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DELOITTE HEALTH EQUITY INSTITUTE. OCTOBER 2021



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1 Deloitte Health Equity Institute October 2021

2 Health Equity Strategy Playbook Document Purpose Purpose Outline the steps an
organization can take to define their health equity strategy to drive change and
impact in the communities in which they serve 2

3 Document Overview Contents Topic Defining Health Equity Phase 1: Understand
Understand your organization Understand your market Phase 2: Define Define your
health equity vision Phase 3: Develop Develop a roadmap for the future Appendix:
Frameworks 3

4 Defining Health Equity 4

5 Defining Health Equity We define health equity as the fair and just
opportunity for every individual to achieve their full potential in all aspects
of health and well-being Differences in health-related outcomes across race,
gender, age, location, disability status, and sexual orientation are the reality
today Deloitte recognizes three root causes preventing the achievement of
equitable health outcomes: Structural and systemic racism and bias Deep
inequities in the non-medical Drivers of Health, and Structural flaws in the
health care system Achieving heath equity is a moral and strategic imperative
calling for business solutions 5

6 Process for Defining your Health Equity Strategy This playbook is organized
across three phases of defining an organization s health equity strategy Phase
Understand your organization Phase 1: Understand Phase 2: Define Phase 3:
Develop Understand your market Define your health equity vision Develop a
roadmap for the future Description Understand your organizations and workforce s
positioning across health equity and DEI drivers Use data and insights to
understand the market and society your organization serves Come together as an
organization to think through your biggest gaps and what you need to fix Develop
an executable roadmap to drive toward the vision Key Questions How well do key
stakeholders feel the organization is positioned across key areas of DEI and
Health Equity? What have been some of the most impactful programs enacted on
Health Equity to date? What are the orthodoxies or deeply held beliefs that
impede your organization from having a meaningful dialogue related to health
equity? What are the health disparities and drivers of health (DOH) resulting in
health inequities? How do the communities you serve compare to state and
national averages? How will we move from current state to future state and
achieve our aspiration? What are the 3-5 health equity priorities that will
enable us to do so? What initiatives can we perform to meet our strategic
priorities? How do we prioritize these initiatives under our identified health
equity priorities? What are the tactical activities needed to complete these
initiatives? How do we measure success? 6

7 Phase 1 7

8 Phase 1: Understand your Organization Understand the current state of health
equity and diversity, equity, and inclusion internally, including perspectives,
feelings, opinions and experiences of employees Phase 1 Assess Internal DEI
Understand Health Equity Influences Assess Workforce Health Equity Conduct an
assessment of your organizations current DEI efforts focusing on how you access
talent while enabling and advancing your workforce (see Equity Activation Model
in appendix) Utilize a human-centered approach to the assessment by
understanding perspectives, feelings, opinions and experiences of employees
Evaluate leadership and culture influences on Health Equity goals and outcomes
Understand the current stakeholders involved in health equity and how they work
together Understand your workforces social, economic and environmental needs
Identify potential levers (e.g., housing, food insecurity, income) that can lead
to more equitable health for your workforce To make an impact and demonstrate
commitment, organizations should bring together both DEI (Diversity, Equity and
Inclusion) and DOH (Drivers of Health) perspectives when advancing health equity
internally 8

9 Phase 1: Understand your Market Conduct a quantitative baseline assessment of
your organization s DEI and health equity positioning through in-depth detailed
market analysis using Deloitte s Drivers of Health (DOH) framework to organize
data Phase 1 Identify Key Markets & Data Sets Understand The Develop And 1 2
Current Landscape Validate Hypotheses 3 Identify Potential Levers 4 Based on the
communities the organization serves, identify markets and organization data sets
to inform health equity market analysis Use data to understand the health
outcomes and the prevalence of DOH factors (see DOH framework in appendix)
Aggregate public data inputs to profile the insight markets to understand where
the health disparities exist today in comparison to the state and national
averages Develop and validate hypotheses in relationship between health outcomes
and Drivers of Health (DOH) Evaluate key relationships between health outcomes
and DOH to establish root cause hypotheses Define the business case for taking
action on these hypotheses to understand how efforts will lead to positive
financial, workforce, clinical, etc. implications Identify potential
foundational changes (people, process, technology) that lead to health equity
Based on qualitative and quantitative data and root cause hypotheses from phase
1, develop potential health equity levers of action (e.g., data infrastructure,
reporting, interventions, training) 9

