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OPINION

To solve health care inequity, Mass. should address the social determinants of health

A piecemeal approach will not remedy centuries of racial injustice. To ensure the state leads the nation in the health and well-being of its residents, equity must guide every decision.

ForsythKids dentist Helen Nguyen talks to 2-year-old Emma Alvarez before her dental examination while her mother Grace Duran stands nearby in October 2020. Since dental services were cut off when schools closed, programs like ForsythKids, which runs a mobile school-based dental program in Lynn and other parts of the state, set up outside of community centers, including the Lynn Boys and Girls Club.
ForsythKids dentist Helen Nguyen talks to 2-year-old Emma Alvarez before her dental examination while her mother Grace Duran stands nearby in October 2020. Since dental services were cut off when schools closed, programs like ForsythKids, which runs a mobile school-based dental program in Lynn and other parts of the state, set up outside of community centers, including the Lynn Boys and Girls Club.Erin Clark/Globe Staff

In the past year and a half, in Lawrence and Roxbury and dozens of other communities across the Commonwealth, health care providers witnessed the same story over and over. While those who could sheltered at home during the coronavirus pandemic, low-income people of color continued to go to their jobs — often as essential workers, putting themselves and their families at risk of getting sick and dying from COVID-19. The pandemic was a catalyst for national conversations about social and racial injustice and health inequity. But these realities are not new, and conversations are not enough.

For generations, the health care system has been just the first of many barriers to health and well-being for Black and brown communities. While systemic racism manifests in poorer health outcomes for Black and brown people when compared to white people regardless of socioeconomic status, there is a clear need to address social determinants of health. How do you apply for a job, with health insurance and other benefits, after being in prison, the victim of over-policing, and over-incarceration in your community? How do you manage a chronic condition if you are experiencing homelessness or don’t have nutritious food in your neighborhood? Research shows social determinants — like food access, affordable housing, transportation, child care, public safety and more — account for 80 percent of a person’s health status, with access to health care making up only 20 percent. To address health care disparities, Massachusetts needs to address social inequity.

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That is why the Massachusetts Health Equity Task Force — of which we are members — spent the last year collaborating with community, health, and state leaders to understand the root causes of systemic inequities in the Commonwealth that impact the health of our residents. Our conclusion: A piecemeal approach will not remedy centuries of racial injustice. To ensure Massachusetts leads the nation in the health and well-being of its residents, equity must guide every decision — not only as we emerge from the pandemic but well beyond. Our report can help move us from conversation to action-oriented solutions and from obliviousness to data-driven accountability.

The task force is calling on the Legislature and Baker administration to create the Executive Office of Equity. The new secretary of equity would be charged with creating a 3-to-5-year strategic plan that takes an “equity in all policies” approach to decision-making, particularly in how federal COVID-19 relief dollars are invested. The secretary also would be tasked with developing data dashboards with stakeholders and the branches of government to support effective, equity-focused policies in the future. At the same time, growing health care disparities must be addressed.

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Community health centers, which provide a broad range of primary care in low-income neighborhoods and served hundreds of thousands of vulnerable residents throughout the pandemic, should be the centerpiece of any strategy. Recognizing the need for more primary care services in under-resourced communities, the Baker administration recently made the largest investment in health equity to date, by increasing structural rates for federally qualified health centers. This is a great start.

Going forward, however, a more holistic approach is needed. For example, oral health accounts for some of the deepest health disparities in communities of color, low-income communities, vulnerable age groups, people with disabilities, and underserved geographic regions, and is directly connected to many diseases and chronic conditions. Yet our health system treats oral health as separate from that of the rest of the body — from insurance and coverage options to data collection and sharing to training for health professionals. Investing in integration of oral health into primary care — a step already begun in the state’s health centers — is critical to addressing these disparities.

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Other policy recommendations from our report that take this holistic approach include extending MassHealth’s maternal postpartum care coverage, requiring universally free school meals, providing legal counsel in eviction and foreclosure proceedings, making driver’s licenses available to all residents regardless of immigration status, and adopting standard and consistent demographic data collection practices to measure progress toward equity. The blueprint offered by this report positions Massachusetts to once again lead the nation, as we did with health reforms in 2006.

We must turn the tide of destructive forces on communities of color, immigrants, and other vulnerable populations. That means examining and upending policies that leave families unstably housed, or not housed at all, and dependent on food from emergency providers. It also means continuing to redress chronic underfunding and fragmentation of our medical, oral, and behavioral health care systems for the poor and underserved. Above all, it is time that equity became central to all state government decision-making. It won’t be easy. But if we apply and expand the lessons learned during the past year and a half’s devastation, we will build a more equitable, resilient, and healthy future for all.

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Dr. Myechia Minter-Jordan is president and CEO of the CareQuest Institute for Oral Health and former CEO of the Dimock Center. Michael Curry is president and CEO of the Massachusetts League of Community Health Centers and chair for the Massachusetts Health Equity Taskforce.