Addressing Historical Racism and Inequality in American Healthcare

We as a country are facing a critical moment in grappling with the legacies of racism and inequality that cut across our society. We at AHRQ are acutely aware of the enduring racial, ethnic, socioeconomic, and geographic disparities embedded in our healthcare system.

A lack of health equity underlies these disparities and continues to result in unconscionable differences in patient outcomes. These differences have been made even more apparent by the COVID-19 pandemic and the stark disproportionate impact of COVID-19 on Black and other minority communities.

On his first day in office, President Biden signed an Executive Order stating that the Biden-Harris Administration would pursue a comprehensive approach to advancing equity for all people. This includes individuals who belong to underserved communities that have long been denied access to appropriate healthcare such as Black, Latino, and Indigenous and Native American persons; Asian Americans and Pacific Islanders; other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons; persons with disabilities; persons who live in rural areas; and persons otherwise adversely affected by persistent poverty or inequality. 

We are committed to being part of the national reckoning on systemic racism and the harmful impacts it has had on the health and well-being of so many Americans. As a Federal health research and care delivery improvement agency, we believe we can contribute to solutions in three important ways:

First, we are assessing our own Agency. Agency leadership has pledged to make AHRQ a diverse, equitable, and inclusive work environment for all individuals.  

Second, we are examining how we can make the health services research field more diverse, equitable, and inclusive. We are revisiting our policies, procedures, and the funding announcements we issue with an equity lens.

Third, we have committed to supporting healthcare systems and professionals in their effort to achieve equity through our work in health services research, practice improvement, and data and analytics.

This work will build on a foundation at AHRQ that includes producing and promoting the annual National Healthcare Quality and Disparities Report and our newly released social determinants of health database.

Examples of the kinds of activities we envision AHRQ might undertake include:

• Expanding how we advertise and recruit for new staff members and establishing career development ladders with mentorship opportunities.
• Requiring grant applications to include an analysis of how the proposed research takes into account systemic racism and how results support increasing health equity.
• Developing new funding mechanisms to support the career development of individuals from communities currently underrepresented in the health services research field.
• Supporting efforts across the Department of Health and Human Services to appropriately collect sociodemographic data, including through the Medical Expenditure Panel Survey and the Healthcare Cost and Utilization Project, so that quality, safety, and value measures can be appropriately stratified to understand health equity.
• Soliciting research proposals that address the impacts of systemic and other types of racism on health outcomes, including maternal mortality, cardiovascular disease, substance use, and HIV in racial and ethnic communities.

We know that we do not have enough answers or evidence. We are committed to learning through listening. In March we asked the members of the Agency’s National Advisory Council to advise us on this undertaking. We plan to continue engaging with our many partners as we move forward. We hope and expect that our stakeholders will not only join us in this work, but also hold us accountable. 

This effort will take time. We have challenged our team to have both patience and perseverance. We undertake these efforts with sincere humility. We recognize that these efforts are as difficult as they are important. We understand that we may make mistakes. And when we do, we’ll admit them, correct them, learn, and continue trying. Inaction, however, is unacceptable.

We recognize that to fully address racial and other disparities in health will require addressing more than healthcare delivery. Both healthcare and health reflect the context of inequities in our society. Nonetheless, improving equity in healthcare will make an important contribution to improving health and other forms of equity in our Nation. And improving the quality, safety, value, and equity of healthcare delivery is our mission. 

David Meyers is Acting Director of AHRQ; Francis Chesley is Director of AHRQ’s Office of Extramural Research, Education, and Priority Populations; and Kamila Mistry is Associate Director of the Office of Extramural Research, Education, and Priority Populations.

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