Vanquishing Healthcare Disparities by Advancing Healthcare Equity

On his first day in office, President Biden formally recognized the enormous human toll of systemic racism and persistent poverty in the United States. Executive Order 13985, Advancing Racial Equity and Support for Underserved Communities Through the Federal Government, mandated federal agencies to launch a whole-of-government approach to advance equity. 

In response to the Biden-Harris Administration’s vision for ensuring equal opportunity for all Americans, federal agencies have taken historic steps to address equity and remove systemic barriers for those who have been historically underserved, marginalized, and harmed by inequality.

Over the past two years, AHRQ has thoroughly examined equity and its connections to Agency activities in alignment with our mission. We are acutely aware of inequities embedded in today’s healthcare delivery systems, and the Agency is committed to expanding its efforts to fund and disseminate research findings to address inequities and advance the well-being of all Americans.

As such, AHRQ recently sponsored the publication of a Health Services Research (HSR) special issue, Achieving Healthcare Equity in the United States. Papers commissioned for this issue summarize the state of evidence and results from an inclusive, participatory process to identify opportunities in five areas to drive more equitable care: healthcare delivery systems and structure; payment; social determinants of health and social needs; implementation science; and access to care.

Along with Marshall H. Chin, M.D., M.P.H., the Richard Parrillo Family Distinguished Service Professor of Medicine at the University of Chicago School of Medicine, we offer an overview of the HSR special issue that explores each area. This commentary—Advancing Health Equity - Agency for Healthcare Research and Quality Research and Action Agenda—highlights key cross-cutting themes that can serve as a basis for informing AHRQ’s health services research agenda and, more broadly, provides areas of collective action for the field of health services research. 

The HSR special issue papers incorporate a literature review, diverse stakeholder input, and expert opinion to ensure an inclusive process for establishing recommendations. The papers provide essential feedback to inform AHRQ’s research priorities. Among the papers’ notable themes:

• Patients and communities must be centered in all efforts to advance equity.
• Structural racism and other systems of oppression (e.g., sexism, homophobia, ableism, socioeconomic disadvantage) are significant drivers of health inequities.
• Alignment of payments and financing holds significant potential to advance health equity, but significant barriers exist.
• Whole-person and whole-community approaches can reduce fragmentation and address inequities’ root causes.
• Addressing evidence gaps in interventions' effectiveness is a critical priority.   
• The healthcare workforce is central to dismantling (or perpetuating) inequities. 

Additionally, as the HSR author teams have worked with stakeholders to explore these issues and formulate recommendations, AHRQ has continued its efforts to fund and support research and training to drive more equitable care. These recent efforts dovetail with recommendations in the HSR special issue and take into account important actions needed to advance healthcare equity. 

For example, the Agency has examined the use of healthcare algorithms and their impact on racial/ethnic disparities in care and approaches to identify and mitigate existing biases. AHRQ also launched the Learning Health System Embedded Scientist Training and Research Centers initiative, a 5-year, $80 million effort to train researchers and scientists to conduct system-focused research to advance healthcare equity and enhance workforce diversity.

Additionally, AHRQ will continue to fund research supplements to further our commitment to ensuring the field of health services research better reflects the diversity of the Nation. While strides have been made, more work is needed to increase the recruitment and retention of students, fellows, and faculty from underrepresented backgrounds to build a diverse and inclusive research workforce. 

AHRQ has also recently funded a research program that charges grantees with leveraging dissemination and implementation science to fill knowledge gaps in the effectiveness and scalability of evidence-based interventions across diverse populations and in the context of addressing disparities and advancing equitable care in healthcare delivery systems. The program also included explicit requirements for community participation at all stages of the research process and evidence of a commitment to shared values, strengthening the potential for a more significant impact in addressing health disparities and advancing healthcare equity. 

Each of these programs aligns with the vital insights detailed in the HSR special issue, many of which center on the critical need for health services research, regardless of focus area or domain, to be grounded in approaches that are participatory, inclusive, and aimed at achieving equitable whole-person and whole-community care. By embedding these central principles of equity within our research programs and anchoring them within our action plan, AHRQ will continue to strengthen its resolve to the fair and impartial treatment of all individuals, including those in underserved communities. 

Dr. Valdez is director of AHRQ. Dr. Chesley is director of the Office for Extramural Research, Education and Priority Populations (OEREP). Dr. Mistry is associate director of OEREP and senior advisor and Agency lead for health equity.

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