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Health equity has improved little in the U.S. despite many efforts, according to a panel discussion on Monday.

"Are we doing better? Are we doing worse? If we look at the numbers, most of it is that we're the same. On ending unequal treatment, we found that the progress is minimal. We're really not there," said Margarita Alegria, PhD, chief of the Disparities Research Unit at Mass General Hospital in Boston, at an event on health disparities sponsored by Health Affairs and the consulting firm Deloitte.

She highlighted the estimated $1 trillion cost of health inequality in the U.S. based on the "" report issued this year -- updating a similar report from 2003 -- from the National Academies of Sciences, Engineering, and Medicine. (Alegria was on the committee that issued the report.)

"There are so many things we can do to lower this cost" and improve health equity, Alegria said. "One of the areas that I think is very innovative is the issue of providing obesity medications to actually reduce diabetes and cardiovascular disease -- two illnesses that are highly preventable in minoritized communities. So buying, for example, the patents of those drugs and actually lowering [their cost] so that everyone can access this medication and prevent some of these illnesses might be one thing."

Quality of treatment is another area ripe for improvement, Alegria said, noting that many minority patients drop out of treatment early because the care is so poor. "Using new models like the accountable care organizations, there's actually great data ... how [new care models such as] accountable care organizations were not only better in terms of quality and access, but also in terms of cost savings."

Finally, there's payment reform. "We believe that payment reform could be used for cost-saving," she said. One example might be "making sure that we provide sufficient [pay] to the practitioners in Medicaid as a way to incentivize people to be able to come to the pool of Medicaid providers ... And expanding Medicaid through the Affordable Care Act really made a huge difference in terms of outcome."

Nelson Dunlap, JD, vice president of public policy and external affairs at the Meharry School of Global Health, in Atlanta, pointed out that a recent Pentagon report found that 77% of young Americans wouldn't qualify for the military today because of obesity, drug use, and mental behavioral health concerns. "So what about those GLP-1 [drugs] -- as an opportunity to address a national security argument?" he suggested. "Understand who you're talking to and how you get them to join your coalition, to actually get it done."

Andrew Anderson, PhD, assistant professor of health policy and management at Johns Hopkins University, in Baltimore, agreed.

"Improvement follows the money," Anderson said. "And I don't think that a lot of our payment programs are designed with this in mind ... In many different [payment] models that have emerged, especially since the Affordable Care Act, there's just not enough of a carrot to do it, and if anything, they might work against, in some instances, business interests. As we continue this long shift to value over volume, we need to make it explicit that this is a priority in our payment program."

Anderson recalled that Sen. Bill Cassidy, MD (R-La.), discussing maternal health, said about his own state in 2022 that "'If you correct our population for race, we're not as much of an outlier as it would otherwise appear.' At the time, I was living in Louisiana, and it was a statement that sparked a lot of outrage," said Anderson. "It was palpable. Advocacy groups rightly [said that] comments like this deflect from the broader root causes like a broken health system and entrenched inequality."

"This isn't just about one senator," he said. "It's about a broader status quo where those with power and resources shift blame. We're told that poor health outcomes are the result of personal irresponsibility, as if suffering is deserved."

"The financial costs of inaction are clear," said Anderson. "But it's also the cost to social cohesion, which I think is even harder to quantify, and it's far more dangerous. I think communities that lose trust in their community, their institutions -- they lose trust in one another."

Having trustworthy data is another important issue in improving health equity, Alegria said.

"Take, for example, Medicaid or Medicare data ... We're finding that some of the data in some states is so bad that it cannot be used. It cannot be used because there are so [many] inconsistencies in the data and [things missing] in the data that it cannot be used to do disparities work. So that tells you that we need to have more enforcement about the quality of the data. And if the quality is poor, it should have some repercussions for the state. It should not be data that we're paying for, if the data is so poor," she said.

Alegria had two suggestions for frontline providers interested in health equity. "One is helping people find out more about their health through health literacy," Alegria said. "We know once people have more health literacy, they make better choices, adhere more to care, and are more satisfied with care."

"And second, I would tell them to vote, that they need to vote to make sure that they're also making their voice heard in many of the important aspects of their healthcare," she said.

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