Racial and ethnic disparities in access to, quality, and outcomes of health care have persisted for as long as medicine has been practiced in the United States, despite improvements in overall care. How can we make substantial progress toward eliminating these disparities and ensuring equitable care for all patients?

This question guided the Urban Institute’s (Urban) reflection on the 20th anniversary of the seminal Institute of Medicine (now National Academy of Medicine) report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. The report found consistent racial and ethnic disparities across clinical services and settings, even when factors like insurance and income were held constant.

EXPLORING APPROACHES TO ADVANCING HEALTH EQUITY

With the vantage point of 20 years, Urban explored the most promising and actionable policy and program strategies to accelerate health care equity and help ensure that, 20 years from now, the nation has made much more substantial progress toward eliminating health care disparities and ensuring equitable care for all patients.

Our initiative culminated in a major symposium, followed by a series of papers and virtual dialogues from national experts on key issues that the symposium elevated, detailed below. This body of work yielded several actionable research and policy strategies that have great potential to accelerate equity. Key among them is addressing the US Supreme Court’s 2023 rulings in Students for Fair Admissions v. Harvard University and Students for Fair Admissions v. University of North Carolina that prohibit the consideration of applicants’ race or ethnicity in higher education admissions.

FUTURE WORK OPPORTUNITIES

Urban will tackle these challenges by elevating the existing evidence and designing new research strategies to bolster legal arguments supporting equity initiatives, to build the case for government’s “compelling interest” in creating health care equity for all.

We are also engaged in issues related to the collection and application of demographic data to advance health equity, with a report forthcoming in December 2024. Looking ahead, we plan to explore the implications of these issues for the 2030 Census.

HEALTH EQUITY RESOURCES EMERGING FROM THE SYMPOSIUM

Several health equity topics were identified from the symposium, leading Urban and its research partners to pursue these 9 health equity resources over the past year.

•  “Guide to Equity in the US Health Care System” (May 2024): Ten guides focused on different health care sectors or systems that consumers, community leaders, activists, policymakers, and advocates can use to understand how complexities in the health care system lead to barriers and inequities, and what policies and strategies could address these challenges.
• Moving Upstream to Achieve Better and Equitable Health in Texas (March 2024): This report identifies health equity advancements addressing the nonmedical drivers of health in Texas. It reviews publicly available health disparities data and health equity initiatives and offers insights and recommendations from health leaders on what it will take to realize the vision of health equity in Texas.
• A Blueprint for Promoting Equitable Health and Health Care through Community-Led Initiatives (February 2024): This report presents examples of community-led efforts for equitable health, highlighting eight common approaches based on interviews with community-led organizations.
• The Sociopolitical Context of the Unequal Treatment Report: Then and Now (January 2024): This report explores the of health care equity strategies, highlighting the shift from individual to systemic views on racial and ethnic disparities, identifying areas of stalled process, and presenting three promising approaches to eliminating these inequities.
• “Envisioning a New Health System Rooted in Equity” (December 2023): This essay proposes principles, values, and conditions for a high-performing, universally accessible health system organized around health and racial equity.
• Can Medicaid Payment and Purchasing Strategies Advance Health Equity? (December 2023): This report examines the potential of four states’ Medicaid payment and purchasing strategies in Medicaid managed care contracting, benefits and care delivery model design, payment reforms, and Section 1115 waiver demonstrations to drive reductions in health disparities.
• “Using Race and Ethnicity Data to Advance Health Equity” (October 2023): This brief explores the use of patient and health provider race and ethnicity data to address inequities and offers federal, state, and institutional recommendations for enhancing data quality and use.
• “Building Equitable Artificial Intelligence in Health Care” (September 2023): This brief dissects the relationship between artificial intelligence (AI), machine learning, and health equity and addresses biases in AI and potential applications to address health equities.
• “Unequal Treatment at 20: Accelerating Progress Toward Health Care Equity” (August 2023): This summary synthesizes the symposium’s takeaways, highlighting challenges to achieving health equity, needed coalitions, and structural and systems approaches ripe for transformation.

VIRTUAL DIALOGUES

The Urban Institute hosted a four-part series with authors, scholars, and social changemakers to explore next- generation health equity strategies for states and the federal government in partnership with communities.

• “The Social and Political Factors of Health Inequities in the US” (April 2024): This event discussed promising solutions that decisionmakers, practitioners, and advocates can use to create a more equitable US health system and address ongoing challenges to eliminating inequities.
• “Beyond Engagement: Community-Led Initiatives toward Equitable Health” (February 2024): This event examined how community members can leverage assets to address pertinent issues, what funders should know about community-led initiatives, and strategies for building effective partnerships for advancing equity in public health.
• “Building Equitable Artificial Intelligence in Health Care: Addressing Current Challenges and Exploring Future Opportunities” (September 2023): This event outlined AI’s role in inequitable health outcomes and approaches to gauging and addressing this issue, including a preview of how AI could address health equity.
• “Envisioning an Equitable Health System: Reweaving America’s Social Contract” (August 2023): This event proposed a vision for health systems centered on equity, prioritizing people and relationships, and strengthening our social contract as a “North Star” as we work to implement more incremental reforms in the near term.

CONTACT INFORMATION

Brian Smedley, Senior Fellow, Health Policy Center and Office of Race and Equity Research
Faith Mitchell, Institute Fellow, Center on Nonprofits and Philanthropy and Health Policy Center

We are grateful to the philanthropic organizations that have supported this work, including The California Endowment, the California Health Care Foundation, the Commonwealth Fund, the Episcopal Health Foundation, and the Robert Wood Johnson Foundation. We also gratefully acknowledge the authors, UT@20 Advisory Committee members, Urban’s Community Advisory Board, Urban Institute reviewers, Co-PI, Dr. Kimá Joy Taylor, and core UT@20 team (Sarah Morriss, Taylor Nelson, Eva Allen, and Dr. Genevieve Kenney) for their contributions to this initiative.