health care equity

If you’re like me, you only have a walking-around understanding of equity, even though it’s the political buzzword of 2021.

It also means you’re like me: lucky enough not to know what inequity looks and feels like.

It means fairness, but fairness, like most things, is relevant.

Lt. Gov. Dianne Primavera is trying to understand it. She was on a Zoom call with community leaders on Sept. 8 to kick off her annual statewide listening tour on how to save Coloradans money on their health care. After all, she leads the agency Gov. Jared Polis created called, aptly enough, the Office of Saving People Money on their Health Care.

“I think a lot of health equity is recognizing that things aren't equitable,” said Kaakpema “KP” Yelpaala, the co-founder and CEO of InOn Health and the host of the “InOn Health Equity podcast.”

Primavera said on the call, “We've made important progress in many areas to reduce the cost of healthcare, but healthcare disparities continue to be a major issue (against) progress in many areas.”

Agreeing everyone should be treated fairly is the easy part. That’s where the clarity ends, however, because an even break means different things to so many different people. Making sure they’re all served to their liking is a Sisyphean task .

“Working to build and sustain a Colorado for all,” Primavera began, citing a Polis campaign slogan from 2018, “means that regardless of your location, your income, race, gender, ethnicity, age, disability, status, veteran status or sexual orientation that you have reliable access to affordable and high quality health care.”

Those doing without know exactly how and where inequality is applied to them.

“For those of us who live these lives and have a real stake in it have known that these things have been around for decades and decades and decades,” said Yelpaala, who is Black.

Talaya Banks, Let My People Vote coordinator for Denver’s Soul 2 Soul Sisters, didn’t mince words about the short end of the stick that's most often extended to Black women.

“For me, health equity right now is addressing the ways in which colonial white supremacy ... is impacting the experiences of primarily Black women, families, girls and gender expansive people,” she said. “And so health equity right now is addressing the inequities in all of the different layers in all of the different systems and then asking how we can have healthy bodies.”

How people are left out depends on their culture, their income and availability of affordable services in their respective communities, experts explain. Again, that's a broad moving target.

Nadine Bridges, executive director of One Colorado, the state’s largest advocacy organization for LGBTQ Coloradans and the families, gummed up the definition as it relates to her constituents.

“From the LGBTQ standpoint, we're not a monolith. The incredible thing about LGBTQ community members is that we are representative of every identity, race, ability, religion, everything that's out there, which means that when we're talking about healthcare, we really have to break it down and understand the intersections of impact.”

That what, however, lacks a how, and sometimes even a why.

In January, the Durango 9-R Board of Education passed a resolution apologizing for what it claimed was a failure to identify and address “diversity, equity and inclusion” in a systemic way.

“Any one person not feeling valued, safe, and welcome in our schools is simply too many,” the resolution states.

Yet, the district was unable to turn up even one example of where one of its schools failed to be fair.

The district said 21% of its students are Latino, 6% are American Indian, 1% are African American and 1% are Asian. The average household income in Durango is $100,398 compared to the state average of $72,331.

Coincidentally, Joe Biden won 59% of the votes  in La Plata last November. (Kanye West got 11 votes.)

In May, the school board provided an update on its equity efforts. 

“In order to increase knowledge of cultural identity and awareness, liaisons worked with students through culturally relevant learning projects/activities, whole-class lessons on diversity, Native American Club and mentoring,” the board explained. “Liaisons also worked with staff to find culturally relevant books and videos. They provided staff professional development regarding implicit bias, importance of Title VI program, Native American Culture of Durango School District 9-R, and Culturally Responsive Classrooms and Schools.”

Democrats own this moment, but Republicans' past declarations about ensuring a fair shake have gone nowhere.

The Reagan administration initiated policies and laws to prioritize issues affecting the health of underserved populations and the disparities experienced by these groups. It didn’t work, or we wouldn’t be talking about it now.

In 2001, then-U.S. Senate Majority Leader Bill Frist, a Republican from Tennessee and a physician, championed health equity to “focus on the uninsured and those who suffer from health care disparities that we so inadequately addressed in the past.”

Until policymakers can define the issue more precisely than “be fair,” then solutions will remain elusive.

One person’s fairness is another person’s stacked deck, but keeping it vague and broad is attractive to more voters, because it’s hard to vote against being fair when you don't have the specifics of what it means and how much it will cost.

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