Family physicians who attended the 2017 National Conference of Constituency Leaders here got a primer on achieving health equity from two very different perspectives, when family physician Kim Yu, M.D., of Novi, Mich., and Daniel Dawes, J.D., presented a session April 27 on how to be a proponent for marginalized patients and effect change at a grassroots level.
During a session on advocating for marginalized patients held at the 2017 National Conference of Constituency Leaders, Kim Yu, M.D., of Novi, Mich., reminds family physicians, "You have voices for your patients in your communities that you need to bring forward."
Yu is chair of the Michigan AFP Board of Directors; Dawes is the executive director of health policy and external affairs at the Morehouse School of Medicine in Atlanta.
Yu led off the discussion by noting that April was National Minority Health Month and that its theme for 2017 is "bridging health equity across communities."
"We know as family physicians, we can be that bridge; but are you being that bridge?" Yu asked attendees. She challenged everyone in the room to imagine a bridge stretching into their community and then picture a health-related need at the end of that bridge that they could work to address.
Yu referenced the Healthy People 2020 definition of health equity(www.healthypeople.gov) -- "attainment of the highest level of health for all people" -- along with its observation that, "Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices and the elimination of health and health care disparities."
- On April 27 at the National Conference of Constituency Leaders, Kim Yu, M.D., of Novi, Mich., and Daniel Dawes, J.D., discussed advocacy for marginalized patients.
- Yu said one way family physicians can advocate for their patients is by working with lawmakers on legislation that supports healthy living.
- Dawes said the immediate impact of legislation to repeal the Patient Protection and Affordable Care Act includes 4.3 million people losing insurance coverage.
"Do we value everyone equally in this current climate in your community and in your work? How can we advocate for patients to make sure they feel valued?" she asked.
Yu said one way family physicians can advocate for their patients is by working with lawmakers on legislation that supports healthy living. But she cautioned that sometimes it can be difficult to try to explain complex issues such as health equity and societal problems to legislators.
"So how can we frame this in language that will reach everyone that we want to?" she asked.
Speaking up for marginalized patients requires family physicians to be brave, Yu warned. But it's essential that they do speak up -- that they be a voice for their patients -- to better their communities.
Yu pointed to the Flint, Mich., water crisis as an example of when a physician -- pediatrician Mona Hanna-Attisha, M.D., M.P.H. -- spoke up in her community and became the whistleblower who shed light on the health catastrophe. The crisis happened to coincide with Yu's year as president of the Michigan AFP.
"Mona spoke up. If it wasn't for her, they still would have (tainted water)," Yu said. "How many of us are 'Monas' for our communities -- willing to speak up? Let's all be more like Mona."
Yu asked attendees whether they were in leadership positions in their state chapters and, if so, how they were driving health equity in their work.
"Do you have that health equity lens that you look through when you think about things that go on in your community?" she asked.
Yu shared that she had attended the Starfield 2: Health Equity Summit(www.starfieldsummit.com) in Portland, Ore., just a few days before this session; that summit focused on primary care's role in achieving health equity. She said family physicians should be on the lookout for results from the summit, which are to be released soon.
"There are conferences on health equity all over the country," she said. "Being present at these conferences isn't enough. We need to also be actively engaged in these conferences; spread your wisdom at these conferences."
Yu closed by touting social media as a great avenue to spread the word on health equity and what it means to patients and communities. "If you're really interested in helping out with health equity, please just start tweeting," she advised. "That's an easy way, isn't it? And if you need help, I'll help you."
Daniel Dawes, J.D., tells attendees to actively review changes being made to the Patient Protection and Affordable Care Act as Congress moves closer to passing the American Health Care Act.
During his portion of the discussion, Dawes presented historical context on the advancement of health equity in the United States, including talking about how the Patient Protection and Affordable Care Act (ACA) has improved the health care outlook for minorities. His book on the topic, 150 Years of Obamacare, chronicles how far the country has come in this regard.
Dawes explained that he was involved in the initial ACA negotiations, founding and leading the National Working Group on Health Disparities and Health Reform.
The working group represented a collaboration of 300 national organizations representing consumers, religious institutions, insurance providers, women, and medical device and pharmaceutical companies, he noted.
"There was an underlying fight for health equity within the ACA," said Dawes. "This is a fight that has taken place in the past 150 years throughout our country."
The working group came up with statistics demonstrating the cost of health disparities in the United States that it presented to lawmakers. Among those figures:
- 83,000 African-American deaths per year,
- $300 billion in financial burden to the country, and
- reduced social and economic vitality of communities, which affects national security.
"Because if people are sick and dying younger, they aren't able to contribute to their communities," Dawes said. "If this is the case, how in the world can we compete with our global competitors?"
Dawes said the working group's collaborative effort also brought together independent campaigns focused on mental health reform, minority health reform, uniform health reform and others, which gave all of these groups an ownership interest in crafting the ACA.
"We allowed them to use an equity lens and knowledge on what was impacting their communities, and create legislation to alleviate these burdens," he said.
According to Dawes, the ACA was the most comprehensive measure addressing health issues that impact disparate groups and the most inclusive law ever produced and passed by the U.S. Congress.
No fewer than 62 provisions on health equity were "scattered" throughout the ACA, said Dawes. "Because we feared should opponents try to remove the health equity measures, we'd have provisions in different sections that would still be implemented," he explained.
These ACA sections included expanded insurance coverage, data collection and reporting, and delivery and payment system reforms.
The health equity progress made with the ACA now is in danger as Congress looks to repeal and replace the law with the American Health Care Act (AHCA), Dawes warned. That bill has now passed its first hurdle: It was approved by the U.S. House on May 4 and now moves to the Senate for an additional vote.
He urged family physicians to carefully review what provisions might be lost should the AHCA be enacted, including coverage for mental health, maternity and rehabilitative care -- especially for veterans.
The immediate impact of an ACA repeal, according to Dawes, includes 4.3 million people losing insurance coverage. Furthermore, he warned, if the existing pre-existing conditions provision is repealed, 52 million Americans could be at risk of being denied coverage in the future.
He closed by calling on attendees to take an active role in shaping the changes being made to the ACA as the nation is being propelled toward a new AHCA. In that vein, he offered a quote from Marian Wright Edelman, founder and president of the Children's Defense Fund: "A new president or Congress is only going to be as good as the citizens outside demanding it."
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