National Academies Call for Federal Body on Health Equity

The federal government needs a new body that can improve racial, ethnic, and tribal health equity, according to a new report from the National Academies of Science, Engineering, and Medicine.

The report, commissioned by the Office of Minority Health under HHS, also indicated that the federal government needs better tools to score new programs based on how they will affect heath equity and more race and ethnicity data reporting.

These recommendations come in response to increasing evidence about how different federal policies have resulted in health inequities or further perpetuated health inequities, according to Sheila Burke, the co-chair of the committee that wrote the report.

“The health inequities experienced by millions of people living in the U.S. today are in part the result of past and current policies that exclude or deprioritize these populations — putting them at a disadvantage that affects their well-being and life expectancy,” Burke, who is also an adjunct lecturer at the John F. Kennedy School of Government at Harvard University, and chair of the Government Relations and Policy Group at Baker Donelson, said in a statement.

“The time to act is now, and we lay out specific steps in our report that the federal government can take to advance health equity.”

The evidence of racial and ethnic health disparities—plus the way federal policies can help drive them—is plentiful, the researchers said. There’s broad evidence supporting that policies like redlining have resulted in racial health disparities across multiple disease states and experience of social determinants of health.

On the flip side, the researchers pointed out that some federal policies have also made headway in closing equity gaps. Increases in the federal minimum wage and closing educational achievement gaps have both positively affected health equity.

But if the US is going to make true progress toward equitable outcomes and equal opportunity to achieve health and well-being, there will need to be better safeguards in place to understand how federal polices both related and unrelated to healthcare will have consequences for equity.

“Addressing the nation’s racial and ethnic health disparities is an imperative for the medical community, and a crucial goal the National Academy of Medicine has worked toward for years,” Victor J. Dzau, president of the National Academy of Medicine, said in the press release about the report. “This report’s recommendations are a path forward for improving equity in the federal policies, systems, and structures that shape our health and well-being.” 

The authors’ recommendations generally fell into four buckets:

• Implement sustained coordination among federal agencies
• Incorporate and value the community voice in government initiatives
• Improve race and ethnicity data reporting to ensure accuracy and completion
• Boost federal accountability in ensuring all government programs result in better health equity

Under the agency coordination umbrella, the paper authors suggested the President create an entity to help guide the government’s efforts for health equity. The Office of Management and Budget (OMB) can assist in orchestrating health equity across agencies. Moreover, these bodies can work together to assess past and future policymaking for impacts on health equity.

Under the community voice category, the report authors advised the President to call on all agencies related to social determinants of health—transportation or food and agriculture agencies, for example—to create bodies that include representation from the communities they serve. The Government Accountability Office (GAO) could monitor this.

The race and ethnicity data recommendation needs to be coordinated by a body like OMB, the researchers said. OMB can call on the Census Bureau to escalate efforts to get representative race and ethnicity data and can also push levers to get more representation on tribal origin in addition to race and ethnicity data.

At CDC, efforts to create standardized measures about SDOH and race and ethnicity will be key to measuring instances of racism. From there, Congress can appropriate money for research into how SDOH affect individual health outcomes.

Finally, within the federal accountability bucket, the government needs to determine strategies to ensure equitable administration of federal services. OMB should investigate policies and programs that exclude certain populations to better understand how that exclusion impacts health and well-being.

The report called for more special attention to American Indian/Alaska Native (AI/AN) populations, who see the worst health outcomes compared to other racial and ethnic groups, the authors said. This should foremost be done by creating funding parity with other healthcare programs. Additionally, Congress may reestablish the Indian Affairs Committee and raise the IHS director level to assistant secretary.

“Including community voices in the policy process is of paramount importance to the nation’s path to health equity,” Daniel Polsky, committee co-chair and Bloomberg Distinguished Professor of Health Economics and Policy in the Bloomberg School of Public Health and the Carey Business School at Johns Hopkins University, said in the paper’s press release.

“Our recommendations call for steps from the executive and legislative branches to increase transparency and boost community representation.”