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TAKING A NO-REGRETS APPROACH TO HEALTH INEQUITY

By

Kenneth Kaufman

December 15, 2021
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MORE FROM KEN

The Workforce Challenge Is a Segmentation Challenge
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Re-setting the Healthcare Gyroscope

I recently finished Denis Johnson’s National Book Award–winning novel about the
Vietnam War, Tree of Smoke. Toward the end of the book, the narrator quotes an
aphorism that I found particularly apt for today: “Don’t interrogate your
opportunities; it’s not what you do that you regret, it’s what you don’t do.”

In the book, this insight is meant as a personal philosophy, a way of thinking
about one’s life and accomplishments, about decisions made and decisions not
made. However, it could just as easily apply to organizations, particularly in
healthcare.

For many years, healthcare organizations have faced a set of historically
intractable problems, some of which have become far more apparent and intense in
the 20 months since the onset of the COVID-19 pandemic, including dealing with
the fallout of a public health system that is fragmented, understaffed, and
wholly inadequate to the challenges brought forward by the pandemic.

A central problem, one that runs through public health, workforce, and many
other issues, is the health and healthcare inequities arising from pernicious
disparities based on individual’s race or ethnicity, as well as gender, sexual
identity, age, disability, socioeconomic status, and geographic location.

The evidence of health and healthcare inequity is staggering. (The statistics
cited in this article come from a new book called Unequal Cities, which I highly
recommend.)

The mortality rate for Blacks is about one-quarter higher than for whites. In
the United States as a whole, annual excess deaths of Black Americans due to
higher Black mortality rates is a shocking 192 preventable deaths per day or 8
preventable deaths per hour. The number of years of life lost due to preventable
death for Black Americans is 59% higher than for whites.

The mortality rate from heart disease is 30% higher for Blacks than for whites,
and the mortality rate for cancer is 20% higher. Annually in the U.S. there are
32,883 more preventable deaths among Blacks than whites from heart disease and
cancer.

These disparities vary significantly depending on where you live. The average
difference in life expectancy for Blacks and whites among the 29 largest cities
in the country is 4 years. However, in Washington, D.C., the difference is 12
years—a 73-year life expectancy for Blacks compared with 85 years for Whites. In
San Francisco the difference is 10.5 years, in Los Angeles 9.5 years, and in
Chicago 8.3 years. Mortality rates from heart disease for Blacks in Washington,
DC, is 144% higher than for whites, compared with an 8% difference in Baltimore.

In this context, the notion of interrogating your options and regretting what
you don’t do is not just philosophical. It has actual results on people's lives.

How much responsibility should healthcare organizations assume for solving the
problem of health inequity? One view is that responsibility should be shared
among the public sector, the private sector, and healthcare organizations. That
is an understandable view, and is indeed the status quo. Health inequity is
enormously complex and pervasive; it touches on agencies, companies, and
individuals throughout the country. However, shared responsibility has not
solved the problem, in part because there has not been a single point of
accountability. No one has stepped up and said, We will be accountable.

Healthcare organizations need to simplify their thinking about health inequity.
They need to say, One of our most crucial responsibilities going forward over
the next decade is to solve this problem. We will not over-interrogate this
opportunity, as healthcare organizations are prone to do. We are going to take
all the necessary actions that we have the power and authority to take. And
although we are more than willing to work cooperatively with all of the
different constituencies we need to work with, we’re not going to wait. We're
going to jump in and figure out how to solve this. When it comes to solving the
problem of health inequity, we are not going to regret the things that we did
not do.

Meet the Author
kenneth-kaufman.jpg
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KENNETH KAUFMAN

Managing Director, Chair
Kenneth Kaufman offers deep insights on the economic, technological, and
competitive forces undermining healthcare’s traditional business model.
Learn More About Kenneth


READ MORE THOUGHTS FROM KEN


THE WORKFORCE CHALLENGE IS A SEGMENTATION CHALLENGE

December 8, 2021
In my conversations with senior executives at healthcare organizations around
the country, I find that leaders have three critical topics on their minds:
workforce, workforce, and...
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WHAT WOULD YOU DO IF YOU WERE CEO OF STATE FARM?

November 12, 2021
The well-worn phrase “culture eats strategy for breakfast” has new relevance in
American business these days. Take the case of State Farm insurance. For almost
ten years, Green Bay...
Thoughts from Ken Kaufman


GETTING CULTURE RIGHT

November 10, 2021
Today, American culture is changing so quickly and with such a high degree of
nuance that it is increasingly difficult both to interpret and to navigate.
However, navigating how those...
Thoughts from Ken Kaufman
Read All Thoughts From Ken

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