NYC Health Dept. Leverages Health Equity Framework to Combat Disparities

The New York City Health Department is partnering with The Healing Acknowledgment, Redress, and Closure (ARC), a campaign of healthcare professionals and other stakeholders seeking the elimination of structural racism and inequities in healthcare, to implement the campaign’s framework into its health equity initiatives.

As part of this effort, the NYC Health Department is spearheading the Coalition to End Racism in Clinical Algorithms (CERCA). The 12-member coalition seeks to evaluate the use of race and ethnicity data in clinical algorithms, which can play key roles in patient care and clinical decision-making. The press release states that the race modifiers within these algorithms are often based on debunked, racist theories and can leave patients with sub-par or delayed treatment.

“Racism exists throughout medical research and healthcare systems in the U.S., diminishing the health outcomes of people of color,” said Bram Wispelwey, MD, Instructor in Medicine at BWH and Instructor at the Department of Global Health and Population at the Harvard T.H. Chan School of Public Health, in the press release. “It’s critical that entities, like CERCA, work to eliminate the embedded racism that fuels discriminatory behaviors, protocols and patterns that shape patient care.”

In CERCA’s inaugural report, the coalition found multiple examples of harmful race-based algorithms and equations, many of which make biological distinctions by race when none exist.

“Research over decades has demonstrated that the human genetic variation cannot be meaningfully categorized within socially and historically derived racial categories, but far too many diagnostic algorithms and practice guidelines continue to biologize race by modifying their outcomes based on race or ethnicity,” Wispelwey continued.

CERCA is working to examine the norms that lead to biased clinical algorithms and create a model to hold the scientific community accountable. In its report, CERCA stated that The Healing ARC’s framework “can guide institutional racial equity initiatives to ensure harms resulting from structural racism are remedied and that patients experience equitable improvement in care and outcomes. The [NYC] Health Department will explore the use of Healing ARC with CERCA members and patient advocacy groups as part of continued work around ending racism in clinical algorithms.”

According to the press release, The Healing ARC was developed to eliminate inequities in heart failure patient care delivery at Brigham and Women’s Hospital (BWH). The Healing ARC framework encourages race-conscious interventions to address disparities, and the NYC Health Department will leverage it alongside other paradigms to promote health justice and equity.

These efforts reflect a larger trend in healthcare IT focused on ethical algorithms and responsible artificial intelligence (AI) deployment.

In March 2022, HealthITAnalytics interviewed Joachim Roski, principal at Booz Allen, who shared the value of an AI development and deployment approach based on the evidence-based medicine movement. Using this approach, health AI experts would leverage past experience, existing risk, and performance assessments to inform the development of standardized guidelines for AI in healthcare.