Addressing Health Equity, Social Determinants From Many Angles

Rather than focus on a specific issue, the Academy has taken a wide-ranging approach to address health equity and SDOH over the years. While it should be emphasized that the following topic lists are by no means exhaustive, they illustrate some of the Academy’s efforts in these areas during the past decade.

Research

In 2016, the AAFP National Research Network began work on a five-year research project, PREPARE (PeRson EmPowered Asthma RElief), designed to address the use of asthma treatments in African American and Hispanic/Latinx patients.

In 2019, the AAFP NRN published a research paper in the International Journal for Equity in Health, the results of which have been used to help shape the Academy’s health equity strategy.

In December 2020, the AAFP announced two initiatives through its Office Champions Quality Improvement model, with the goal of improving immunization rates; one project will focus on minority populations as a whole, while the second focuses specifically on African American adults.

And in January 2021, a study by researchers at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care was published online ahead of print in The Journal of Racial and Ethnic Health Disparities. The study, “Patient-Physician Racial Concordance Associated With Improved Healthcare Use and Lower Healthcare Expenditures in Minority Populations,” analyzed several years’ worth of Medical Expenditure Panel Survey data and found that racial concordance between patients and physicians resulted in less ER use and reduced health care expenditures. The authors concluded that their research supports the hypothesis that racial concordance contributes to a more effective therapeutic relationship and improved health care and underscores the need for more medical education that involves cultural humility, as well as a more diversified workforce.

Health Equity

In 2017, in response to a resolution from the Congress of Delegates, the Academy formed the Center for Diversity and Health Equity with the goal of helping family physicians identify and address social determinants of health to improve patient and population outcomes. A key component of the center is The EveryONE Project^TM, which provides members with tools and resources to help advocate for health equity and promote workforce diversity.

In 2018, the Academy, along with the Association of Family Medicine Residency Directors, established a Health Equity Fellowship. Now in its third year, the program, which offers support from mentors and AAFP staff, provides fellows with knowledge and experience they can use to translate the concepts of health equity into clinical practice.

That same year, The EveryONE Project published a physician toolkit that provided resources on implicit bias training, practice leadership, assessment and action, and community collaboration and advocacy. The EveryONE Project also published a Health in All Policies issue brief to guide policymakers in making informed decisions about policies and services to improve the health of the public.

In August 2019, the AAFP released a health equity curricular toolkit, giving FPs a valuable resource for discussions on social determinants of health, vulnerable patient populations, economics and policy.

In January 2020, The EveryONE Project published an implicit bias training guide to increase clinician awareness of implicit bias and provide resources on how health care professionals can reduce its negative effects on patients.

And in February 2021, the Academy debuted a Health Equity webpage to raise awareness of the AAFP’s ongoing advocacy on this topic. Members who visit the page can review recent communications from the AAFP to the Biden and Trump administrations, along with joint communication efforts of the Academy and other health care organizations.

Advocacy

In March 2020, the AAFP sent a letter to two members of the Black Maternal Health Caucus urging passage of the Black Maternal Health Momnibus Act. The Group of Six, which includes the Academy, sent a similar letter in support of the Black Maternal Health Momnibus Act of 2021.

In April 2020, the AAFP sent a letter to the Senate Finance Committee in response to a request for information on improving the nation’s maternal morbidity and mortality rates.

In May 2020, the Academy released a statement attributed to (then) President Gary LeRoy, M.D., of Dayton, Ohio, that strongly condemned racism in any form.

Also in May 2020, the AAFP submitted a letter to CMS Administrator Seema Verma, M.P.H., that, among other things, called for policies that would educate physicians about implicit bias and build strategies to address the issue by supporting culturally appropriate patient-centered care.

In June 2020, the Academy sent a letter to the Domestic Policy Council saying, among other things, “It is time for the United States to officially recognize racism as a public health issue and declare a public health emergency to address the negative impacts racism is having on the physical and mental well-being of millions of people.” The AAFP also recommended that the council convene an interagency task force of experts from the federal government along with state and local government officials, the private sector, medical professionals and community-based organizations to develop a federal response to systemic racism.

And in February 2021, the AAFP released a statement praising President Biden for signing an executive order that required agencies to review the public charge regulation instituted by the previous administration.

Education

Among the AAFP’s numerous CME offerings, the Academy’s Global Health Summit Self-Study Package contains several modules on health equity and addressing health care disparities from the 2020 AAFP Global Health Summit, including a panel discussion, “Health Equity Across the African Diaspora.”

In June 2020, the Academy hosted a Virtual Town Hall titled “The Public Health Crisis of Racism” to help participants identify and address racial trauma in the clinical setting, and help advance strategies that promote racial equity in the community.

In September 2020, AAFP produced a CME activity titled “Racism in Healthcare: Understanding” to educate learners to recognize the ways in which racism affects the health of the public and to develop strategies to recognize both implicit and explicit bias.

And in March 2021, the Academy hosted a Virtual Town Hall based on the award-winning documentary Power to Heal that discussed ways to advance health equity for Medicare beneficiaries, along with related legislation and advocacy.

The Academy has also developed a pair of CME webinars, “Managing the COVID-19 Crisis: Tackling Implicit Bias”  and “COVID-19: Special Populations and Demographic Connection,” as part of its Pandemic Self-study Package: COVID-19.

News and Other Resources

AAFP News has routinely reported on the results of studies and surveys from medical journals and other publications regarding workforce diversity and health equity, including

• creating a diverse family medicine residency,
• the rate of diversification in the specialty and
• mobilizing for health equity.

On Oct. 15, 2020, the editors of American Family Physician, FPM and several other family medicine journals, as well as the editor of the monthly FP Essentials^TM monographs, published a joint statement, “Systemic Racism and Health Disparities.”  In the statement, the editors expressed a commitment to “actively examine the effects of racism on society and health and to take action to eliminate structural racism in our editorial processes.”

The Annals of Family Medicine has compiled a bibliography on systemic racism and health disparities generated by the family medicine community.

AFP has assembled a topic collection on the care of special populations, featuring several articles that discuss the care of ethnic minorities.

Finally, FPM has maintained a long-running topic collection on health equity, diversity and social determinants of health.