Advancing Health Equity

The Health Affairs briefing “Advancing Health Equity” held at the National Press Club, focused on reducing inequities in the health system. The March  “Health Affairs” issue provides vital data from a number of journal authors on programs that could help effectively advance health equity.

Opening the briefing, Alan Weil, Editor in Chief Health Affairs JD, announced that the March issue explores various approaches to reducing inequity and analyzes a range of programs designed to achieve health equity.

Several of the authors presented their thoughts, ideas, and details on innovative new studies and a new concepts to help reduce inequities in the population. Marsha Regenstein PhD Professor Department of Health Policy and Management at the Milken Institute School of Public Health at George Washington University, discussed Medical-Legal Partnerships (MLP).

Dr. Regenstein and co-authors contributed to the article “Addressing Social Determinants of Health through Medical-Legal Partnerships”. The MLP concept was first initiated in children’s hospitals and is now spreading to other populations in other states and in the federal sector.  For example, the VA now has two MLPs to help homeless veterans.

MLPs maintain the use of civil legal aid professionals in healthcare settings to address difficult social problems that contribute to poor health outcomes and health disparities. Today, these partnerships exist in more than 300 sites such as hospitals, clinics, and health systems.

Developing MLPs entails working with a defined patient population, screening the population to be studied, providing civil legal services if necessay, providing training on how to address inequities, providing the know-how to effectively share information, and finding ways to obtain the needed resources to maintain the MLP program.

In another innovative study, a program called “Family Awards” was described by Emilie Courtin Research Fellow, at the Department of Global Health and Social Medicine at King’s College in London. Courtin and other authors contributed to the article “Conditional Cash Transfers and Health of Low-Income Families in the U.S. Evaluating the Family Rewards Experiment”.

The “Family Awards Experiment” program in New York City is the first conditional cash transfer randomized controlled trial geared to low income families in the U.S. The study entails the use of conditional cash transfers to provide money to people if they complete tasks designed to produce long term benefits. This concept has already been used in low and middle income countries.

The Family Rewards program from 2007-2010 offered 2,377 New York City families in six New York neighborhoods cash transfers that were conditional upon their investments in education, preventive healthcare, and parental employment. Their health and other outcomes were compared to those of a control group of 2,372 families.

As Courtin explained, “This experiment only led to a modest improvement in health insurance coverage but at the same time, led to a large increase in the use of preventive dental care. Plus the fact, that the reward program did help the participants improve the perception of their own health, plus the participants reported feeling better off financially. However, the study did not delve into the effects on chronic disease risks due to the length of time it takes to compile all of the information needed.”

In another study, Nathan Nickel PhD, Assistant Professor, at the Manitoba Centre for Health Policy at the University of Manitoba and co-authors reported on their study in the article “An Unconditional Prenatal Income Supplement Reduces Population Inequities in Birth Outcomes”. The study examined the effects of using an unconditional cash transfer program directed to a specific group. This group consisted of low-income pregnant women in Manitoba Canada.

He explained, “The study’s goal was to examine whether an unconditional prenatal income supplement for low income women would produce reduced population level inequities. The study looked at specifics of care and hospitalization within two years of birth and noted the outcomes.”

First, the study identified all mother-newborn pairs from the period 2003 to 2010 in Manitoba and divided the pairs into three groups. The three groups included a low income exposed group that received the supplement, a low income unexposed group that did not receive the supplement, and a not low income unexposed and ineligible for the supplement.

As Dr. Nickel reported on the study, “The data was obtained by measuring inequities in low-birthweight births, preterm births, and breast feeding initiation among these groups. It was found that health inequities were reduced between low income and other women when the low income women received the income supplement although the results were different in urban and rural areas.

Philipp Hessel PhD, Associate Professor at the Alberto Lleras School of Government, University of the Andes, in the article, “Social Pension Income Associated with Small Improvements in Self-Reported Health of Poor Older Men in Colombia” talked about a study involving poor older men that do not always have access to pensions.

As he explained, “Governments in Latin America have introduced a noncontributory pension program to reduce poverty and food shortages. The study assessed the effects of distributing this large national noncontributory pension program and how it affects the health and health care use of older people men.

The study found that by providing cash benefits to older men, these men were 5.6 percent less likely to report bad health, and had a 5.4 percent reduced likelihood of being hospitalized. However, no significant effects were found among women or among men for other health and healthcare use outcomes.

Dr Hessel study suggests that the effects of providing a small noncontributory pension to help vulnerable older men is small in magnitude. The country needs to maximize health benefits by working with health policy makers in the country in order to maximize the health benefits of cash transfers to poor older people.

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