The Robert Wood Johnson Foundation (RWJF) provides the following definition:
“Health equity means that everyone has a fair and just opportunity to be as healthy as possible."
To achieve health equity, healthcare must take steps to remove obstacles to health.
The barriers and obstacles facing our clients are collectively called the Social Determinants of Health, SDoH. The Social Determinants of Health focus on five areas;
- socioeconomic status (education, income, occupation);
- neighborhood and physical environment (housing, built environment, toxic environmental exposures);
- food environment (food insecurity, food access);
- health care (access, affordability, quality); and
- social context (social cohesion, social capital, social support).
The American Diabetes Association identified healthy inequity, specifically understanding of social and environmental factors of diabetes, accounts for 50 to 60 percent of health outcomes.
The stark nature of recent reports has made it clear reducing the medical and human cost of diabetes care will require professionals working in this field to understand how bias, stigma, and the SDoH are impacting engagement, medical care, and policy.
Understanding how the SDoH can be impacted by race is a complex process. Dr. Williams created an analogy to visualize racism as similar to building a house. In the article, The House that Racism Built,
Williams, et al., define racism “As an organized system, premised on the categorization and ranking of social groups into races and devalues, disempowers and differentially allocates desirable societal opportunities and resources to racial groups regarded as inferior.” Williams states, “Research finds that although socioeconomic status, SES predicts variations in health status within each racial group, racial disparities persist at every level of SES.” The point Williams and his colleague are making is poverty does not cause racism. This means racism is separate from poverty and conversations which do not consider the historical, intergenerational, persistent-institutional, and personal trauma of racism and intersecting forms of gender, sex, and size oppression are unlikely to establish the necessary interpersonal trust needed in healthcare.
Williams DR, Lawrence JA, Davis BA, Vu C. Understanding how discrimination can affect health. Health Serv Res. 2019 Dec;54 Suppl 2(Suppl 2):1374-1388. Doi: 10.1111/1475-6773.13222. Epub 2019 Oct 29. PMID: 31663121; PMCID: PMC6864381.
The Solution to Health Inequity is Inclusion
To address health inequity and reestablish medical trust, the Inclusive Diabetes Care Certificate pilot program was created. The goal of the program is to deepen the understanding and need for diversity, inclusion, and equity among diabetes care workers. This unique program provides small groups and interactive relationship-based learning, which creates the conditions to reestablish trust, community, and justice.
The IDC Certificate Program uses a combination of self-paced education, a private community environment, and small group coaching over an 11-month period of time. The learning process is layered into five areas to help professionals deepen their understanding of inclusive diabetes care:
- Inclusive Diabetes Care is the first track. It forms the vision of the organization. Exploring the concept of inclusion helps shift a person’s identity to the felt sense of belonging to a diverse group standing in solidarity supporting all bodies impacted or at risk of diabetes.
- The Health Equity in Diabetes Care track creates this program's goal while helping uncover the hidden barriers faced by individuals with or at risk of diabetes. Humanizing the need for ease begins to unlink the many rights denied by people with diabetes and elevated blood sugar. Helping clients experience a felt sense of ease and sustainability is the next step in this five-track program.
- Understanding Trauma begins a multi-layered process of expanding understanding while creating the felt sense of being seen and heard.
- The Counseling track shifts diabetes care from knowledge to connection, helping professionals deepen their non-judgmental, inclusive communication skills. The complex task is practiced with multiple support layers as participants engage in coaching and small group discussion over the 11-month program. Individuals in the IDC program learn how to humanize their knowledge-driven educational meetings to offer patient-centered therapeutic care.
- The final track strengthens the prevention, identification, reduction, and treatment of disordered eating and coping. This track intends to understand the interdependent role of the individual and the community. Completing this final track fosters the client and professional in identifying and engaging in a felt sense of kind/wholesome self-care.
Shifting the focus of diabetes care to inclusion is an essential solution to the challenges for those at risk of or who have elevated blood sugar. The IDC Certificate program provides the needed training to help healthcare workers support all bodies.
Helpful Tools For Advancing Health Equity
- The Challenge is a 16-page research paper that provides an in-depth review of the economic challenges in diabetes care and how these are related to the Social Determinants of Health.
- Logical Fallacies supporting Health Inequity. This workbook explores 22 different logical fallacies that perpetuate the status quo.
Weight Neutral Self-Assessment objectively evaluates healthcare beliefs on the spectrum between weight-centric or weight-liberated approaches to health.
- Why a Weight Neutral Approach is Essential to Diabetes Care ebook provides the research for a non-judgmental approach to diabetes care.