This letter was offered to the American Nurses Association Massachusetts (ANAMASS) as part of their newsletter.
Massachusetts is often celebrated nationally as a leader in health care. But if we look closely, we see another painful reality — deep chasms of racial and ethnic health inequities in the Commonwealth — created by generations of structural racism and socioeconomic inequality.
From a study reported by GBH, “Black women in Massachusetts are 2.5 times more likely to die from pregnancy-related causes than other women.” The latest Department of Public Health (DPH) data show that the rate of COVID-19 infections in Massachusetts is almost three times higher for people identifying as Latinx as compared to white people. And the stark and ugly list could go on and on from here.
What if we could ensure that a governor’s administration and the state legislature had to prioritize racial and ethnic health equity — in all levels of state government — when making budgeting and policy decisions? This would mean that all major spending choices, all consequential policies, would be evaluated as to whether they increased or hurt health equity.
This very question propelled Representative Liz Miranda (D-Boston) and me to file S.1388/H2373, An Act Establishing Health Equity at All Levels In Government, also known as The HEALING Act.
The COVID-19 pandemic demonstrated how brutal inequities can mean the difference between life and death. That’s why this legislation tackles structural racism head-on by centering health equity throughout government, in every agency, with leadership in the governor’s office and sharp, community-led accountability measures.
This is a racial justice imperative. It is also a matter of urgent health policy. And the related issues are so massive that we can’t reform. We must transform.
The HEALING Act initiates three concrete steps to (1) build a culture of health equity throughout the Commonwealth’s government; (2) provide government agencies and the Legislature with tools and structures to engage; and (3) ensure accountability through community oversight.
The bill starts from the understanding that our individual and community health is only partially based on our medical care system. Government also has a significant impact on our health through what it does around education, housing, transportation, environmental policy, and more — and through how it responds in a pandemic. Where we build a road, or whether school meals are available to children, or which toxic chemicals are permitted in our water all have an enormous impact on health equity.
Why go about it like this? We spoke with experts from other states that have created similar initiatives with success. The key, we learned, is to build a culture throughout state government which recognizes that advancing health equity is the role of the entire government.
Our legislation proposes a HEALING Initiative within DPH, a new hub which would advise other state agencies and track decisions across state government. The initiative would provide training and technical assistance, assisting with self-audits and policy review. It would also bring public voices into these decisions to provide feedback and accountability.
Because the best time to consider how a policy will affect health equity is before it becomes law, the HEALING Act also gives DPH and the Legislature a new tool — the Health Equity Assessment — to evaluate the potential impact of pending legislation and spending decisions.
Health equity requires genuine buy-in from all sectors that contribute to the social determinants of health. So, the HEALING Act asks each agency to take charge of its own health equity work. The legislation proposes that agencies develop health equity strategic plans, working with DPH’s HEALING Initiative and a well-constructed Community Oversight Board.
As nurses, you experience firsthand the role social factors play in determining who is sick and who is well. You can see the aching disparities across race and ethnicity. You also have substantial political power, with the voice of nursing reflecting the need for compassionate care for the whole patient. I respectfully ask the nurses of Massachusetts to review this legislation, and determine if they can put their full weight behind it, as a call for equity and justice for everyone in our Commonwealth. I remain deeply grateful for your tireless service.