April 5, 2022, 8:41 a.m. Danielle Jones, Ph.D., M.P.H., and Viannella Halsall, M.P.H. — In 2017, in response to a resolution from the Congress of Delegates, the AAFP established the Center for Diversity and Health Equity to take a leadership role in advancing diversity in the family medicine workforce, advocating for health in all policies, promoting health equity through collaboration within the Academy and with external organizations, and furthering knowledge and awareness of social determinants of health.
Since that time, Academy members, chapters and staff have used the CDHE to position the AAFP as a leader with significant impact and influence on the myriad health and social issues faced by the patients and communities family physicians serve.
In recognition of the CDHE’s five-year anniversary, and in observance of Minority Health Month, the following summary encapsulates the Center’s accomplishments while also offering a brief glance at the Center’s recent and upcoming projects.
In 2018, the AAFP launched The EveryONE Project™ initiative to offer our members education and resources to advocate for health equity, promote workforce diversity, and collaborate with other disciplines and organizations to reduce harmful health disparities.
As part of The EveryONE Project™, a four-part SDOH toolkit was developed to support members in addressing social needs in their practices and the communities they serve. Among other things, the toolkit includes resources for social needs screening, implicit bias training guides, practice leadership materials and a physician advocate brief.
Another resource launched in 2018, the Neighborhood Navigator, helps family physicians connect patients with supportive resources in their neighborhoods. Through January 2022, the Neighborhood Navigator has handled more than 273,000 cumulative searches by more than 107,000 unique users, and has provided more than 182,000 resources to meet patients’ needs.
The CDHE has supported the development of several AAFP policies and position papers on health equity as directed by the Congress of Delegates. A few examples of more recent policy statements include those pertaining to implicit bias, birth equity, institutionalized racism and race-based medicine. These policies position the AAFP as a vocal and outspoken leader on health and social issues at the federal level and provides our members and chapters a platform to serve as advocates in their communities.
The CDHE leverages the Academy’s policies and position statements in the development of a vast array of CME products that provide members with both foundational knowledge and the clinical skills to address health disparities at the point of care. The AAFP’s health equity CME portfolio addresses important topics such as weight bias, birth equity and social determinants of health, while additional topics such as racism in health care, and COVID-19 and implicit bias are offered at live events such as FMX or made available via livestream.
Between 2016 and 2021, the total number of CME sessions conducted has increased more than six-fold (from 58 to 393). Similarly, the total number of unique learners reached has nearly tripled (from 4,495 to 12,984), while the total number of credits reported has increased more than five-fold (from 9,485 to 52,243).
A recently developed self-study CME course, “Health Equity: Leading the Change,” includes learning objectives that allow family physicians to differentiate individual and institutional racism and to understand racism as a risk factor. The course offers up to 6.5 enduring credits and is available for free to all members. New CME offerings covering topics such as the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care, primary care for people with disabilities, and race in medicine will launch later this year.
The Health Equity Fellowship, which debuted in 2018, provides an opportunity for family physicians to gain knowledge and experience in translating the concepts of health equity into clinical practice through a capstone project. The fellowship is a vital part of the Academy’s work to create leaders across the specialty who can address health inequities at the system and community levels. To date, 17 members have participated in the fellowship, with funding support from the AAFP Foundation and the Association of Family Medicine Residency Directors. Capstone projects developed by past fellows have included social needs screening in outpatient clinics, development of a weight bias curriculum, assessment of imposter syndrome among faculty underrepresented in medicine, development of a pathway program for minoritized students and implementation of an addiction medicine curriculum with an equity lens.
In 2021, fellows were asked to complete an anonymous online evaluation at the end of their fellowship. In general, fellows who completed the evaluation rated the fellowship from “good” to “excellent,” with 50% rating the experience as excellent, and all strongly agreed that their experience would have positive personal benefits. One fellow commented that they “gathered skills and experiences to assist in (their) next career step as well as new contacts and resources,” while another stated, “I also feel like my understanding and knowledge of the depths of institutional racism has grown and expanded.”
Additionally, several chapter grant programs have been established to facilitate the dissemination and implementation of educational materials and resources developed by the CDHE. Over the past five years, 22 chapters have been awarded $170,000 in funding to support the development of health equity champions and implicit bias training.
In March 2021, the CDHE partnered with the School-Based Health Alliance to develop and implement two national learning collaboratives with the goal of increasing awareness about SDOH and social needs screenings in school-based health clinics. Administrative and clinical practice teams from 22 health clinics across the country participated in these collaboratives and received a participant workbook developed in part by the CDHE.
In conjunction with these collaboratives, in May and June 2021 CDHE staff, in partnership with the Health Equity Fellows, provided one-on-one technical assistance through coaching calls with five school-based health center teams. Post-session evaluations demonstrated that the majority of participants were very satisfied or extremely satisfied with the presentations, and all participating centers committed to initiating and expanding SDOH screening and referral efforts at their sites.
The CDHE also was instrumental in developing the AAFP’s proposal for a three-year grant opportunity from the Health Resources and Services Administration to create and implement well-being and mental health programming for health care professionals through an equity lens. The Building Resiliency Intersectionality During Graduate Education program will develop, pilot and disseminate training and education materials by expanding on the Academy’s Physician Health First® initiative to include conference sessions and workshops with a focus on the intersection of health equity, and apply a “train the trainer” model for building resiliency skills to support underrepresented medical students and family medicine residents. To guide the proposed programming, the AAFP is establishing a stakeholder advisory group that will include medical students and family medicine residents along with representatives from AAFP state chapters, the Society of Teachers of Family Medicine, the American Board of Family Medicine, the National Medical Association and the National Hispanic Medical Association.
The CDHE continues to execute strategic priorities established by the AAFP Board of Directors.
The CDHE, the ABFM and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care have also partnered in a research initiative designed to examine key issues related to diversity and equity. Under the initiative, research will be published through a series of policy briefs, commentaries and related items in the Journal of the American Board of Family Medicine, with the first article, “Informing Equity & Diversity in Primary Care Policy and Practice,” available now.
The CDHE is also partnering with the Robert Graham Center on the evaluation of the STFM’s Academic Family Medicine Antiracism Learning Collaborative. In a separate project, the CDHE is working with the Academy’s Division of Research, Science and Health of the Public on the United Health Foundation Leading Physician Well-Being program to examine the effects of discrimination, bias, microaggressions and racism on physician well-being.
Finally, the CDHE supported the development of a handbook, How to Be a Family Medicine Ambassador, which is designed to help family physicians take steps to grow the specialty, recruit a diverse workforce, and generate a positive vision for the future of family medicine. The handbook was shared with AAFP chapters in December 2021 to pilot and gather initial feedback.
Danielle Jones, Ph.D., M.P.H., and Viannella Halsall, M.P.H., are the director and health equity project and program specialist, respectively, of the AAFP’s Center for Diversity and Health Equity.