By Lloyd Michener, MD
Family medicine groups have responded wonderfully to the COVID-19 pandemic, providing critical clinical services, and helping staff testing and vaccination sites. As COVID-19 underscored the depth of the disparities across our states and communities, family physicians have also taken on local and national leadership roles in health equity efforts, efforts to achieve health equity are now expanding rapidly, and the approaches and even the language used are changing as well.
As a particularly horrific example, a new report from the US Civil Rights Commission calls for equity in maternal health, noting that Black women in the United States are 3 to 4 times more likely to die from pregnancy-related complications than White women in the United States. The report calls for coordinated prenatal, maternity, delivery, and postpartum care that manages chronic illness and optimizes health, and points out the role that states can play in supporting equitable health, including Georgia, New Jersey, and North Carolina. Maternal health equity is an opportunity for family medicine, partnering with our health systems, our communities, and our states, to make a difference.
At the same time, academic health centers (AHCs) are increasingly engaged in health equity efforts, seeking to build and strengthen community partnerships for health. As David Skorton, CEO for the Association of American Medical Colleges, stated:
“the traditional tripartite mission of academic medicine — medical education, clinical care, and research — is no longer enough to achieve health justice for all. Today, collaborating with diverse communities deserves equal weight among academic medicine’s missions. This means going beyond “delivering care” to establishing and expanding ongoing, two-way community dialogues that push the envelope of what is possible in service to what is needed.
It means working with community-based organizations in true partnership to identify and address needs, and jointly develop, test, and implement solutions. This requires bringing medical care and public/population health concepts together and addressing upstream fundamental causes of health inequities.”https://journals.lww.com/academicmedicine/pages/articleviewer.aspx?year=9000&issue=00000&article=96573&type=Abstract
This is a new challenge for many AHCs, and a place in which family medicine can make a much-appreciated difference. A private, research-intensive school headlined such an example:
In many ways, the COVID-19 pandemic forced positive changes in how medicine is practiced in communities and at academic medical centers, with family medicine departments working at the front lines to provide care and forge relationships with community partners, according to a Duke Health review.https://corporate.dukehealth.org/news/pandemic-response-shows-path-improved-health-care-future?utm_source=newsletter&utm_medium=email&utm_content=The%20pandemic%20shows%20a%20path%20toward%20a%20better%20health%20care%20future&utm_campaign=dukedaily2021_09_20
As these partnerships grow, the language shifts. Family medicine is growing accustomed to the idea that we have a role in the ‘social determinants of health,” while community organizations may use a broader, more positive framing of the “vital conditions of health” which is inclusive of the intersections of health and safety, work, transportation, education, civic muscle, housing, and the environment. Family practices can have important roles in this larger effort, both as trusted sources of care and information, as one of the community hubs that link individuals and families to needed services, and as respected advocates for needed policy change so that all communities have the opportunity to thrive.
Guidance on how to partner and support community health equity is increasingly available, including, to cite just a few:
- Principles of Community Engagement, 2nd Edition (A third edition of this federal guidance will be published next year)
- Practical Playbook II: Building Multisector Partnerships that Work (A third edition, on improving maternal health, is in the works)
It is noteworthy that every one of these draws from diverse groups and sectors, as working effectively with community organizations towards health equity requires partnerships far beyond any one discipline, profession, or sector.
Within all this complexity and challenge, family medicine has a wonderful opportunity to serve as builders of bridges to and with our diverse communities, many of whose members come to us for care. By expanding our vision so that we are engaged with communities around their priorities and needs, we can help build on their strengths, add our own and those of our academic colleagues, to our shared goal of achieving health equity.