Health Equity Requires Understanding Diversity of Patient plus Coordinated Inclusion Strategy

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Major health systems are recognizing that health equity is only feasible when comprehensive, coordinated initiatives link quality of care to a culture of inclusion. Dr. Maria Hernandez, founder of Impact4Health, has seen increasing concerns and demands for more engagement among clinicians and administrators to address unconscious bias, culturally effective care and involving community partners in healthcare.

Oakland, CA —The pandemic has brought to light inequities in our health care system that are undeniable, but it’s a problem that has languished long before disaster struck.1 Dr. Maria Hernandez, founder of Impact4Health, says healthcare organizations have a clear and present responsibility to improve, equity and inclusion efforts in order to better service patients and their families.

The Association of American Medical Colleges wrote as recently as 2019, “To effectively enact institutional change at academic medical centers and leverage the promise of diversity, leaders must focus their efforts on developing inclusive, equity-minded environments. A shared desire for change, aided by a growing number of resources, will enable medical schools and academic health centers to assess their institutional culture and climate and improve their capacity for diversity and inclusion”.2

However, each issue can cause different challenges, and measuring those differences presents a broad range of challenges, not only in collecting data but in taking action on that information.

“In training physicians about unconscious bias, most will quickly say that they treat every patient the same, but that’s a problem” explains Dr. Hernandez. “Treating everyone the same assumes all patients have the same resources or live in the same conditions and that’s painfully not the case. Hospital services need to take into account different backgrounds, history, and issues related to our multicultural society. Inclusion is what you do about that diversity to ensure that this diverse population not only feels that they are welcomed and belong, but truly get the right care that meets their needs.”

A culture of inclusion is also of value to diverse staff. Physicians of color have increasingly voiced concerns about how they experience the work environment.  “In every training session, we are hearing how often they are subjected to bias by patients or other staff. Left unaddressed, these experiences take their toll on professionals”, say Hernandez.

The growing diversity of patients and staff is no longer a question. But creating a culture of inclusion is a strategic choice when it comes to recruitment, training and designing patient services in healthcare systems.

“Diversity is being asked to the party,” explains Dr. Hernandez. “Inclusion is being asked to dance.” The real-world examples of the benefits of inclusion are manifold, but to name just a few:

  • Higher levels of morale, largely due to a sense of being part of a larger community
  • Better care for diverse populations from an inclusive staff that includes team members who can identify patients, communicate with them, and better serve their unique needs
  • Better problem solving because staff have a better understanding where their patients are coming from, both physically and culturally

Dr. Denis Nash, an epidemiologist and executive director of the City University of New York Institute for Implementation Science in Population Health (ISPH) says, “We live in a

country where your wealth and your socioeconomic status is a big determinant for how healthy you are, how long you will live, and whether you live with a higher burden of disease while you’re alive”.3 This growing knowledge that diverse patients bring different health needs is at the heart of new initiatives to improve healthcare now.

Naturally, training and education are key to expanding the values of inclusion. Diversity in hiring practices goes a long way but nurturing inclusivity among all staff improves not only better health results, but better patient interaction and cooperation. Diversity training helps increase culturally effective care by teaching staff how to respond to cultural differences; identifying

and mitigating personal, subconscious and unconscious bias, and acknowledging potential barriers to care based on cultural differences or access to key resources.

The goal, obviously, is better health outcomes and training and acknowledgement of the issues involved is a good place to start. Impact4Health’s free Inclusion Scorecard for Population Health is a valuable tool that can serve as a powerful catalyst for a shift in a facility’s culture. “The Scorecard is a key tool for health systems to assess where they are in this journey and target key activities for their health equity strategy,” explains Dr. Hernandez. It’s what we do about that diversity that matters, especially when it comes to inclusion and how we treat people, and really, just putting people at ease. If someone is your advocate—whether it’s a friend, family member, or a hospital employee— when we put people at ease because they’re around people who either look like them, or understand their unique needs , healthcare outcomes improve.

“This is important. If you talk about health equity, then you need to walk the talk,” says Hernandez. “This is a radical change in how healthcare actually works, so naturally it’s not going to be easy. This issue isn’t solved behind a desk—it’s in our waiting rooms, our exam spaces, and in every interaction that we have with patients, regardless of their cultural or racial background. The better we understand each other, the closer we are to real healthcare equity.”


Impact4Health is a multidisciplinary team of community psychologists, public health researchers, physicians and health educators who promote health equity, working in partnership with hospitals, public health departments, and healthcare insurance providers. Strategies employed include training in cross-cultural health, inclusive leadership, and implementing the Inclusion Scorecard for Population Health. Impact4Health is also a leader in the development of health-related Pay For Success initiatives to address asthma-related emergencies for children living in vulnerable communities.

For more information, please visit us at:

  1. McKinskey & Company  “Diversity Wins: How Inclusion Matters” diversity-and-inclusion/diversity-wins-how-inclusionmatters Accessed May 2021
  2. Association of American Medical Colleges “Diversity in Medicine: Facts and Figures 2019” Accessed May 2021
  3. Diverse Issues in Higher Education “COVID-19 Pandemic Highlights Need to Diversify Healthcare Workforce”

Accessed May 2021

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