A new study published in The Milbank Quarterly is noteworthy for identifying approaches to reduce health inequities through clinical care, particularly in a primary health care context. It is among the first to demonstrate empirically that providing more equity-oriented health care (EOHC) predicts better patient health outcomes over time.
EOHC builds on the concepts of patient-centered care and culturally competent care to address structural correlates of health – such as poverty, income inequality, and various forms of discrimination – to create care environments that take into account the unique needs, history, and life circumstances of individual patients.
“While most health equity initiatives to date have focused on population-level interventions, this new study tests out an equity-oriented approach in everyday clinical encounters,” says Joel Teitelbaum, JD, LLM, the author of a recent book on the social and structural determinants of health, health equity, social justice, health policy, and systems of care for underserved populations.
The data used in the study were collected as part of the Canadian EQUIP Healthcare study exploring the process and impacts of an organizational health equity intervention on staff as well as the organizational capacity to implement equity-oriented care. “Over a 24-month period, higher levels of EOHC predicted greater patient comfort and confidence in the health care patients received, leading to increased confidence to prevent and manage their health problems, which, in turn, improved health outcomes (depressive symptoms, PTSD symptoms, chronic pain, and quality of life),” observes the mainly Canadian team of authors from the University of Western Ontario and other universities across that country, plus a colleague from Johns Hopkins University.
“The results are intriguing, but EOHC remains an emerging concept,” Teitelbaum says. “Beyond this study there is almost no evidence that equity-oriented primary care results in improved patient health. Given this paucity of evidence – but the interesting conclusions drawn in the immediate study – equity approaches to improving the health and well-being of marginalized groups deserve more attention in both population and individual care settings.”
“How Equity-Oriented Health Care Affects Health: Key Mechanisms and Implications for Primary Health Care Practice and Policy” can be found here.