Health equity and social determinants research seeks to understand disparities and influence real change, but the national data collection systems that investigators rely on for their work are incomplete and hardwired for racism. structural, Shale Wong, MD, told attendees of the 10th Annual Colorado Clinical and Translational Sciences Institute Academic Summit Sept. 14.
“If we depend on these systems, we risk informing policy with inaccurate data that continues to perpetuate inequalities,” said Wong, who is the executive director of the Eugene S. Farley, Jr. Health Policy Center and professor and Vice Chair for Policy and Advocacy in the Department of Pediatrics at the University of Colorado School of Medicine.
In his talk, “Mental Health Equity: How is Data Shaping Policy?” Wong addressed the challenges of using data to inform policy and described how policy influences data collection.
Wong provided a brief overview of the Farley Health Policy Center at CU Anschutz Medical Campus, where she and her colleagues work to develop and translate evidence to advance social policy to improve health, equity and well-being. be.
“Many of the disparities that exist are due to structurally flawed systems that create barriers to care,” Wong said. “We believe local, state and federal politicians are responsible and have some authority to reshape and dismantle systems of structural racism because politics can prevent individuals and communities from living their healthiest lives.
Wong shared key findings from the groundbreaking report “The Economic Burden of Mental Health Inequities,” released Sept. 12 by the Farley Health Policy Center, Satcher Health Leadership Institute, and Robert Graham Center.
“This study aimed to answer two questions: How many lives and how many dollars could be saved if we tackled racial inequality?” she says.
Over a five-year study period, racial inequities in mental and behavioral health caused the premature deaths of nearly 117,000 Indigenous people and people of color in the United States. In addition, racial inequalities have generated more than $278 billion in additional costs.
An invisible population
“While these numbers are horrific and commanding attention, what may be more important is what we missed and couldn’t see,” Wong said.
She also revealed that national estimates and publicly available datasets excluded at least 5.8 million people – many of whom bear the heaviest burden of mental behavioral problems: the incarcerated; the homeless; active military; and those in nursing homes and assisted living facilities and psychiatric facilities.
When the report’s authors analyzed the published literature, a glaring misrepresentation of the true burden of these inequalities was uncovered. The authors found between $63 billion and $92 billion in annual excess costs related to mental illness and substance use disorders among incarcerated and homeless people.
Policy to promote fairness and improve data collection
Wong said general principles need to be in place to begin to balance behavioral health inequities through policy.
“If you look at existing policies, there is stigmatizing language that needs to be systematically removed and re-addressed as new policies are written,” she said. “There is a choice – either you maintain the policies that perpetuate inequalities, or you take new policy measures to reduce them.”
As a multiracial individual, Wong said most general health screenings require him to choose a category, identifying as “Asian.” Yet Asia comprises more than a dozen countries, each with unique origins and cultural distinctions.
“We lose specificity when we classify for convenience,” she said. “When we can start to disaggregate the data – addressing cultural identity and intersectionality – we can start finding solutions where we can make a difference.”
Wong said the policy can be leveraged to improve data collection at the National Institutes of Health. This includes requiring changes to what is asked, collected and reported, to align with census data and to drill down to a much deeper level, such as language preference and country of origin.
“Then we can ask better questions and improve our results because politics uses big data, but fairness is local,” she says. “We have to have the courage to say we did it wrong, we can do more, we can do better.”
Policy Principles for Balancing Inequalities in Mental Health
As part of The Economic Burden of Mental Health Inequities report, the Farley Health Policy Center conducted an evidence-based state and national policy environment scan and scan. The report provided several policy proposals, ranging from the very large-scale investments needed to smaller-scale ideas that can be immediately implemented to meet current and future needs.
Here is a summary of the recommendations:
- Invest in rebuilding and sustaining equitable mental and behavioral health systems over the long term to ensure access to the right care in the right place at the right time.
- Begin with prevention, early intervention and identification to provide a continuum of services including treatment and crisis needs.
- Establish inclusive health equity standards and quality measures for accessible health systems, fund research to study equity in mental/behavioural health, evaluate policies and monitor measures.
- Target interventions that build on community strength and resilience and address unmet needs and involve those affected by the policy in policy development.
- Ensure consistent language services are person-, community- and culture-centred.
- Systematically review existing policies and laws to remove stigmatizing language and ensure it is excluded from new legislation.
- Recognize the impact of political and systemic power differences on historically marginalized communities to enable political actions toward equitable culture shifts.
Guest Contributor: Jessica Ennis is a freelance writer specializing in healthcare and academic medicine.