On April 27, Illinois Gov. J.B. Pritzker signed House Bill 158, a health care equity bill sponsored by the Illinois Legislative Black Caucus, making law the Illinois Health Care and Human Services Reform Act. In drafting the bill, the caucus consulted with Ruby Mendenhall, an Illinois professor of African American studies and sociology and assistant dean for diversity and democratization of health innovation at the Carle Illinois College of Medicine. Mendenhall has researched health care disparities and public health concerns in underserved populations. She discussed the law and its provisions with News Bureau biomedical sciences editor Liz Ahlberg Touchstone.
Why do we need laws governing health care equity? What are some disparities that have not otherwise been addressed?
When thinking about laws that foster health care equity, I like to use a quote from Dr. Martin Luther King Jr. from March 25, 1966. Speaking to the press before his speech at the Medical Committee for Human Rights, he stated, “Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death.” The use of word “inhuman” suggests the failure to see the humanity of others. Historically, such inhuman treatment has played out in the medical abuse of slaves, the Tuskegee experiment and the seizure of Henrietta Lacks’ cells.
Health care equity laws are needed to get at the root causes of health disparities – for example, racism and its interlocking oppressions – and to transform U.S. systems. Policies to improve housing, employment, education, etc., are health policies because they are social determinants of health. The list of health disparities is long and includes stroke, hypertension, diabetes, infant and maternal mortality, and COVID-19 cases and deaths. This level of inequality and excess death, especially during a pandemic, reveals the extreme effort that will be required to dismantle and replace current health policies that continue to diminish individuals’ humanity.
In a nutshell, what are some of the main provisions in the Illinois Health Care and Human Services Reform Act?
The law includes Medicaid coverage for programs that foster infant and maternal health such as doulas and home visiting. The act also requires implicit bias training for health care professionals.
Another key aspect of the law includes the creation of a Community Health Worker Certification Board and legislation that allows for Medicaid reimbursement. In Section 5-5 of the act, a community health worker is defined as a frontline public health worker who is a trusted community member or has an unusually close understanding of the community served. This trusting relationship enables the community health worker to serve as a liaison and intermediary between health and social services and the community to facilitate access to services, and to improve the quality and cultural competence of service delivery. A community health worker also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities including outreach, education, informal counseling social support and advocacy.
In a time of global pandemic, police killings, social unrest and community violence, we need a corps of community health workers in every community across the state to foster health, well-being, a sense of community and even hope.
Why is training important for medical professionals to address structural racism? What kinds of implicit biases may health care providers hold?
Training on implicit bias, structural racism and other topics is important because it allows medical professionals to understand all the ways that racism and its intersecting oppressions are manifested in the lives and communities of their patients, students that they are training and their co-workers. The goals of the training should be to look at the brutality of oppression and its health consequences. For example, 2005 research by David Satcher and colleagues estimated that “83,570 excess (Black) deaths could be prevented in the United States if this Black-white mortality gap could be eliminated.” The training should also include successful efforts around the country to create policies and practices that foster a “culture of health.”
Colleagues and friends across the socioeconomic spectrum and from across the country have described to me having medical providers dismiss their health concerns and make assumptions about their level of education and knowledge about their own health. This often results in a lack of access to medical resources unless they have the knowledge and/or emotional strength to engage in advocacy.
The law also addresses violence as a public health crisis. What does violence have to do with public health?
Violence, public life and public health are very connected. My colleagues and I recently published research that shows the constant stress of living in neighborhoods with high levels of violence can affect the functioning of gene activity in the immune system. Some of the Black mothers that I work with have lost children to gun violence. When this happens, the entire family, and often community, experience intense grief, sadness and sometime depressive symptoms. The stress and emotional pain are often manifested physically as headaches, backaches, hair loss or trouble sleeping.
Overall, how could the Illinois Health Care and Human Services Reform Act affect health care delivery and outcomes in Illinois?
The Illinois Legislative Black Caucus has a bold vision to address systemic racism with its four pillars: criminal justice reform, violence reduction, and police accountability; education and workforce development; economic access, equity and opportunity; and health care and human services. We are in intense times that demand bold policies to address systemic racism. This suite of legislation is historic. I believe the Illinois Health Care and Human Services Reform Act has an enormous potential to address root causes of health disparities and foster health equity on an unprecedented level. Specifically, it can address workforce development in communities of color. Community health worker initiatives can serve as pathway programs to nursing, behavioral health and medical careers.