10 Phase 2 10

11 Phase 2: Define the Health Equity Vision Engage leadership and key
stakeholders across the organization to gather input to inform and shape the
health equity vision for the organization Phase 2 Engage A Cross-functional Team
Define Health Equity Aspirations Outline Health Equity Priorities Build a
cross-functional team of leaders from across the organization to define the
health equity vision Have representation from all functional groups within the
organization to gain required input and facilitate adoption via enhanced
ownership Using the levers identified in phase 1, align with leadership on the
organization s vision related to health equity, meaning its aspirations and
purpose for pursuing the work The aspirations should set the organization s
strategic direction and can cut across various categories (i.e. talent,
partnerships, investments, internal/external policy, etc.) Based on the
aspirations, define the organization s precise priorities related to health
equity that culminate in the broader strategic narrative These priorities should
not be stand alone but rather brought through the organization's broader
strategy The health equity priorities should directly tie to and support the
aspirations but are intentionally limited in number As the health equity vision
is defined, it is important to share updates on the work with leaders to gain
organizational alignment early, which can lead to more effective implementation
11

12 Phase 3 12

13 Phase 3: Develop a Roadmap for the Future Consolidate inputs from phases 1
and 2 into organization-wide priorities and tactical initiatives, which can be
executed against to advance health equity across the communities that the
organization serves Phase 3 Define Health Equity Initiatives & Activities
Develop Future 1 Prioritize Initiatives 2 3 Roadmap Identify Health Equity
Metrics 4 Based on the communities the organization serves, identify markets and
organization data sets to inform health equity market analysis Use data to
understand the health outcomes and the prevalence of DOH factors (see DOH
framework in appendix) Aggregate public data inputs to profile the insight
markets to understand where the health disparities exist today in comparison to
the state and national averages Develop and validate hypotheses in relationship
between health outcomes and Drivers of Health (DOH) Evaluate key relationships
between health outcomes and DOH to establish root cause hypotheses Define the
business case for taking action on these hypotheses to understand how efforts
will lead to positive financial, workforce, clinical, etc. implications Identify
potential foundational changes (people, process, technology) that lead to health
equity Based on qualitative and quantitative data and root cause hypotheses from
phase 1, develop potential health equity levers of action (e.g., data
infrastructure, reporting, interventions, training) Building on your health
equity vision, developing a roadmap for the future with prioritized initiatives
can enable the organization to take action on addressing health equity, with
both short-term and long-term outcomes to drive towards 13

14 Appendix: Frameworks 14



15 Deloitte Equity and Health Equity Frameworks Three Deloitte frameworks can
guide organizations in defining their health equity strategy Equity Activation
Model Drivers Of Health Framework Health Equity Domains Framework The Equity
Activation Model captures Deloitte s foundational perspective on how
organizations can and should spark DEI transformation This framework can be used
by any organization in Phase 1 to understand the current state of health equity
and DEI in the organization and market across three spheres of influence:
Workforce, Marketplace, and Society The Drivers of Health Framework depicts the
economic, social, and environmental conditions that impact equity in health and
health care This framework can be used by any organization in Phase 1 to
understand the health and well-being of the organization and the markets and
communities it serves The Health Equity Domains Framework is a systems-based
strategy that places health equity at the center and expands across the
organization, its offerings, its community, and its ecosystem The framework
notes specific questions for life sciences and health care organizations to
examine in Phase 3 when creating a roadmap of actions to meaningfully advance
health equity Phase 1 Phase 2 Phase 3 15

16 Deloitte s Equity Activation Model A systems-based view for how businesses
across all industries can activate equity within and outside of their own
organizations Phase 1 The Equity Activation Model is a systemsbased view for how
businesses across all industries can activate equity within and outside of their
own organizations, structured around three primary spheres of influence within
the reach of every organization: Workforce, Marketplace, and Society. Products
and services Community impact and partnership Marketing and sales Standards and
policy Each sphere, in turn, includes multiple activators key areas of activity
and everyday choices through which organizations can exert their influence to
activate equity. Access Ecosystems and alliances Supply chain When understanding
your organization and market, it is important to assess each of the spheres of
influence and activators within the model. Spheres of influence Society
Advancement Enablement Marketplace Workforce Denotes the activators within each
sphere of influence Enablers and organizational culture Enablers Leadership
Governance Resource allocation Legal, risk, and compliance Data and analytics
Infrastructure Technology Workplace Organizational culture 16



17 Deloitte s Drivers of Health (DOH) Framework There is not a single solution
to health, rather an ecosystem of factors that can be influenced or altered
Phase 1 Examining each market across these factors, along with an understanding
of clinical health outcomes, can enable a more holistic view of the drivers of
health and unlock opportunities to support the organization s health equity
goals 17

