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Health Equity: A Framework for Improving Health Outcomes for People Living with Diabetes

By Tom Cirillo and Cherise Shockley

At our virtual Musings Under the Moon #8 gathering, experts in health equity gathered to discuss what health equity really means, what its barriers are, and what actions are needed to achieve health equity. 

COVID-19 has changed the way people with diabetes look at the world. It has forced the healthcare community to consider not just the impact of the pandemic on communities but everything from climate change to racial injustice. In changing the ways in which we look at the world, COVID-19 is shining a spotlight squarely on health inequity. 

Many communities of color are experiencing worse health outcomes than white communities, including higher rates of death from COVID-19. This disturbing reality underscores how type 2 diabetes and obesity (and the life-altering consequences of these conditions) also unequally affect many people of color. Never before has the issue of health equity – or in these cases health inequity – been so discussed. Health equity and social determinants of health have become more important in the shadow of COVID-19, as it becomes clear that healthcare inequities are barriers to the well-being of all people and to achieving a more just society for everyone. “I’m not well if everyone with diabetes is not well,” said diaTribe at this event. 

On September 1, The diaTribe Foundation hosted its third event in the virtual series, Musings Under the Moon: Applying Revelations from COVID-19, and it’s 8th Musings “evening” with the theme “Health Equity: A Framework for Improving Health Outcomes for People Living with Diabetes.” About 200 people gathered to listen to experts talk about health equity and the actions we can take to address it, and the related issues of cultural intelligence and racism. Listeners were able to ask questions, contribute to the discussion through the chat function, and join community breakout sessions. You can watch the full panel discussion here

Health Equity: A Framework for Improving Health Outcomes for People Living with Diabetes featured three incredible health leaders, joined in conversation by diaTribe co-founder Kelly Close:

  • U. Michael Currie, Senior Vice President and Chief Health Equity Officer, UnitedHealth Group
  • Conrod Kelly, Executive Director, Policy/Government Relations - Social Determinants of Health, Merck
  • Lili Gil Valletta, Co-founder and CEO, CIEN+ and Culturintel

Read on for some of our most memorable quotable quotes from the virtual event.

On the definitions of health equity and social determinants of health

“Health equity, simply put, is the opportunity to live your healthiest life possible. Whatever your abilities or disabilities are, it is the ability to receive tailored and unique programs and services to allow you to live your healthiest life and drive the healthiest outcomes possible.” – Michael Currie (UnitedHealth Group)

Social determinants of health take into account socio-economic status, neighborhood, education, physical environment, employment, social services, and access to health care. People typically go to the negative, but social determinants of heath are not necessarily bad or good, they are just factors.” – Conrod Kelly (Merck)

Upwards of 80% of all factors that drive positive health outcomes are related to things that are not medical care or clinical treatments. However, 88% of the money we spend is toward the [remaining] 20% of clinical care and medical treatment – it’s not really driving what impacts outcomes.” – Lili Valletta (CIEN+, Culturintel)

On shifting demographics and data

“One hundred percent of population growth is driven by diverse sectors… when we look at the factors that impact outcomes and the fact that we are living in a fast-approaching majority-minority population, the efforts we have [in place now] to drive health equity, reduce healthcare spending, or have better outcomes are just not going to work.”  – Lili Valletta (CIEN+, Culturintel)

“You cannot manage what you don’t measure. Everything starts with data because it allows you to determine where the issue is and the order of magnitude that it exists. We look at data and demographics across our various lines to evaluate and assess where there are health disparities at a population and demographic level.” – Michael Currie (UnitedHealth Group)

“I heard from a panelist at Davos [Switzerland], who said: ‘We’re not going to get healthcare right until we understand and acknowledge that Netflix may know our patients better than we do.” – Lili Valletta (CIEN+, Culturintel)

On cultural competency and cultural intelligence

“Cultural intelligence is so important because we need to be aware of, understand, and apply cultural competence in what we do every day. [Cultural intelligence] is an inclusive approach to everything you do.” – Lili Valletta (CIEN+, Culturintel)

“[We need] the continued promotion and encouragement around culturally intelligent training and education. This allows physicians to listen and communicate in a way that takes the person into account. We need more person-centric care. Listening and communicating in a more compassionate and sensitive way.” – Michael Currie (UnitedHealth Group)

It’s not diversity training, it is training to serve a diverse America.” – Lili Valletta (CIEN+, Culturintel)

On racism and health equity

You can’t really disconnect racism and health…bias is hardwired into algorithms. … There is an absence of representation of minorities in healthcare. It is so unlikely to walk into a doctor’s office and see a black physician, a Latino physician, or even an Asian physician.” – Conrod Kelly (Merck)

“There is no way to disconnect systemic, historical racism from the disparities that we see now. We must understand history and how we got here…learn and prevent mistakes from going back. Bright minds move us forward” – Michael Currie (UnitedHealth Group)

“The disparate effects of COVID-19, combined with the Black Lives Matter movement, have created an opportunity for us to examine what we need to do as a country about health inequity. And to narrow that down, what we need to do as a diabetes community to ensure better outcomes for all our members.” – Kelly Close (diaTribe)

We need to fix the trust issue – we are rapidly racing towards a majority-minority population. And that will put lots of strain on the healthcare system and our economy because the Hispanic and African American population are disproportionately affected by diabetes, cancer, etc. Something needs to change.”  – Conrod Kelly (Merck)

On prevention and actions to address inequity

“Without a more equitable way of looking at care and prevention in diabetes, we will not get the outcomes we want; and unless all of us are doing better, none of us are doing well.” – Kelly Close (diaTribe)

“We need a culture of prevention in healthcare. So much of the current system is built around treating the illness instead of addressing the systemic issues and policies that lead to poor health.” – Conrod Kelly (Merck)

Inclusion (and diversity) is not a program, it is a mindset. There is an awakening. This is not an altruistic mission; it is the only way to be healthy in the new America.” – Lili Valletta (CIEN+, Culturintel)

“Sustainably addressing health equity requires policy changes. … It also requires finding diverse partners to bring into the fold, even outside of healthcare, who can leverage their capabilities, resources, and platform to advocate for health equity.” – Conrod Kelly (Merck)

“Advancements in telehealth and adoption of telemedicine have helped reduced the impact of transportation on accessing care. But there are other gaps in care among diverse populations: not everyone has equal access to reliable internet coverage or a computer/handheld device, and the health and digital literacy to benefit from telehealth. Telehealth is better than not having it, but we need to make sure that other things do not become barriers to care. [This is] one solution uncovering another problem.” – Conrod Kelly (Merck)

Our focus is always on evidence-based high-quality care and that is what we work to ensure. That is our promise to you.” – Michael Currie (UnitedHealth Group)

What is step one? What do you most want to see next?

“Personal stories, inspire, empower, and drive change. Martin Luther King Jr.’s story about his dream awakened a nation. We shouldn’t stand around waiting for the next MLK. We each hold tremendous power in our words, actions, and personal stories. Sharing your story can be the spark!” – Conrod Kelly (Merck)

Collective demand. Don’t go at it alone. You can do it as a collective. Businesses respond to consumer demand.” – Michael Currie (UnitedHealth Group)

“Be an ambassador for the knowledge that you’ve gathered. If you share what you have learned here with one person, that is progress. There is room for a groundswell from people like us. Be a megaphone.” – Lili Valletta (CIEN+, Culturintel)

Thank you to our generous sponsors for making this outstanding conversation on such an important topic possible! For more in this series you can read our articles, Health Equity: What It Means, Why We Care, and What We Can Do and Why Social Determinants of Health Matter in Clinical Care