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To Improve Health Equity, Look at Politics

February 24, 2022

The Political Determinants of Health

Daniel Dawes, JD, a key figure in shaping the Affordable Care Act, urged the audience at last month's Health Equity Summit to look upstream and focus on the political and structural barriers to health equity.  

"Ensuring that every individual has a fair opportunity to achieve full health potential is a defining challenge of our time," Dawes said, noting that 83,000 African Americans die prematurely each year as a result of health inequities.

Dawes, the director of the Satcher Health Leadership Institute at Morehouse School of Medicine, told the audience that the social determinants of health are widely recognized as contributing to health but more needs to be done.

He noted the medical abuse that recently took place in Arkansas, where four inmates in a county jail were given experimental drugs to treat COVID-19 without their consent. And he cited the ongoing opposition to voting rights legislation, which contributes to racial injustice.

Dawes was a keynote speaker at the conference hosted by The Hastings Center with the AAMC Center for Health Justice and sponsored by the American Medical Association, the American Nurses Association, the American Hospital Association, and the ABIM Foundation. The virtual event drew more than 2,500 attendees.

Dawes urged audience members to look at what gives rise to the social determinants of health equity -- the political determinants. These are "the systemic processes, distribution of resources, and administering power that shape and hinder health equity. They create structural barriers to communities that lack power and privilege."

He noted to attendees that as we seek to eliminate the health inequities that sit downstream, we must "ensure that we keep structural racism at the forefront of our research and analysis so that the impact of explicit and implicit racial biases does not get watered down."

Dawes delivered a multipronged call to action to:

  • Advance the research and discussion about structural racism and implicit racial bias as a causal factor of health disparities.
  • Expand the bioethical focus to hone in on racial and ethnic inequities.
  • Focus upstream on the political determinants of health to create a more informed dialogue about the origins of and solutions to the social determinants of health that have and continue to create sustained and exacerbated health inequities.

"When extraordinary people come together, magic in health equity happens," Dawes concluded. "Let's make magic together and move the needle of health equity to a place we never dreamed possible."