Massachusetts is often celebrated nationally as a leader in health care. But if we look closely, we see another painful reality — chasm after chasm of racial and ethnic health inequities in the commonwealth — created by generations of structural racism and socioeconomic inequality.
From a study reported recently by WGBH, “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 more than 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 racial equity.
If decisions had the potential to worsen conditions for people of color, we wouldn’t move forward. And conversely, decisions that had the potential to close racial and ethnic health equity gaps would be front-burnered.
That’s what I’m after this legislative session and why I filed S.1388, An Act Establishing Health Equity at All Levels In Government, also known as The Healing Act.
The COVID 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.
Health equity isn’t a new concept. Groups like the Western Massachusetts Health Equity Network and individuals like Dr. Frank Robinson, vice president of public health for Baystate, have been leading the way for years.
Over time, the imperative of health equity has driven more and more academic research. After fielding significant criticism surrounding its take on structural racism, the Aug. 17 issue of the Journal of the American Medical Association, or JAMA, is devoted to disparities and inequities in medicine and health care. In one article, researchers studied nearly 600,000 people from 1999 to 2018 and found that, regardless of increased access to health insurance, people of color largely had persistent health inequities which translated into worse overall health outcomes and higher mortality rates.
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 commonwealth 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.
Why go about it like this? We spoke with experts from other states that have created similar initiatives with success. The 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 also educate the public on the connection between our state government’s choices and our health.
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, subject to approval by DPH’s HEALING Initiative and a well-constructed Community Oversight Board.
If this sounds like pie-in-the-sky thinking, it isn’t.
A 16-member, statewide Health Equity Taskforce (with Dr. Robinson as a key member) this summer returned the recommendations which track closely to this legislation:
- Create a cabinet-level Executive Office of Equity charged with creating three- to five-year strategic plans, and create accountable Equity Offices within each secretariat.
- Create an Equity in All Policies practice to evaluate the impact of state policies and programs.
- Ensure equity data and dashboards on multi-dimensional indicators to track measurable progress and build transparency and accountability.
What we need now is the political and social will to make this necessary and absolutely possible shift.
Is this the only action we should be taking? Absolutely not. Thanks to the Health Equity Taskforce, we now have a statewide equity roadmap. You can read it here: https://malegislature.gov/Bills/192/SD2731.
State Sen. Jo Comerford represents 160,000 people living in 24 cities and towns in the Hampshire, Franklin, Worcester district in the Massachusetts Legislature.