While health inequities existed long before 2020, the pandemic amplified their impact on vulnerable populations across the country and in Indiana, says Marion County Health Department Director Dr. Virginia Caine. Indiana’s life sciences initiative BioCrossroads pushed the topic into the spotlight during its recent Life Sciences Summit, summoning Caine and private sector leaders to share their perspectives and highlight the urgent need to address health inequities in research, clinical settings and the delivery of care.
“The pandemic has been miraculously intense; I’ve never had a more challenging 18-month period in my 30-plus years of working in academic health centers,” says Indiana University Health President and Chief Executive Officer Dennis Murphy. “It’s been really hard, but it’s also given me a glimpse of how much we can change and adapt for better when we really put our minds to it.”
When national data early in the pandemic showed that, adjusted for age, people of color experienced death rates two to three times higher than white populations, Murphy says IU Health realized the need to examine its own outcomes by race and ethnicity. “Those numbers didn’t look as good” for IU Health very early in the pandemic as they do now more than 18 months later, says Murphy, noting that the health system is actually showing better outcomes for African Americans than white patients. The Covid death rate for black patients at IU Health is 10% and 14% for white patients.
While Murphy says the improvement showed that “you can change the course of care and the behaviors you have,” the largest healthcare system in the state realized much more progress was needed after the December 2020 death of Dr. Susan Moore; she was discharged from IU Health North in Carmel while battling Covid. In a video she posted on Facebook, she said she was treated poorly due to her race.
“You can look at these broad statistics and say, ‘We’re doing ok,’ but Dr. Moore’s death really opened our eyes to the fact that, at the end of the day, this is about each individual patient, and do they feel like they got the appropriate care?” says Murphy. “It was a sentinel moment for us to evaluate what does it mean not to look at just the technical components of care, but also the humanistic components of care, and what does that mean for each and every patient?”
Caine, who was also part of the panel discussion at the summit, says health systems often don’t realize that vulnerable populations’ ability to access care is an issue at the organizational level. She’s encouraged that three health systems in Indianapolis—IU Health, Eskenazi Health and Community Health Network—have recently pledged that diversity and inclusion is a major focus of their institutions.
“I think we’ve made a significant amount of progress in the last one to two years. We’ve had some painful dialogues; it’s sometimes painful to talk about this,” says Caine. “How do you attract and retain the type of talent in your organization that has a better understanding of [health disparities], so that it’s blended in your processes every day in your organization?”
Murphy says IU Health has increased its focus on transparency; the health system is now tracking its workforce diversity and sharing the data on its website.
Caine notes that organizations often say it’s a challenge to find qualified applicants who are people of color; she says this highlights the need to increase diversity within the pipeline of future healthcare workers.
“Do we have enough internships for high school students to get exposure to healthcare careers?” says Caine. “If young students live in the inner city, they may not get the same exposure as white students living in a suburban area. We’re not starting out on a level playing field. What can we do as businesses, institutions and governmental agencies to level the playing field?”
Murphy says taking action is one pillar of IU Health’s effort to improve health equity. It recently launched a pipeline program at Crispus Attucks High School, within Indianapolis Public Schools, to train students to become medical or nursing assistants; they’re guaranteed a job with IU Health and tuition assistance to complete a related post-secondary degree. For the health system’s major project in downtown Indianapolis to build a new hospital and medical campus, IU Health aims to award 25% participation on design and construction to certified veteran, women and minority-owned businesses. IU Health also established the Community Impact Investment Fund, which awards grants to address social issues affecting health outcomes across the state.
“There should be no activity that we’re working on that we don’t take the time to understand how it impacts different people and different populations—it has to be woven into everything you do,” says Murphy. “We know we have to do better; now it’s the persistent and consistent execution on that. I believe this has been a wakeup call, and there’s also a road forward for us to be better.”
Murphy says being transparent with data and information is central to accountability.
Caine says the health equity effort in central Indiana has progressed in the last few years and is no longer “just lip service.”