Promoting Health Equity in Adult Immunizations
Content contributed by Laura Lee Hall, Ph.D., President, Center for Sustainable Health Care Quality and Equity, National Minority Quality Forum (Rise to Immunize™ Partner)
While gains have been realized over the last 30 years in health equity, people of color—including those who are Black and Latino—still face disparities in health status, care, and outcomes. Immunization rates are significantly lower among Black, Latino, and Native American populations, resulting in increased vaccine-preventable disease, morbidity, and mortality.1
Considerable research has identified racial and ethnic health disparities along with contributing factors. In some instances, certain conditions may be more common among specific racial and ethnic subpopulations. In other instances, social determinants of health—including access to care and healthy foods, socioeconomic status, transportation, educational resources and attainment, language and cultural factors, and housing—drive disparities and inequities in care.
These factors, along with barriers presented by systemic racism and historic examples of mistreatment that have fueled distrust, have led to a healthcare system that does not sufficiently meet the needs of communities of color. As a result, people of color experience health problems disproportionately and die younger, even as more resources are spent on expensive care in the emergency department and hospital.2
Clinicians in the ambulatory setting can make a difference. To better understand and meet the needs of your community, consider the following strategies:
- Understand the local population and needs. A number of geologic mapping and community assessment resources can help you identify the demographics and health needs of your local population. Health systems often develop annual or biannual community assessments, as do local and state health departments. Several national resources also exist, including U.S. Census Bureau’s Interactive Maps, Centers for Disease Control and Prevention’s (CDC’s) VaxView Vaccination Coverage and CDC Wonder, and University of Wisconsin Population Health Institute’s County Health Rankings & Roadmaps.
- Look at your own data. Analyzing electronic health record (EHR) data can reveal the demographics of patients seen in a practice, as well as the treatments and outcomes realized. Such reporting may reveal various gaps, including inconsistent recording of data around race and ethnicity and disparities in vaccination rates.
- Assess your approach and bias potential. Clinicians can unknowingly develop racial and ethnic biases that may be held by others around them in society. Assessing such biases through tools such as the Harvard Implicit Association Test is an important first step to rooting them out. Many professional societies and other institutions have developed training materials on unconscious and implicit bias as well, such as the American Public Health Association’s Advancing Racial Equity Webinar Series and Kirwan Institute for the Study of Race and Ethnicity’s Implicit Bias Module Series.
- Implement targeted quality improvement (QI) activities. Identifying gaps in care or outcomes can lead to targeted, rapid-cycle QI activities that can test workflow changes, provider or patient education tools, or patient outreach approaches. Results can help the QI team assess the impact of tested changes and consider next steps for the practice. A number of resources are available to train and support QI clinical leaders in a practice, including the Institute for Healthcare Improvement’s QI Essential Toolkit and National Minority Quality Forum’s Center for Sustainable Health Care Quality and Equity’s DRIVE program.
- Effectively engage diverse patient populations. Addressing health disparities and improving trust with diverse patient populations requires two-way communication and a tailored approach. Consider conducting brief surveys of specific patient populations about their healthcare needs, barriers, priorities, and local resources. These surveys can help you identify changes with the potential for impact and develop tailored patient education materials that are appropriate in terms of culture, language, and health literacy level. Also consider how your approach can be tailored to be effective for subpopulations (e.g., overcoming access issues by leveraging technology, addressing misinformation through a trusted messenger). The identification and implementation of patient-centered solutions is key.
- Listen. Understanding your patients and their views, experiences, questions, and resources can help you shape and prioritize steps for improving health equity. There are a variety of ways to listen and gain such an understanding, including conversations with your patient, discussions with clinic staff who are members of a racial or ethnic subpopulation of interest, participation in community town hall meetings on health-related issues, and others.
- Support your patients. Many health systems and community-based organizations have resources to assist patients in accessing care, such as vaccine clinics. Consider identifying and building relationships with community stakeholders—including patient navigators, community health workers, local health departments, and aging agencies—and working to connect your patients with them.
- Make referrals to clinical trials. Even though clinical trial participation can lead to enhanced care and resources, people of color are significantly underrepresented in clinical trials. Increasing trial recruitment and referral among these populations can improve your patients’ access to care and help ensure treatment advances work for all patients.
- Advocate. Clinicians and their practice teams are dedicated to promoting health for all patients. Working to do so in the clinic setting is key, but advocating for health equity across your health system and among policymaking bodies can expand the impact. Actions such as speaking out in public forums, writing op-eds for your local newspaper, attending gatherings and forums hosted by groups representing people of color, and others can create real change and build trust among you, your patients, and the community.
1 Lu P, Hung M, Srivastav A, et al. Surveillance of Vaccination Coverage Among Adult Populations — United States, 2018. MMWR Surveill Summ 2021;70(No. SS-3):1–26. DOI: http://dx.doi.org/10.15585/mmwr.ss7003a1external icon.
2 Office of Minority Health and Health Equity. (April 2021). Impact of Racism on our Nation's Health. Centers for Disease Control and Prevention. Retrieved from https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html
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