5 keys to building health equity in Mass.

SINCE MARCH, the COVID-19 pandemic has tested our health care system. Our hospitals, health care workers, first responders, medical researchers, labs, and public health leaders have exhibited heroism and innovation in navigating through the spring surge and in the continued fight with this deadly virus.

Yet, this crisis has taken a deep toll here in Massachusetts. And the data clearly show that this toll has fallen disproportionately on people of color.

In addition to reporting higher rates of infection, hospitalization, and death (adjusted for age) than white residents, black, Hispanic and Latinx residents are at risk of suffering disproportionately from the mental health crisis caused by the pandemic and from the inability to access needed medical care. Communities of color are also more likely to have more essential workers, rely on public transportation, and lack the space to isolate at home, making them more vulnerable to the health and economic effects of the virus. In these ways, COVID-19 has threatened the very fabric of these communities.

These heartbreaking disparities are not new. They are rooted in deep-seated inequities in the social, economic, and environmental conditions that are necessary for a healthy life.

COVID-19 is a call to action for stakeholders across Massachusetts to take meaningful steps towards achieving racial justice and equity in health. Though our health care institutions are national leaders in patient care, research, and innovation, our system, like others across the country, too often leaves behind patients of color.

Earlier this week, my office released a new report entitled Building Toward Racial Justice and Equity in Health: A Call to Action. Building on conversations with patients, health care providers, public health organizations, researchers, and community groups across the state, this report outlines five key steps that we as a Commonwealth can take to advance racial justice and health equity.

First, we need to improve our collection and reporting of important patient demographic characteristics, especially race and ethnicity. Expanding access to this data is the first step to understanding disparities and tracking our progress towards health equity.

Second, our state needs to ensure that low-income communities and communities of color have access to the same health care resources as any other community in Massachusetts. We need to examine new ways of ensuring that providers who serve those with greater health and social challenges are not systematically paid less than those who serve people with lesser needs and greater means, as occurs today.

Third, we need to make sure that clinical tools work to promote health equity—starting with telehealth. Telehealth can address many longstanding barriers to accessing health care. But this will only work if we address the digital divide, build digital health literacy, and ensure patients have options to access care online or by phone and with the language and accessibility supports they require.

Fourth, we must address the fact that our health care workforce does not represent the diversity of the patients it serves, and that this lack of representation hurts communities of color—both in employment opportunities and patient outcomes. Academic institutions, health care employers, and policymakers should center educational opportunities and health care workforce development around diversity, anti-racism, cultural humility, and equity.

Finally, it is important to recognize that the health care system alone cannot end health disparities. Underlying social determinants of health—such as poverty, environmental inequities, housing quality, and incarceration—play a significant role in determining population-wide health risks and outcomes. We need to consider how state funds can be better targeted towards addressing these root causes of health inequity and bring cross-sector stakeholders together to build healthy communities.

The goal of this report is to build on our statewide dialogue and invite collaboration. While some recommendations require legislation, many can be implemented immediately by health care stakeholders changing their policies or practices.

COVID-19 has amplified and worsened a generations-long public health crisis. We must work together to meet this crisis with the urgency it demands and to reimagine a health care system and public health infrastructure that serves all residents equitably. I am confident that Massachusetts has the resources, talent, and vision to emerge from the COVID-19 crisis not only as a continuing national leader in health care, but also as a leader in health equity.

Maura Healey is the attorney general of Massachusetts.