2019 is the Year of Change
As the new Director of the Disparities Solutions Center (DSC), I’m pausing a moment to reflect on the growth of the Center. In 2005, MGH launched the first ever disparities action-oriented center to be based in a hospital under the leadership of Dr. Joseph Betancourt. This was also the same year that I joined the DSC. I have been fortunate to have been part of a fantastic team that has led the DSC to national leadership in the area of disparities and equity, particularly as it relates to health care. However, the environment in which we play has not stayed stagnant, and as we are poised now to determine what DSC 2.0 will look like, I reflect on what I have observed in the last decade or more of doing this work:
- The goal of providing high quality care remains as we have not significantly narrowed the gap in disparities since the 2002 IOM Unequal Treatment report came out.
- We have, however, widened the scope of our work beyond the health care setting to include the influences of social determinants of health like hunger, lack of housing, and immigration.
- Health care reform was a step forward, but we struggled with how to deliver pay for performance without widening the disparities gap and leaving some groups behind.
- There are now daily examples in the news and social media of interpersonal racism, structural racism, and many other “isms.”
- Despite these daily examples, conversations about race, racism, and the importance of diversity remains a challenge, whether it be in the board room, during clinical meetings, or among peers.
- And more importantly, we really need to consider these issues of disparities in the context of our country’s history to understand how we got to “here.”
With this changing landscape it’s imperative that we continue to innovate and develop strategies that stay relevant and work in practice. As we strategize about what DSC 2.0 will look like our team will be thinking about how we can respond to this changing environment for sustainable action.
This week my husband and I were watching the local news which had a segment about a police incident with a former Black NFL player that happened right at the end of our street (linked here). As longtime residents of that neighborhood, we both agreed that if we were in the driver’s position we would have both pulled over in the same area. But as an Irish immigrant male, or a Dutch-Indonesian female, we would likely have a different interaction with the police. This is a stark reminder that the racial and ethnic disparities we see in health care are just the tip of the iceberg, and that this continues to be a complex, nuanced problem our nation faces.
In January I said to myself, “2019 is the year of change!” It certainly has been in the small microcosm of our Center. Our commitment to addressing racial and ethnic disparities has not changed. And while as a nation we’ve made some progress, even within the field of disparities there are some groups that have been, for the most part, largely ignored. Providing high quality care to American Indians, immigrants, and people who speak a language other than English have not received as much attention as I would like to see. And so, for our Center as we forge a path ahead we will aim to develop a framework in which to better address disparities in these populations. I hope that you will join us and continue to support our work in our journey towards equity.
Aswita Tan-McGrory, MBA, MSPH
Administrative Director, the Mongan Institute
Director, the Disparities Solutions Center