equity in businesses) compared to Black and Hispanic households. White households are also more likely to hold secured debts compared to Black and Hispanic households.
The presenters then explained that the benefits of inclusive and equitable decision-making and resource allocation on financial performance and solution impact are well documented. Additionally, by investing in solutions created for with, and by communities that have historically not been included in health innovation resourcing the U.S. ca make measurable progress in national health and economic prosperity.
As the session came to a close, the presenters explained that although there are no clear standards or best practices for centering equity in design, AMA has taken major steps in advancing health equity innovation. One major initiative is dubbed “In Full Health.” AMA’s website says that “The initiative is built around five principles for advancing equitable health innovation opportunities, inviting community members to:
- Understand how structural racism, sexism and bias impact health innovation resource allocation, so that steps can be taken to dismantle them.
- Assess the value of all health innovation solutions by their impact on health equity as a fundamental metric.
- Invest in health innovations designed by innovators building from and for historically marginalized communities.
- Utilize health innovation investment models that support asset ownership and wealth development within historically marginalized communities.
- Engage industry influencers in addressing systems-level barriers and needs.”
