Crossing Boundaries: Perspectives on Health Equity
- May 23, 2022
- Dr. Joan Reede , Harvard Medical School
Adopting a systemic and multi-level perspective, “Emerging Issues in Health Equity in the United States: Legal, Legislative, and Policy Perspectives”—a special issue of the American Health Law Association’s Journal of Health and Life Sciences Law—examines and deconstructs multiple, interconnected sources of health disparity at the micro, meso, and macro levels: underserved patients, their communities, and health care delivery modalities. The structure, administration, and impact on health equity among a broad array of polices, programs, and practices implemented across the health care system are examined. The actions explored embody systemic interventions—presidential executive orders, the provision of digital resources, organ transplant services, the oversight and discipline systems for medical staff, the Medicaid program, corporate governance, the impact of laws, and differential pregnancy outcomes.
These articles address a multiplicity of disparate adverse health impacts related to policy, research, and care delivery that operate in systems where racism and bias are actors. These barriers to equity manifest in many seemingly separate domains. In expressing these issues in separate and siloed contexts, our work toward advancing health equity is often viewed through narrow apertures that constrain our perspectives, interpretations, understanding, and ultimately actions taken. There is a strong need to de-silo these domains and acknowledge that evidence of racism, bias, and exclusion are interconnected systemically and systematically with resulting cumulative and compounding disparate effects. This issue measurably elevates the discourse among constituencies and as such, offers stakeholders a position to widen the aperture, setting the stage for bridging the silos and better addressing inequities.
The derivative effects of institutionalized racism and its close companions, interpersonal and internalized racism, constitute health and public health crises that limit the economic, physical, and mental well-being of individuals from marginalized groups. The constraining and pernicious effects of racism are evidenced and manifested within systems where diagnosis, care, and treatment at individual, group, and community levels are replete with disparities in access and outcome. Structural polices, programs, and practices codify institutional and legal frameworks that substantively affect the delivery and receipt of services, demonstrating that medicine and public health are neither immune nor insulated from broader social ills.
It is important to enlighten those involved in medicine, public health, health policy, and health law that obstacles in our quest toward health equity are not only the result of many separate societal ills but are infectiously infused in and undergird the social ecosystem, from individual interactions to institutional decisions and the shaping of legal frameworks. Systemically addressing complex issues in ways that lead to transformative change requires and benefits from a diversity of perspectives, heuristics, resources, and networks. Strategically, it is important that we collaborate and build cross-disciplinary bridges in education, training, and practice that provide opportunities to share existing and create new understandings, and which are powered by partnerships that actualize our shared values of health equity and justice. Valuing and implementing these perspectives as an action agenda requires ongoing dialogue, the shedding of myths, the challenging of assumptions, and an unequivocal resolve to achieve health equity.
Author Profile
Joan Y. Reede, MD, MPH, MS, MBA Dean for Diversity and Community Partnership and Professor of Medicine, Harvard Medical School and Professor of Society, Human Development, and Health, Harvard T.H. Chan School of Public Health.
Dr. Reede has a lifelong passion for mentoring and supporting diversity in the biosciences. She is responsible for the development and management of a comprehensive program that provides leadership, guidance, and support to promote the increased recruitment, retention, and advancement of underrepresented minority faculty.
While at Harvard Medical School (HMS), Dr. Reede created more than 20 diversity and leadership-focused programs, including founding the HMS Minority Faculty Development Program and the Biomedical Science Careers Program. Before joining Harvard, she served as the medical director of a Boston community health center and worked as a pediatrician in community and academic health centers, juvenile prisons, and public schools. She has held many advisory roles, serving on the U.S. Department of Health and Human Services’ Advisory Committee on Minority Health and the Secretary’s Advisory Committee to the Director of the National Institutes of Health. Dr. Reede is a member of the National Academy of Medicine and a fellow of the American Association for the Advancement of Science.
Dr. Reede graduated from Brown University and Mount Sinai School of Medicine. She holds an MPH and an MS in Health Policy Management from the Harvard T. H. Chan School of Public Health, and an MBA from Boston University.