Home | Pediatricians’ Voices on Equity Needed Outside the Clinic

Pediatricians’ Voices on Equity Needed Outside the Clinic

January 16, 2018

By Nate Chomilo, MD, Minnesota Doctors for Health Equity

Nate ChomiloHere’s a statistic that may be hard to hear: Only 10 to 20 percent of health outcomes are attributable to health care.

For all our education, training and expertise, there is only so much we as physicians can do if we choose to only work within our clinics or hospitals.

We can highlight the ongoing health disparities (health differences that arise from economic, social or environmental disadvantages) that are worse in Minnesota than almost every other state, but putting a spotlight on the problem alone is not a solution. These disparities also arise from implicit bias, explicit bias and the structural racism intrinsic to many parts of our society, our healthcare system being no different.

As physicians we have the power and opportunity to promote equitable care and approaches to health. Equity is not equality; it is assuring that those who have been left behind or started at a disadvantage get what they need to reach their full potential. Health disparities define the problem; health equity defines the solution.

Minnesota Doctors for Health Equity (MDHEQ) came together to equip physicians for this work. It started with a handful of us acknowledging that while there were state-wide discussions about things like affordable access to care, racism, sexism and poverty, we weren’t having the same discussions amongst physicians. Physicians, and at times the groups that speak for us, weren’t actively advocating for equity. We decided to create a supportive environment for other physicians interested in the work of health equity. We have done that by engaging physicians to use their power and privilege in several different areas of action.

  • Individually: As “citizen-physicians” who are engaged in our democracy and use our expertise to inform public and private discussions that promote Equity in our communities. We have shared different books/articles that can inform one around Equity, started a book club about racism & medicine, given examples through our monthly newsletter about discussions you can have with colleagues and patients around Equity, discussed how you can engage your legislators and hosted a workshop on being a citizen physician and one on facilitating difficult discussions.
  • At work/in your health care system: We are (mostly nowadays) all part of or affiliated with large health systems. As the main drivers of everything these systems do physicians can demand equity throughout our organizations. We are building coalitions of physicians within health systems to look at how do these systems interact with their community. Not just from a PR standpoint but less obvious decisions like what businesses do they buy food from for their conferences? Are they tracking health outcomes by race/income/language/sex? What do they do with that data? Healthcare employs 5% of the ENTIRE workforce in MN. Holding the systems we work in accountable for equitable practices can have a far reaching impact.
  • With community organizations: What are local efforts that we can use a physician’s 3 Ps (Power, Privilege, Plenty, coined by University of Minnesota Med-Peds program director Mike Aylward, MD FAAP) to raise up? We have had conversations with Simpson Housing Services & Voices for Racial Justice in the Twin Cities so far.
  • Within our professional associations: The MNAAP has long had a tradition of putting our patients’ interests first. We understand that kids can’t vote but we can. Other physician organizations have talked about equity but when it comes to legislation that can help address the inequities our patients face, like the Provider Tax, they have actively worked against patients’ interests. We are engaging members of physician organizations around the state to be active in their chapters, so these organizations truly reflect what all their members believe is best for patients. We recently co-hosted the MMA’s Health Equity Forum with many of our members serving as speakers or table facilitators.
  • Through legislative advocacy: As former Commissioner of the MN Department of Health and Med-Peds Dr. Ed Ehlinger would often say, there is health in all policy. We are looking at how to frame policies that are being passed in MN to make the case that there is health and equity opportunities in almost all of them. We have had 4 OpEds published in the last year by members providing a physician voice to support policies that would improve access to care. We have had members testify at a State Senate committee hearing in support of a MNCare Buy-In as well as several members testify at their City council meetings in support of stricter tobacco legislation.

In one year MDHEQ has grown from a handful of physicians to a movement that now includes 110 physicians from across the state, over 40 of which are pediatricians! We are excited to work with any physicians interested in gaining or sharing the knowledge and skills required to be agents of change. No matter how small or large a step members wish to take, we invite you to join us as we work to educate, connect and activate our colleagues to be champions for equity.


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