18 Health Equity Domains Framework A systems-based strategy for life sciences
and health care organizations to meaningfully advance health equity Phase 3
Organization Offerings Community Ecosystem A purpose-driven strategy enables an
inclusive culture, holistic benefit package, and equitable talent infrastructure
to support and attract a diverse, empowered workforce Health services advance
wellness equitably by being accessible and affordable for all patients Strategic
investments in the DOH lead to healthier local communities, enabling a
differentiated social value proposition Diversity, inclusion and belonging are
infused in strategic partnerships, supply chain, and advocacy efforts building a
strong brand association with health equity How do we get our own house in order
and address the social and economic needs of our workforce? How effective are
our DEI programs? Is our data on these topics transparent? How are we ensuring
that our products and services and even our algorithms are addressing health
equity? How will we transform the physical and virtual communities where we
recruit, operate, and invest in to achieve equitable health outcomes? Are our
supplier and vendor partners diverse? How do we amplify our positive impact in
the industry? What role can our ecosystem relationships and advocacy agenda play
in health equity? 18

19 Glossary of Terms Bias The negative evaluation of one group and its members
relative to another, typically used to refer to both implicit stereotypes and
prejudices 1 Diversity, Equity, and Inclusion (DEI) Drivers of Health Equity
Activation Model The acronym DEI (for diversity, equity, and inclusion)
represents the summation of activities and/or the formal function within an
organization that focuses on supporting diversity, anti-oppression, inclusion,
belonging, and equity aspirations and outcomes. Diversity, inclusion, and
antiracism are distinct, but related they can each exist without the others but
are mutually reinforcing 2 The social, economic, and environmental factors
beyond health care that impact individual and community health, well-being, and
equity. The Drivers of Health are also known as the Social Determinants of
Health (SDOH) 3 A systems-based view for how businesses across all industries
can activate equity within and outside of their own organizations, structured
around three primary spheres of influence within the reach of every
organization: Workforce, Marketplace, and Society 4 Explicit Bias The
traditional conceptualization of bias where individuals are aware of their
prejudices and attitudes toward certain groups 5 Health Disparity Quantifiable
differences in health-related outcomes across dimensions such as race, gender,
age, location, disability status, and sexual orientation 6 Health Equity The
fair and just opportunity for every individual to achieve their full potential
in all aspects of health and well-being 7 Health Equity Domains Framework
Implicit Bias Racism A systems-based strategy that places health equity at the
center and expands across the organization, its offerings, its community, and
its ecosystem 8 All the subconscious feelings, perceptions, attitudes, and
stereotypes that have developed as a result of prior influences and imprints. It
is an automatic positive or negative preference for a group, based on one s
subconscious thoughts 9 A system consisting of structures, policies, practices,
and norms that assigns value and determines opportunity based on the way people
look or the color of their skin 10 Structural Racism Macro-level conditions that
limit opportunities, resources, power, and well-being of individuals and
populations based on race/ethinicity 11 Systemic Racism A form of racism
expressed in the practices of social and political institutions. It is reflected
in disparities regarding wealth, income, employment, housing, health care,
political power, education, and the criminal justice system, among other
factors. Individual, interpersonal, institutional, and structural racism
together form a system, referred to herein as systemic racism or racism 12 19

20 End Notes 1. Fitzgerald, Chloe and Samia Hurst, "Implicit bias in healthcare
professionals: a systematic review, BMC Medical Ethics, 2017;18(1):19, March 1,
Deloitte, "The equity imperative: The need for business to take bold action now,
February Kulleni Gebreyes, Jessica Perez, David Rabinowitz, and Elizabeth Baca,
Activating health equity: A moral imperative calling for business solutions,
Deloitte Insights, April 12, Deloitte, "The equity imperative: The need for
business to take bold action now. 5. United States Department of Justice,
Understanding Bias: A Resource Guide, July 29, Gebreyes et al., Activating
health equity: A moral imperative calling for business solutions. 7. Ibid. 8.
Ibid. 9. United States Department of Justice, Understanding Bias: A Resource
Guide. 10. Centers for Disease Control and Prevention, Racism and Health,
accessed August 16, National Institutes of Health, Structural Racism and
Discrimination, accessed August 16, Deloitte, "The equity imperative: The need
for business to take bold action now. 20

21 This presentation contains general information only and Deloitte is not, by
means of this presentation, rendering accounting, business, financial,
investment, legal, tax, or other professional advice or services. This
presentation is not a substitute for such professional advice or services, nor
should it be used as a basis for any decision or action that may affect your
business. Before making any decision or taking any action that may affect your
business, you should consult a qualified professional advisor. Deloitte shall
not be responsible for any loss sustained by any person who relies on this
presentation. About Deloitte Deloitte refers to one or more of Deloitte Touche
Tohmatsu Limited, a UK private company limited by guarantee ( DTTL ), its
network of member firms, and their related entities. DTTL and each of its member
firms are legally separate and independent entities. DTTL (also referred to as
Deloitte Global ) does not provide services to clients. In the United States,
Deloitte refers to one or more of the US member firms of DTTL, their related
entities that operate using the Deloitte name in the United States and their
respective affiliates. Certain services may not be available to attest clients
under the rules and regulations of public accounting. Please see to learn more
about our global network of member firms. Copyright 2021 Deloitte Development


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