COMMUNITY VOICES:
Interview: We speak to Brenda Battle, UChicago Medicine’s vice president of the Urban Health Initiative and chief diversity, inclusion and equity officer, about the importance of health equity.
A Q&A from UChicago Medicine, sponsored content
Q: We hear a lot about health disparities in the community. What are the most pressing health problems impacting residents of the South Side?
A: South Side residents suffer disproportionately from chronic health problems, including diabetes, heart disease, and conditions associated with maternal health. A disproportionate number of residents either don’t have access to or don’t seek mental health services when needed. All of these disparities are further complicated by the lack of access to care in the community. Nearly 60% of residents on the South Side have no choice but to leave their community to get care.
Other factors that affect persons living on the South Side are the social determinants of health. These are the economic and social conditions that influence health— things like access to jobs, food insecurity, violence, racial injustice, etc. Black men on the South Side between ages 16 and 24 have an unemployment rate of more than 60%. The overall unemployment rate on the South Side is over 20%, twice that of Illinois and three times the national average. Food deserts on the South Side leave residents with purchasing food at gas stations, pharmacies and corner stores, limiting their options of good, healthy food for their families.
COVID-19 has further exacerbated these existing challenges, resulting in high positivity rates and deaths. Many residents work essential jobs that require them to travel by public transportation to and from work. Some live in multiple generational homes with limited or no ability to self-isolate.
The South Side has suffered decades of disenfranchisement, marginalization, redlining and conditions that create these disparities.
Q: Your team unveiled a health equity plan for UChicagoMedicine. How do you define health equity, and why does it matter?
A: I define health equity as conditions that afford everybody the ability to achieve health and wellness at an optimal level, including providing equal access to health care, knowledge and resources. Health equity puts everyone on an even playing field in their ability to be healthy. Without health equity, you have health disparities— which is what we are experiencing now.
We started our work in health equity by focusing on creating an environment that’s inclusive, gaining a better understanding of the populations that we’re serving, embedding cultural competence in our practices and training, and identifying where there are disparities, gaps and variations in health care outcomes, and addressing them.
The second iteration of our plan is more intentionally focused on creating and sustaining a diverse workforce at all levels in our organization. This plan requires us to make decisions about how to improve the health of patients and the community we serve through an equity lens, identifying the root cause of variations in care and addressing them. We’re improving our climate to ensure that the community feels welcome, respected, understood and heard.
We are looking at our policies and practices through an equity lens and making changes that are necessary to address structural and interpersonal racism. We’re asking ourselves a variety of questions about putting strategies, skills, education and training in place to dismantle barriers for people— whether for our patients, community or staff.
Questions include: How do we leverage our ability as an anchor institution on the South Side, in partnership with community-based organizations and other health care providers, to address health disparities so that people can achieve their optimal level of wellness and health? How can we be more effective in creating better access to care? How can we help our community to navigate linkages to care and resources to improve their health outcomes by using community health workers and navigators? How do we take our expertise to the community so we can close the knowledge gap? And how do we support the community-based organizations that we’re asking to increase the supply of resources to help our community?
Q: Why the focus on health equity now?
A: While we have been working on health equity for a number of years, we’ve not done enough. With all of the collective efforts of the health care industry, we still have health inequities, health disparities, poor access to health care, and disproportionate investments in the health ecosystem in Chicago, Illinois and around the country.
What we have been doing doesn’t work quickly enough to make the differences we need to make. COVID-19 exposed what we already know about these disparities. We can no longer put off focusing on health equity, and we have to work on this with intentionality and fervency.
Q: What’s the community’s role?
A: The community needs to tell us what their needs are and guide what we do. Every program of the Urban Health Initiative— in obesity, diabetes, asthma, violence, cancer— has been created with community input and guidance. We formed the Community Advisory Council four years ago to provide oversight to ensure the successful execution and effectiveness of these programs.
True community engagement means that the community owns it and participates in it. When the community participates in efforts to address health equity, they feel ownership of it, because it was created by them for them.
Q: In June, U Chicago Medicine joined 35 other health care organizations in declaring racism a public health issue. Why was that important?
A: The U.S. health care system was built off the ideologies of racism. The public health system in the U.S. created a system of care for poor people and one for people with means. As health care advanced in the U.S., many of these ideologies have led to some of the issues that confront our communities today.
As health care providers in Chicago, the 36 of us made a commitment to look at our respective institutions from an equity lens to begin dismantling the systems and structures within our organizations that impede equity and have contributed to health care disparities and inequities. They have contributed to the disproportionate rate of chronic illnesses for certain population groups, more utilization of emergency departments for preventable illnesses, and lack of preventive care in communities. They have contributed to the lack of presence of Black, Latinx and other underrepresented groups as providers caring for populations that need their representation.
We want to change this. It’s important that we make an open commitment and hold ourselves accountable to it.
Q: You often talk about coordination of care. Why do you emphasize that?
A: The health care delivery system is very fragmented. Individuals with an acute or a chronic health problem need help to navigate next steps after a hospital, emergency room, or clinic visit.
Care coordination is a connective process that includes a technology system that informs all of the care providers of what services an individual has had, as well as a team that helps that person navigate to the necessary resources to enable them to get what they need, follow through on what they were prescribed to do, and then get to wellness. It helps individuals to get care in the right place, at the right time.
It is essential to provide care coordination in support of the overall delivery of care.
Q: What about other collaborations?
A: Collaborations are necessary to strengthen the health care ecosystem. Through the Urban Health Initiative, we formed a collaborative with federally qualified health centers and community hospitals called the South Side Pediatric Asthma Center (SSPAC), where we deploy community health workers to other hospitals and health centers to assist them in managing their patients’ chronic asthma care when at home, school or in the playground.
There are certain services our patients need that our hospitals don’t provide. Therefore, we form collaborative relationships that allow us to link patients to so that they can get the services or resources necessary to improve their health and well-being. For example, through our violence recovery program, called the BHC Collaborative, our specialists work with patients impacted by violence to access social and other wraparound support services needed to prevent violence recidivism. These services are provided through partnerships we have with social services and other agencies.
Q: What would the future look like with health equity?
A: We would be preventing health problems upfront. There would be easy access to care providers where patients live. There would be no need to leave communities for care or to let care wait until one is too sick for certain interventions to help. Persons would not fear that they won’t be treated respectfully when they get care at any hospital or clinic.
Achieving equity means having jobs, healthy food, access to wellness programs, mindfulness programs and yoga classes. It means having resources that enable people to deal with the stress that life causes without having to get to a place where they’re at a breaking point. It means there is no stigma to accessing behavioral health services.
Some people would still get diabetes, but it would be managed earlier. Some people would still get cancer, but it wouldn’t get diagnosed so late in their disease. There wouldn’t be a 30-year life expectancy gap when living in an affluent community vs. a poor community, such as what we see with the average 90-year life expectancy in Streeterville vs. the 60-year life expectancy in Englewood.
Q: What keeps you motivated to work on what some people might view as intractable problems?
A: I don’t see these problems as insurmountable or intractable. I’ve seen the effect of helping individuals and communities through education, resources and access to care. I’ve seen the positive outcomes on health. Care has to be better coordinated, and providers and community-based organizations have to work in alignment.
I think it’s doable. That’s what keeps me coming to work every day. That’s what keeps me motivated. There are a lot of systemic changes that have to be made. It takes commitment and resources— from the state, federal government, city, private institutions, employers, health care industry, and philanthropy. With hope and help it can be done.