Image courtesy of the Boston Public Health Commission’s Racial Justice and Health Equity Initiative.
Massachusetts recently opened the door for community organizations to engage with health care institutions in moving the needle on what are commonly referred to as “Social Determinants of Health.” Social Determinants of Health (SDoH) are the conditions in which we live, work, and age and which impact our health outcomes. The Department of Public Health’s (DPH) recently updated Determination of Need (DoN) regulations and the Attorney General’s Office’s (AGO) updated Community Benefits Guidelines both emphasize that investment in SDoH is necessary to move the needle on health care outcomes. In particular, the DoN regulations identified the following Social Determinants of Health (SDoH) as priority areas: built environment, social environment, education, employment, violence, and housing. These same priorities were adopted in the AGO’s Community Benefits Guidelines.
In addition to emphasizing SDoH, the DoN subregulations describe an opportunity for “the Commonwealth to address health inequities based on race, class, and other socioeconomic factors, which are a result of historical policies and practices.” The AGO Guidelines further assert that “Racism has an independent influence on all social determinants of health, and racism in and of itself has a harmful impact on health.” Together, these guidelines open the door for community advocates to move health care policy conversations towards explicitly addressing racism as a social determinant of health.
The challenge to organizations like MACDC is how to effectively push health care institutions to adopt racial justice as the primary lens with which to address health inequities. MACDC has been engaged in moving health care institutional focus toward racial equity through active engagement with:
The Boston Community Health Needs Assessment Collaborative – Several Boston area hospitals recently collaborated on a joint Boston Community Health Needs Assessment (CHNA) for the first time. MACDC recognizes this collaboration as an opportunity to help direct the more than $180 million these hospitals spend annually on Community Benefits Programs. In light of our recognition of the importance of this collaboration, MACDC engaged in the CHNA process through assigning two of our members to the CHNA Steering Committee, attending community forums to prioritize goals and craft strategic approaches to achieving these goals, submitting a detailed letter to the Boston Collaborative, and submitting a detailed strategy document to the Collaborative. Through these channels, MACDC expressed support for naming the achievement of racial and ethnic health equity as a core focus/aspirational goal in which specific health goals would be encapsulated. We were pleased to the see that the Boston CHNA Collaborative ultimately adopted a lens of racial equity in their completed Community Health Needs Assessment.
The Alliance for Community Health Integration’s Housing and Health Policy Work Group – Through our membership in the Alliance for Community Health Integration (ACHI), MACDC has been part of an effort to engage health care institutions around high-level housing policy issues. This effort has resulted in a statement of principles for which ACHI is in the process of gathering signatures and two webinars that provide a high-level overview of housing policy for health care providers and executives. Because African Americans and other communities of color are disproportionately affected by housing challenges and disproportionately bear the burden of poor health outcomes, our work is inherently rooted in racial equity. Furthermore, our ongoing challenge is how to use this platform to further push health care institutions to explicitly address structural racism in the way that they talk about and address health inequity in their communities.
Our engagement in the ACHI Health and Housing Policy Work Group and with the Boston CHNA Collaborative are important areas in which to challenge health care institutions to adopt a racial equity lens. As health care institutions continue to define their missions, agendas, and programs under the new state guidance, it is our job, as anti-racist community advocates, to continue to challenge health care institutions to tackle their community health work from a racial equity perspective.