Getting Real About Health Equity: A Conversation With Dr. Patrice Harris

As a psychiatrist, Patrice Harris, MD—former president of the American Medical Association— says she is used to asking hard questions and having uncomfortable conversations. And she thinks organization leaders should be, too, particularly when it comes to health equity.

Everyone has to decide if their commitment to health equity is performative or real, she said when talking with Hinge Health Director of Content Marketing Jenny Sucov on the Movement 2023 On Air podcast. Then they have to realize that what one person may need to achieve good health may be different from what someone else needs, she added.

Dr. Harris shared her insights on why organizations need to prioritize and reorganize themselves in order to address the issue of health equity—and why there is no universal starting point or one-size-fits-all solution.

Jenny Sucov (JS): In your speech at Movement 2023, you spoke about health equity and what organizations need to do to be able to address those issues. Can you recap some of the great points you shared?

Patrice Harris, MD (PH): I think health equity needs to be a foundation of all the work going forward. And we should agree on a couple of things:

The first is the definition of health equity, which is everyone having an optimal opportunity to achieve good health—plain and simple. But what you may need to achieve good health may be different from what I need.

Once you know that health equity is important to your organization—and hopefully it is important to every organization—then you look inwardly and decide the best path forward.

There is no one-size-fits-all sort of solution here. It's about centering health equity, defining it, having a commitment from the leadership, having appropriate resources to carry out that mission, and then collecting data about where you are today.

Because everyone has a starting point and it will be different. Every organization has a history. The American Medical Association had a history of being exclusive of Black physicians.

So every organization has a history that they can say, 'We have this history. We're going to move forward from this point.'

There has to be some recognition and appreciation of that history and discussion, again, about how you move forward with appropriate resources, accountability, and leadership.

JS: In recent years, more organizations have created diversity, equity, and inclusion task forces, but they are often segmented from the rest of the company. How do we help them put health equity at the center?

PH: I don't mind, and maybe this is because I'm a psychiatrist, asking hard questions and having uncomfortable conversations. And that's what everyone has to have and decide: Is this performative or is this real? And if it's real, how are you going to demonstrate that?

You could start with an organization's mission and values, or their population.

Who are you trying to help? What's your why?

Sometimes organizations think about the people they serve, but don't look inward at their own teams and who is around decision-making tables.

Another concrete recommendation I make is to put this on the agenda. This way, it's not anyone's responsibility to raise the issue. What are we going to talk about today that centers health equity?

In my career, I've been the only woman or the only African-American. And it was sort of my responsibility to raise issues that weren't discussed. And I can tell you that although I have been happy to do so, it can be a bit of a burden. Everyone is waiting on me to do it.

The leader of the meeting should also ask: Who is not at this table?

JS: Talk to me more about asking employees what they need. Why isn't that something that everyone does?

PH: Sometimes it's not mal-intended, right? We're all trying to solve problems and everyone around the C-suite table says, 'Oh, this is a great idea.' I've been there, done that too. I get it.

But, do you know what your employees think? Ask them and take learnings from that.

I believe that leads to ownership of the problem. Be transparent: 'We're trying to solve this problem. We have some ideas. We want to hear from you. What do you think?'

And then I think the key is going back to that group and saying what you've come up with. If you have 100 ideas, you can't implement 100 ideas. Say what rose to the top.

Then, inspect what you expect. Earlier today, we heard about how Hinge Health is collecting data, looking at insights from that data, then going back and collecting more. The learning has to be sustained. There should be allowances for evolution of the data.

When you ask people what they want to do to solve a problem, they will ask where you are with that. You should go back and make sure people understand some of those insights and results of the work.

JS: Tell me more about the importance of building trust.

PH: I am privileged to belong to a profession that is still trusted. But it's important to remember that trust needs constant care and feeding. And in order to be trusted, you have to be trustworthy. And that's a set of behaviors.

Of course, we've seen the erosion of trust in institutions, some of that warranted, actually. And so, again, we need constant feedback and iteration to ask: Am I being trustworthy?

This came up in COVID around vaccines, particularly in communities of color. I think there was sort of a knee-jerk reaction, particularly in the Black community, because of past studies like the United States Public Health Service study at Tuskegee. That may help people understand why some do not trust this brand-new vaccine that is coming from the government.

Those of us around the table who appreciated that and so many other issues said, 'We've got to go to the community, use brokers who are trusted by the Black community, and have them talk about the data and evidence.'

Not browbeat people, even though I'm pretty rabid about the need for vaccines. But give people information so they can make informed choices and not choices based on all of the misinformation we see on social media.

Trust is important, but trust is earned. And you have to be trustworthy.

JS: How does context matter in health care?

PH: Let's say I'm a person in pain who has health coverage. If I can get time off work and have transportation, I can get to my physical therapy appointments. But my co-pay is $30/visit. At three visits a week, that's hundreds of dollars a month. But an opioid prescription is $10.

You have to understand all of these issues and make sure that solutions are equitably available. That's health equity.

JS: You were the chair of the AMA's Opioid Task Force. Where are we as a country today?

PH: When you look at the context of the opioid epidemic, and now we say the overdose epidemic, we are kind of in our fourth wave.

The first wave was in the seventies and eighties, when heroin was the main problem. This is outside of the healthcare system, but our country's approach to that—incarceration—is important to learn from.

It was only when we were in this next wave with pain medications—where most of the people impacted were white, upper-middle and middle class—that our country decided to take a look at this from a healthcare perspective and say, 'boy, we need more treatment.' As a psychiatrist, I'm glad we got to that point. But I just think have to at least mention the past. We just have to appreciate that and understand that context.

And certainly, the federal government has a role to play. Folks have pain, need treatment for their pain, and need access to a multifactorial approach to it (e.g., physical therapy, what is happening here at Hinge Health).

There's no question we want the use of opioids to be appropriate and judicious. But we also want to have other options equitably available so that it's not just about the medication.

These responses have been edited for clarity and brevity.