Developing and Implementing Racial Health Equity Plans in Four Large US Cities: A Qualitative Study

Understanding the Roles, Responsibilities, and Factors for Success of Health Equity Officers in Health Care Settings: A Qualitative Study

CONTEXT

Recent national guidelines aimed at addressing equity in health care settings have contributed to an increase in equity officer positions, yet little is known about their roles, responsibilities, or strategies for engaging in health equity work.

OBJECTIVE

To understand the roles and responsibilities of equity officers, as well as facilitators and barriers to their success.

DESIGN

In-depth semi-structured interviews with selected respondents from the Equity Officer National Study.

SETTING

Hospitals and health care systems across the United States.

PARTICIPANTS

Twenty-six equity officers who had responded to the Equity Officer National Study survey.

MAIN OUTCOME MEASURES

The interview guide explored strategies, facilitators, and barriers for engaging in health equity work in hospitals/health systems and communities.

RESULTS

The job roles described by participants fell into 4 categories: community benefits/relations, population/community health, workforce, and health equity. Equity officers described key areas to support success at the individual equity officer level: knowledge and expertise, professional skills, and interpersonal skills; at the hospital level: leadership, workforce, infrastructure and resources, and policies and processes; at the community level: leadership and partnerships; and at the system level: requirements and regulations, investment and resources, and sociocultural and political characteristics of the community. These key areas have been organized to create a Framework for Equity Officer Success.

CONCLUSIONS

The Framework for Equity Officer Success should be incorporated into hospital board, community stakeholder, and policymaker discussions about how to support health equity work in hospitals and health care systems.

Pre-pandemic trends and Black:White inequities in life expectancy across the 30 most populous U.S. cities: a population-based study

BACKGROUND

Racial inequities in life expectancy, driven by structural racism, have been documented at the state and county levels; however, less information is available at the city level where local policy change generally happens. Furthermore, an assessment of life expectancy during the decade preceding COVID-19 provides a point of comparison for life expectancy estimates and trends post COVID-19 as cities recover.

METHODS

Using National Vital Statistics System mortality data and American Community Survey population estimates, we calculated the average annual city-level life expectancies for the non-Hispanic Black (Black), non-Hispanic White (White), and total populations. We then calculated the absolute difference between the Black and White life expectancies for each of the 30 cities and the U.S. We analyzed trends over four time periods (2008-2010, 2011-2013, 2014-2016, and 2017-2019).

RESULTS

In 2017-2019, life expectancies ranged from 72.75 years in Detroit to 83.15 years in San Francisco (compared to 78.29 years for the U.S.). Black life expectancy ranged from 69.94 years in Houston to 79.04 years in New York, while White life expectancy ranged from 75.18 years in Jacksonville to 86.42 years in Washington, DC. Between 2008-2010 and 2017-2019, 17 of the biggest cities experienced a statistically significant improvement in life expectancy, while 9 cities experienced a significant decrease. Black life expectancy increased significantly in 14 cities and the U.S. but decreased significantly in 4 cities. White life expectancy increased significantly in 17 cities and the U.S. but decreased in 8 cities. In 2017-2019, the U.S. and all but one of the big cities had a significantly longer life expectancy for the White population compared to the Black population. There was more than a 13-year difference between Black and White life expectancies in Washington, DC (compared to 4.18 years at the national level). From 2008-2010 to 2017-2019, the racial gap decreased significantly for the U.S. and eight cities, while it increased in seven cities.

CONCLUSION

Urban stakeholders and equity advocates need data on mortality inequities that are aligned with city jurisdictions to help guide the allocation of resources and implementation of interventions.