Is Health Equity Within Reach?
Explore your role in increasing health equity for people working to prevent or manage diabetes.
What is health equity? How does it impact you and your work in diabetes care? What are the advantages of learning about racism, oppression, and stigma? This article will clarify these terms while identifying practical resources for healthcare workers.
What is Equity?
The Robert Wood Johnson Foundation (RWJF) provides the following definition:
“Health equity means that everyone has a fair and just opportunity to be as healthy as possible.”
To achieve health equity, healthcare must remove obstacles to health. Our clients' barriers and obstacles are collectively called the Social Determinants of Health, SDoH. The Social Determinants of Health focus on five areas;
socioeconomic status (education, income, occupation);
neighborhood and physical environment (housing, built environment, toxic environmental exposures);
food environment (food insecurity, food access);
health care (access, affordability, quality); and
social context (social cohesion, social capital, social support).
The American Diabetes Association identified health inequity, specifically understanding of the social and environmental factors of diabetes, as accounting for 50 to 60 percent of health outcomes.
The stark nature of recent reports has made it clear reducing the medical and human cost of diabetes care will require professionals working in this field to understand how bias, stigma, and the SDoH are impacting engagement, medical care, and policy.
Understanding how the SDoH can be impacted by race is a complex process. Dr. Williams created an analogy to visualize racism as similar to building a house. In the article, The House that Racism Built.
Williams, et al., define racism “As an organized system, premised on the categorization and ranking of social groups into races and devalues, disempowers and differentially allocates desirable societal opportunities and resources to racial groups regarded as inferior.” Williams states, “Research finds that although socioeconomic status, SES predicts variations in health status within each racial group, racial disparities persist at every level of SES.” Williams and his colleague make the point that poverty does not cause racism.
This means racism is separate from poverty, and conversations that do not consider the historical, intergenerational, persistent-institutional, and personal trauma of racism and intersecting forms of gender, sex, and size oppression are unlikely to establish the necessary interpersonal trust needed in healthcare.
What does this mean for you, the healthcare professional?
Are you comfortable talking about oppression and its relationship to diabetes care? If not, why?
You know that diabetes is one of the most expensive conditions.
You know that people with diabetes face multiple forms of stigma - including financial, weight, racial, health, and the stigma of ignorance.
You already know that having a chronic condition increases emotional stress. Imagine how a marginalized or Trans-folk currently feels as the political divide in the United States widens.
Talking About Oppression
You may wonder, “How can I talk about racism and stigma at work?” There isn’t a single way. There isn’t a recipe to follow. Stigma and oppression aren’t things you fix or a problem you must solve. Think of these issues as complex knots that you help untangle. Untangling racism, sexism, healthism, and oppression isn’t a job for someone else. It is a job for everyone. Whether you know it or not, oppression hurts you and everyone you love. Unsure how, read The Sum Of Us - by Heather McGhee.
You don’t have to start big. Start with yourself and engage in training and professional development that enables you to understand the world's historical, institutional, persistent-institutional, and personal trauma. Read books like Weathering to grasp better how racism impacts health. Recognize and call out all forms of stigma, including weight, health, and diabetes. Set clear intentions to reduce stigma in the workplace and identify resources that help people heal from the harm caused by stigma.
If these suggestions don’t sound right, visit The Other and Belonging Institute. They are an excellent resource that provides organized training opportunities for personal and professional development.
Williams DR, Lawrence JA, Davis BA, Vu C. Understanding how discrimination can affect health. Health Serv Res. 2019 Dec;54 Suppl 2(Suppl 2):1374-1388. Doi: 10.1111/1475-6773.13222. Epub 2019 Oct 29. PMID: 31663121; PMCID: PMC6864381.