At the Commonwealth Fund, we have long been focused on shaping national health policy with respect to coverage, cost, quality, and equity. In recent years, we have also embraced the objective of creating an anti-racist health care system. Our Advancing Health Equity initiative has three strategic thrusts, one of which is directly focused on health policy.

The Fund’s first strategy is changing mindsets. Underlying past and present racist structures in our health care system are attitudes, biases, and ways of thinking about race among the many millions of individuals who work daily in our $4.3 trillion health care system. These mindsets are often unconscious and unexamined, but to the extent that they are prevalent—and health care workers are not immune to attitudes that circulate in the larger society of which they are part—they can present significant barriers to lasting and meaningful progress toward equity in health care.

A second strategic thrust addresses the impact of systemic racism on underlying structures in health care by identifying and scaling organizational approaches, methods, and models for combating racism and improving equity in health care. There are numerous approaches, such as improving measures of equity, creating systems to deploy those measures, addressing the equity effects of new technologies, and more. The aim is to create structures and processes that institutionalize efforts to promote equity within health care organizations.

The Fund’s third approach is to identify and promote health policies that advance equity and combat racism while also assessing existing and new policies for their intended and unintended effects on equity in health care.

Though only the last of these three strategies addresses policy explicitly, all are relevant to health care policy. To the extent that the people who work in health care embrace equity and anti-racism, they are more likely to support government action with those purposes. This makes it politically easier for government to move forward.

And once government does act, its policies inevitably work through health care organizations in one way or another. The requirements or incentives created by new health policy—for example, much discussed pay for equity initiatives in public insurance programs—lead health care organizations to seek ways to comply with or promote public purposes. The availability of proven organizational models to increase equity then becomes a critical spur to policy success.

Read the full article about equitable health advocacy by David Blumenthal and Laurie Zephyrin at Grantmakers In Health.