• Addressing Health Equity and Systemic Racism

    AAFP Leads Charge in Providing Members With Resources, Guidance

    December 2, 2021, 4:41 p.m. News Staff — On his first day in office, President Joe Biden issued an executive order that called for the federal government to “pursue a comprehensive approach to advancing equity for all, including people of color and others who have been historically underserved, marginalized and adversely affected by persistent poverty and inequality.”

    Equity spelled with blocks

    While health equity was not specifically mentioned in the Jan. 20 executive order, Biden signed another executive order a day later that, among other things, established a COVID-19 Health Equity Task Force. The task force’s final report, published in October, found considerable improvements in COVID-19 hospitalization rates, deaths and vaccination rates among Black and Hispanic individuals compared with white individuals over the past year. The report also featured a list of 316 recommendations focused on areas such as investing in community-based efforts, improving health-related data collection by race and ethnicity, and increasing representation of people of color in the health care system.

    Just as the administration has taken steps throughout the year to improve health equity and address systemic racism, so have several individual medical professional organizations — including, of course, the AAFP. As the year comes to a close, the following illustrates how the Academy and other groups have tackled these issues in 2021 and will continue to do so in the years to come.

    Year in Review: Actions Taken by the AAFP

    The AAFP has focused on health equity over the past several years through the work of the Center for Diversity and Health Equity. The center has overseen the creation and curation of numerous resources for members to address health equity in their practice and community, which can be found in the EveryONE Project toolkit

    Story Highlights

    Highlights among the AAFP’s diversity and equity activities in 2021 include the following:

    In February, the Academy rolled out a health equity-focused advocacy webpage to increase member awareness of the organization’s advocacy efforts. Updated regularly, the page contains links to communications from the AAFP to the Biden and Trump administrations, along with joint communications efforts from the Academy and other health care groups.

    In March, the Academy hosted a Virtual Town Hall on Power to Heal, an award-winning documentary on Medicare and the Civil Rights movement. Speakers at the event discussed ways to advance health equity for Medicare beneficiaries, as well as recent legislative and advocacy efforts.

    In April, the Academy recognized National Minority Health Month with an emphasis on publishing news stories and blogs from family physicians who have worked tirelessly to address health equity and serve minority patients.

    Also in April, the AAFP hosted “Striving for Birth Equity,” a Virtual Town Hall that debuted in conjunction with Black Maternal Health Week and addressed topics related to rural health, the COVID-19 pandemic and advocacy.

    In September, the AAFP and Association of Family Medicine Residency Directors issued a call for applicants for the 2021-2022 AAFP Health Equity Fellowship. A committee has reviewed the applications, and an announcement on the 2021-2022 class of fellows and their research projects will be published soon.

    Most recently, the Academy partnered with the American Board of Family Medicine to produce “Health Equity: Leading the Change,” an enduring CME program that covers social determinants of health, supporting vulnerable populations and other topics — just one of several CME products the Academy offers on health equity.

    And as always, the AAFP continues to add to its vast assortment of journal articles from American Family Physician and FPM on issues related to health equity.

    Other Steps and USPSTF Support

    The AAFP has also been working to be more intentional in using a health equity lens in developing clinical recommendations and policies. Recent clinical practice guidelines were developed using the GRADE evidence-to-decision framework, which provides a mechanism for panel members to discuss impacts on equity in addition to other relevant domains of patient preferences/values, feasibility, acceptability and benefit/risk analyses.  In addition, the AAFP has included discussions of systemic racism and health equity in recent clinical preventive services recommendations, and the Academy has made the adoption of gender inclusivity and gender-neutral language a primary focus going forward.

    These actions put the Academy in step with the U.S. Preventive Services Task Force, which has made a number of public efforts to outline its work in addressing systemic racism, equity and gender inclusivity.

    In the Jan. 25 issue of JAMA, the task force published an editorial, “Addressing Systemic Racism Through Clinical Preventive Service Recommendations From the U.S. Preventive Services Task Force,” that outlined its commitment to several actions designed to help achieve the goal of improving health equity through evidence-based clinical preventive services. In response to those actions, in July the USPSTF published a technical brief, “Addressing Racism in Preventive Services: A Methods Project for the U.S. Preventive Services Task Force.” 

    As a followup to the editorial, the task force published two additional papers in the Nov. 25 issue of JAMA — one a methods report that summarizes the issues surrounding racism and health inequity and how those issues are being addressed in preventive health, the other an article that briefly reviews the technical brief’s findings while focusing on updates of the task force’s methods to address systemic racism and promote health equity with regard to preventive services.

    And in November, the task force submitted a report to Congress that called for more research in areas where evidence is lacking for populations that are disproportionately affected by health conditions. In particular, the USPSTF requested that more research be conducted related to health equity in the areas of cardiovascular disease and cancer prevention. The AAFP was one of 15 partner organizations that signed a statement of support for the task force in highlighting systemic racism and other issues of inequity.