Advancing equity in US health and healthcare: Health systems’ actions in seven major domains

A focus on equity has risen to the fore in many US healthcare systems, in reaction to the May 2020 murder of George Floyd and its repercussions, and to the many racial and ethnic disparities highlighted anew by the COVID-19 pandemic. Both senior management and boards of directors of healthcare systems across the country have undertaken new efforts, or redoubled existing ones, to address equity, first, in the context of provision of care and the fundamental operations of health systems and, second, in addressing the broad upstream drivers of social and economic inequity that are largely extrinsic to healthcare. This paper describes some of the actions taken by health systems in seven main categories: speaking out publicly against inequity; taking larger steps internally to address diversity, equity and inclusion (DEI); examining themselves through the lenses of structural racism and critical race theory (CRT); widening their traditional equity lens to encompass widespread discrimination against multiple population groups; ramping up efforts to address the quality of care and reducing undesirable variation as a means of reducing inequity and disparities; harnessing data and information technology to assist in these quality-improvement efforts; and using their resources to address upstream health drivers, including those in priority areas of the social and economic determinants of health. All told, a growing number of US health systems now recognise and accept that they must play a dominant role in a process of social and economic transformation to eliminate structural and institutional racism and other forms of discrimination and place the nation on the road to better health.