A new individually authored discussion paper in NAM Perspectives — the digital periodical of the National Academy of Medicine — published September 15, 2021 identifies health equity as the area of most urgent and cross-cutting concern for health care quality organizations and outlines a proposed agenda for centering equity in efforts moving forward.

On the occasion of the 20th anniversary of the publication of To Err is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century, the National Academy of Medicine convened leaders from seven prominent U.S. health care quality organizations to discuss and author this paper identifying the most important priorities for health care quality over the next 20 years. The authors identify and call attention to equity as a necessary focus for the next 20 years, noting, “For care to be considered high quality, it must be equitable. Inequitable care is low-quality care and must be treated as such.”

The discussion paper outlines the current state of health care quality, and key barriers that are impeding progress toward health care equity, including the impact of racism and discrimination, inadequate attention to social determinants of health, lack of data, and lack of trust. After identifying these barriers, the discussion paper turns to envisioning an ideal future state for health care quality, and outlines strategies to improve racial equity in health care quality, including increasing patient trust and involvement; increasing community engagement; rewarding organizations for progress toward equity; improving data quality; and implementing new and improved measurement strategies.

The paper ends by noting that the health care system alone cannot ameliorate the many issues that have caused disproportionately poor outcomes among communities of color and other made-to-be vulnerable communities. However, “it can take many steps that would advance equity … [and] perhaps most importantly, it can lead the way for other sectors by establishing a measurable and transparent racial equity agenda and holding itself accountable.”

Read the paper online or download a free PDF here: https://nam.edu/an-equity-agenda-for-the-field-of-health-care-quality-improvement/.



This paper is not a consensus study or report of the National Academy of Medicine or the National Academies of Sciences, Engineering, and Medicine. The National Academy of Medicine, established in 1970 as the Institute of Medicine, is an independent organization of eminent professionals from diverse fields including health and medicine; the natural, social, and behavioral sciences; and beyond.  It serves alongside the National Academy of Sciences and the National Academy of Engineering as an adviser to the nation and the international community.  Through its domestic and global initiatives, the NAM works to address critical issues in health, medicine, and related policy and inspire positive action across sectors.  The NAM collaborates closely with its peer academies and other divisions within the National Academies of Sciences, Engineering, and Medicine.

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