Dr. Harold Paz, CEO of The Ohio State University Wexner Medical Center, shares the healthcare organization's strategy that addresses social determinants of health in its communities.
In May 2020, the Franklin County Board of Commissioners declared "racism as a public health crisis" in Ohio. And in June, an Ohio Senate committee introduced a Concurrent Resolution "to declare racism a public health crisis and to ask the Governor to establish a working group to promote racial equity in Ohio."
In line with these declarations, The Ohio State University Wexner Medical Center created Anti-Racism Initiatives to "elevate, engage, equip, and empower" the community, students, faculty, and staff to focus on improving racial inequalities in healthcare. The medical center also states that "racism is a social determinant of health."
HealthLeaders recently spoke to Dr. Harold Paz, executive vice president and chancellor for health affairs at The Ohio State University and CEO of The Ohio State University Wexner Medical Center, about the medical center and university's focus on addressing social determinants of health and racial inequities in their surrounding communities through an anti-racism action plan.
This transcript has been edited for clarity and brevity.
HL: Why is it important for hospitals and health systems to focus on social determinants of health and racial inequities?
Paz: Study after study has shown … that healthcare, the thing that we spend over $3 trillion on in this country, contributes to about 20% of your health status. Genetics attributes, on average, something around 10% or so. And then the [rest] are the environmental, social, and behavioral determinants of health.
I would say that racism is a social determinant of health, because of the challenges that it puts in front of individuals who are affected by it, and how it affects their health overall. And we know there's ample evidence from a number of studies that show, on the basis of race, there are real differences in health status and longevity.
In the COVID-19 pandemic, although black people are a smaller percentage of the overall population, they were a higher percentage nationwide of those who are hospitalized and died from COVID-19. That group has higher rates of diabetes, hypertension, and obesity, which is a risk factor for COVID-19 hospitalization, and we've seen similar issues with the Hispanic population as well compared to non-Hispanic whites.
So, without a doubt, discrimination is a known stressor, and stress leads to physical damage. There's plenty of studies to show that stress leads to things like delayed wound healing, faster aging of the body, and weight gain.
On the basis of all this data and information, we felt that there's a direct line between racial discrimination and health outcomes. And that's why we made a decision to include racism as one of the social determinants of health, in addition to poverty, housing, violence, food insecurity, transportation. We think it's very important.
HL: How has training for medical and health science students changed to address social determinants of health and racial inequities?
Paz: We do lots of different work in this area. We think it's exceptionally important, and we're proud of the track record we have. Ohio State Wexner Medical Center was ranked fourth in the country in Forbes, this year, among the best employers for diversity list. U.S. News and World Report ranked the Ohio State College of Medicine as No. 2 in the U.S. for its number of African-American medical students when you exclude the black colleges and universities. Twenty-four percent of the incoming class is from underrepresented backgrounds in medicine.
This has been a priority area for a long time, but we feel strongly that that's not where we stop. As a matter of fact, we feel we have a huge obligation and sense of urgency to take our accomplishments and move even further and faster. We want to continue to move forward and we want to continue to provide leadership.
We have an array of different programs from cultural competency training for faculty and staff, to implicit bias training across the organization, because we recognize that has an impact on selection committees for the College of Medicine, [and] search committees for faculty and staff.
For example, we were in the midst of a search for the Dean of the College of Medicine. We made sure that committee was exceptionally diverse by gender and also by racial makeup. We included implicit bias training in their thinking so that when the list of candidates came forward, we would have a diverse group of candidates who would be well positioned to take on the role.
HL: Can you talk about the anti-racism action plan and the medical center's approach on improving education, engagement, funding, and policies and practices?
Paz: We have two committees at the [Ohio State Wexner Medical Center]. One is an internal committee that looks at diversity and inclusion led by our chief diversity officer. The other is an external committee to look at diversity and equity in the community.
We wanted to have our existing two committees … come together and develop a road map for us, and we would make it very public, we would hold ourselves accountable to it, we'd make investments in it, to continue to move our organization forward in ways to deal with these issues.
It began by organizing roundtables about action against racism with institutional and community leaders led by our health equity steering community. That was one step along the way to do things like screening consistently for social determinants of health questions in the electronic medical record, to engage in policy work that contributes to anti-racism efforts to make sure that this is included in our hiring promotion and search committees, to create an annual anti-racism report. And then to do the work in our organization; continue to do more work in implicit bias training, the anti-racism listening sessions and safe space discussions, and discussion for students and faculty and staff to continue to advance cultural competency training.
We have all these resources here at Ohio State Wexner Medical Center, and work and invest in the Near East Side, which has traditionally been the community that has been underserved and predominantly African American and minority, and expanding access to care. We purchased the community hospital there, we put major facilities into it including service lines, built a large outpatient facility there, to serve the underserved.
We invested millions of dollars in creating something called Partners Achieving Community Transformation (PACT) to address socioeconomic factors that influence health. For example, we launched something in 2010 called our Moms2B program where we went into high-risk neighborhoods in the Near East Side and elsewhere to provide access to safe cribs, healthy meals, education about prenatal care, nutrition, smoking cessation, breastfeeding, because that was our effort to reduce infant mortality. We saw a fivefold reduction in mortality.
We're doing more now. We serve different communities with that program. We launched something called the Mid-Ohio Farmacy, which is a partnership with the Mid-Ohio Foodbank, to make sure that patients are prescribed access to fresh produce. We've launched a community health day, which provides free health screenings. Our College of Dentistry provides free dental care through its service learning programs to underserved populations.
One of the things I'm very proud of is our Community Care Coach that we launched this year, where
[healthcare professionals] go into underserved neighborhoods to deliver primary care and OB/GYN services. And since the pandemic started, we've repurposed that to focus on addressing needs in those communities around the pandemic. We've distributed over 9,000 COVID-19 Community Care kits in those neighborhoods. That includes a mask, soap, hand sanitizer, and educational material targeted to these vulnerable zip codes, because we know that there's a disproportionate number of individuals from those communities who are impacted by the pandemic.
HL: What would you say to other health systems that want to implement changes like this, but don't know where to start?
Paz: I would say that it starts with conversations in the community because all of us serve diverse and broad communities. And to invest in communities that have tremendous need and reflect our underserved and the challenges that we just spoke to. This creates huge opportunities to better engage with the community, to create surface-learning experiences for the students, and volunteer opportunities for the faculty and staff.
[And] to internally look at the data. Look at opportunities for diversity and inclusion; focus on [those] as part of workforce practices and hiring in leadership roles. Make sure that leaders continually speak to this and emphasize it, and that there's good data that is publicly available to track the progress that our organizations are doing to make sure that we achieve our responsibilities.
Related: 3 Community-Based Strategies Health Systems Can Implement Right Now
“I would say that racism is a social determinant of health, because of the challenges that it puts in front of individuals who are affected by it, and how it affects their health overall.”
— Dr. Harold Paz, The Ohio State University Wexner Medical Center CEO, Ohio State University executive vice president and chancellor for health affairs
Melanie Blackman is a contributing editor for strategy, marketing, and human resources at HealthLeaders, an HCPro brand.
Photo credit: Photo courtesy of The Ohio State Wexner Medical Center
KEY TAKEAWAYS
The Ohio State University Wexner Medical Center considers racism a social determinant of health.
The medical center has implemented robust health programs to bolster its community members' well-being.
The medical center was ranked this year by Forbes as fourth among the best employers for diversity in the country.