4 Strategies to Drive Health-Equity Success

Innovative community-centered partnerships and creative investment strategies can mitigate health disparities that adversely affect excluded or marginalized groups. And many health systems are using these approaches to achieve powerful results, notes a recent NEJM Catalyst analysis.

These approaches can bring sustainable health-equity advances and help provider organizations improve their brand reputation, strengthen their organizational culture and potentially boost financial performance, the authors explain.

Collaboration and Power Sharing

Collaboration with community stakeholders, nonprofits, philanthropic organizations, businesses, government agencies and other hospitals is essential to community-centered strategies. Leveraging resources and expertise across sectors and experiences in cross-functional teams enhances implementation of resources to solve challenges in treating chronic conditions, prevention and accessing health care. Sharing power with action teams and community stakeholders means hospital leaders must listen, ask for authentic inclusive participation and co-design solutions that address community concerns rather than hospital priorities.

Be Well Fox Valley, a financial and community partnership among 19 Wisconsin-based health systems, health departments, nonprofits and philanthropic organizations, has found success by targeting community health conditions, including diet. From grants and pooled money from the participating health systems and other community partners, the initiative raised more than $260,000 in 2022.

That money funded many initiatives, including a 13-week Eat Well for Life program that offers free, healthful meals. Between July 2021 and December 2022, about 200 people participated in the program. Post-intervention analysis from the first of four cohorts showed that average hemoglobin A1c levels dropped from 9.6% before the program to 8.1% 16 weeks after the program start date.

Small Investments Can Produce Big Impact

Boston Medical Center’s StreetCred program helps lower-income families file tax returns and claim refunds during visits to its hospitals and clinics. StreetCred partners with local nonprofits to recruit, train and deploy volunteers into medical settings. Some volunteers help patients collect and upload tax-related documents to a secure online portal, while Internal Revenue Service-certified volunteers use the documents to complete patients’ tax returns.

Since its 2016 launch, StreetCred has facilitated more than $14 million in tax refunds (e.g., Earned Income Tax Credit and Child Tax Credit) to more than 6,000 low-income families at nine clinics in five states. More than 90% of low-income families who receive extra funds use the money on food, clothing, shelter and education. In addition, evidence suggests that families receiving funds via financial services programs see improvements regarding infant birth weights, premature birth rates, maternal stress, employment rates among single mothers and K-12 school performance. To expand the program, StreetCred has created an open-source toolkit and coalition of 24 health and financial services organizations in 10 states and the District of Columbia to share best practices on launching, growing and sustaining similar programs in medical settings.

Build Trust by Listening

Houston-based Memorial Hermann Health System learned a valuable lesson about the importance of listening to the community when it began a program to help children become more active. One of the health system’s school-based health center nurse practitioners noticed a growing number of students presenting with Acanthosis nigricans — a skin condition characterized by dark patches in body folds and creases, which is often associated with diabetes and obesity.

The school nurse talked with parents about why their children weren’t receiving adequate physical activity. Parents shared safety concerns about sending their children to nearby Clark Park. They wanted safer routes to the park and more organized activities for children and adults. Memorial Hermann built a 1.1-mile sidewalk from the middle school to the park, added lighting for safety, rebuilt the basketball court, revamped the soccer field and created a soccer program for kids.

Among the 262 children who participated in the soccer program, 75% reduced their body mass index and 85% improved their aerobic cardiovascular endurance on running tests.

4 Keys to Successful Health-Equity Investments

In talks with health system leaders, the authors highlighted the following elements of successful programs to improve health equity.

1 | Empower staff to advocate for patients.

Staff can offer valuable insights on community needs based on their patient interactions. “Well-managed hospitals empower employees to listen to, partner with and advocate for patients,” the analysis states. Employees’ trust in leadership’s commitment to patient-centeredness is essential to help them feel psychologically safe in finding creative ways to help patients.

2 | Focus on ‘equity care.’

Charity care can address the immediate needs of patients, but it may not address health equity. Boston Medical Center leaders told the authors that a $1 million charity investment for 10 open-heart surgeries has a different impact than a $1 million equity-care investment in 10,000 prenatal visits with low-income women. In other words, 10 surgeries affect 10 patients; 10,000 prenatal visits can lift entire communities.

3 | Measure your success.

Rigorously evaluate your programs’ effects on community health and make needed adjustments. StreetCred tracks patient demographic characteristics (e.g., race, income) and program outputs such as clients served, dollars returned, etc., and shares results with partner clinics’ leaders and funders. Moving forward, research must compare program effects on outcomes to better understand how funding allocations may affect health equity.

4 | Act on survey results.

Conducting community-based health-equity research is best practice, but so is sharing results and action plans with community members, the authors note. Inaction in any of these areas can erode trust.