Original Article
Movement Advocacy, Personal Relationships, and Ending Health Care Disparities

https://doi.org/10.1016/j.jnma.2016.11.003Get rights and content

Abstract

Deep-rooted structural problems drive health care disparities. Compounding the difficulty of attaining health equity, solutions in clinics and hospitals require the cooperation of clinicians, administrators, patients, and the community. Recent protests over police brutality and racism on campuses across America have opened fresh wounds over how best to end racism, with lessons for achieving health equity. Movement advocacy, the mobilizing of the people to raise awareness of an injustice and to advocate for reform, can break down ingrained structural barriers and policies that impede health equity. However, simultaneously advocates, clinicians, and health care organizations must build trusting relationships and resolve conflict with mutual respect and honesty. Tension is inherent in discussions about racial and ethnic disparities. Yet, tension can be constructive if it forces self-examination and spurs systems change and personal growth. We must simultaneously advocate for policy reform, build personal relationships across diverse groups, and honestly examine our biases.

Section snippets

Health as a human justice issue and the role of movement advocacy

Dr. Martin Luther King, Jr. famously stated, “Of all the forms of inequality, injustice in health is the most shocking and the most inhuman.”4 When the injustice is great, power differential between oppressor and oppressed is large, and willingness of the powerful to reform the system is low, then movement advocacy is necessary. Think the 1960s Civil Rights Movement, or Rodney King, Freddie Gray, Laquan McDonald, and the police departments of Los Angeles, Baltimore, and Chicago. Deeply rooted

Movement advocacy to change systems

Presidential candidate Hillary Clinton described the power of advocacy when she met with representatives of the Black Lives Matter group. She stated, “Look I don't believe you change hearts. I believe you change laws, you change allocation of resources, you change the way systems operate. You're not going to change every heart. You're not. But at the end of the day, we could do a whole lot to change some hearts and change some systems and create more opportunities for people who deserve to have

Interpersonal relationships, trust, and achieving health equity

A key challenge, however, is that the daily work of achieving health equity requires trusting interpersonal relationships, difficult to attain when addressing charged issues such as racism, heterosexism, and class distinctions. Reducing disparities requires self-awareness and commitment, whether by clinicians understanding their subconscious biases in shared decision making with patients,14 administrators recognizing that how their clinic delivers care may systematically lead to worse outcomes

Reconciling movement advocacy and trusting relationships

So, is it possible to reconcile movement advocacy and constructive tension with the creation of trusting relationships and safe spaces required to achieve health equity? I attended a workshop on conflict resolution led by Jennifer Smith, MD, whose perspectives were shaped by countless difficult family situations she encountered as a palliative care physician and general internist at Cook County Hospital.17 Dr. Smith explained that a conflict is a personal narrative with a beginning, middle, and

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Funding: Dr. Chin was supported by a National Institute of Diabetes and Digestive and Kidney Diseases Midcareer Investigator Award in Patient-Oriented Research (grant number K24 DK071933), the Chicago Center for Diabetes Translation Research (grant number P30 DK092949), Robert Wood Johnson Foundation Finding Answers: Solving Disparities Through Payment and Delivery System Reform Program Office, and the Merck Foundation. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Prior presentation: This paper was presented in part in Integrating Health Literacy, Cultural Competency, and Language Access Services: A Workshop, Institute of Medicine Roundtable on Health Literacy, Irvine, California, October 19, 2015, and the Society of General Internal Medicine Annual Meeting, Hollywood, Florida, May 12, 2016.

Conflict of interest: Dr. Chin co-chairs the National Quality Forum (NQF) Disparities Standing Committee. He is the Immediate Past-President of the Society of General Internal Medicine and a member of the America's Essential Hospitals Equity Leadership Forum. He has provided technical assistance to the Center for Medicare and Medicaid Innovation and is a member of the National Advisory Board of the Institute for Medicaid Innovation. The views expressed in this commentary do not necessarily represent the views of the National Quality Forum, Society of General Internal Medicine, America's Essential Hospitals, Centers for Medicare and Medicaid Services, Institute for Medicaid Innovation, National Institutes of Health, Robert Wood Johnson Foundation, and Merck Foundation.

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