EquiCare Toolkit

Articles

American Academy of Pediatrics, Section on Adolescent Health, Council on Community Pediatrics, & Committee on Adolescence. (2019). The impact of racism on child and adolescent health [Policy Statement]. Pediatrics, 144(2), Article e20191765. https://doi.org/10.1542/peds.2019-1765

Baker, R., & Wynia, M. K. (2021). Living histories of structural racism and organized medicine. AMA Journal of Ethics, 23(12), E995–E1003. https://doi.org/10.1001/amajethics.2021.995

Braveman, P. (2006). Health disparities and health equity: Concepts and measurement. Annual Review of Public Health, 27(1), 167–194. https://doi.org/10.1146/annurev.publhealth.27.021405.102103

Braveman, P., Arkin, E., Orleans, T., Proctor, D., Acker, J., & Plough, A. (2018). What is health equity? Behavioral Science & Policy, 4(1), 1–14. https://doi.org/10.1177/237946151800400102

Braveman, P. A., Kumanyika, S., Fielding, J., Laveist, T., Borrell, L. N., Manderscheid, R., & Troutman, A. (2011). Health disparities and health equity: The issue is justice. American Journal of Public Health, 101(Suppl 1), S149–S155. https://doi.org/10.2105/AJPH.2010.300062

Bridges, A. J., Villalobos, B. T., Anastasia, E. A., Dueweke, A. R., Gregus, S. J., & Cavell, T. A. (2017). Need, access, and the reach of integrated care: A typology of patients. Families, Systems, & Health, 35(2), 193–206. https://doi.org/10.1037/fsh0000268

Dovidio, J. F., Eggly, S., Albrecht, T. L., Hagiwara, N., & Penner, L. (2016). Racial biases in medicine and healthcare disparities. Testing, Psychometrics, Methodology in Applied Psychology, 23(4), 489–510. https://doi.org/10.4473/TPM23.4.5

Gopal, D. P., Chetty, U., O’Donnell, P., Gajria, C., & Blackadder-Weinstein, J. (2021). Implicit bias in healthcare: Clinical practice, research, and decision-making. Future Healthcare Journal, 8(1), 40–48. https://doi.org/10.7861/fhj.2020-0233

Green, A. R., Carney, D. R., Pallin, D. J., Ngo, L. H., Raymond, K. L., Lezzoni, L. I., & Banaji, M. R. (2007). Implicit bias among physicians and its prediction of thrombolysis decisions for Black and White patients. Journal of General Internal Medicine, 22(9), 1231–1238. https://doi.org/10.1007/s11606-007-0258-5

Henry, T. L., Britz, J. B., Louis, J. S., Bruno, R., Oronce, C. I. A., Georgeson, A., Ragunanthan, B., Green, M. M., Doshi, N., & Huffstetler, A. N. (2022). Health equity: The only path forward for primary care. Annals of Family Medicine, 20(2), 175–178. https://doi.org/10.1370/afm.2789

Huang, D. T., Bassig, B. A., Hubbard, K., Klein, R. J., & Talih, M. (2022). Examining progress toward elimination of racial and ethnic health disparities for Healthy People 2020 objectives using three measures of overall disparity. Vital Health Statistics, 2(195). https://doi.org/10.15620/cdc:121266

Osseo-Asare, A., Balasuriya, L., Huot, S. J., Keene, D., Berg, D., Nunez-Smith, M., Genao, I., Latimore, D., & Boatright, D. (2018). Minority resident physicians’ views on the role of race/ethnicity in their training experiences in the workplace. JAMA Network Open, 1(5), e182723. https://doi.org/10.1001/jamanetworkopen.2018.2723

Shahidullah, J. D., Hostutler, C. A., Coker, T. R., Allmon Dixson, A., Okoroji, C., & Mautone, J. A. (2023). Child health equity and primary care. American Psychologist, 78(2), 93–106. https://doi.org/10.1037/amp0001064

Streeter, R. A., Snyder, J. E., Kepley, H., Stahl, A. L., Li, T., & Washko, M. M. (2020). The geographic alignment of primary care health professional shortage areas with markers for social determinants of health. PLOS ONE, 15(4), e0231443. https://doi.org/10.1371/journal.pone.0231443

Yearby, R., Clark, B., & Figueroa, J. F. (2022). Structural racism in historical and modern U.S. health care policy. Health Affairs (Millwood), 41(2), 187–194. https://doi.org/10.1377/hlthaff.2021.01466

Publicly Available Resources

American Academy of Family Physicians. (n.d.). The Everyone Project. https://www.aafp.org/family-physician/patient-care/the-everyone-project.html

Overview: The EveryONE project toolkit empowers healthcare providers to define and promote health equity in their practices. It offers practical guidance on a range of topics including implicit bias training for staff and assessing patients’ social needs.

American Psychological Association. (2023). Inclusive language guide (2^nd ed.). https://www.apa.org/about/apa/equity-diversity-inclusion/language-guidelines.pdf

Overview: The second edition of APA’s Inclusive Language Guide builds on its 2021 version, reaffirming the American Psychological Association’s commitment to equity, diversity, and inclusion. This guide highlights the power of language, explains why certain terms are harmful to marginalized communities, and offers culturally sensitive alternatives. It also provides the origins of problematic phrases and encourages respect by using terms individuals identify with. The guide emphasizes continual learning and adaptation as language evolves, supporting effective communication in a diverse and inclusive society.

American Psychological Association, APA Task Force on Race and Ethnicity Guidelines in Psychology. (2019). Race and ethnicity guidelines in psychology: Promoting responsiveness and equity. APA Task Force on Race and Ethnicity Guidelines in Psychology. https://www.apa.org/about/policy/approved-guidelines

Overview: APA’s 2019 guidelines emphasize the core values of psychology and provide insights on addressing race and ethnicity in practice, research, and education.

Artiga, S., & Hinton, E. (2018). Beyond health care: The role of social determinants in promoting health and health equity (Issue Brief). Kaiser Family Foundation.   https://resource.nlm.nih.gov/101740257

Overview: This issue brief highlights the importance of addressing social, economic, and environmental factors to improve health and achieve health equity. It provides an overview of social determinants of health and identifies emerging initiatives to tackle them.

Braveman, P., Arkin, E., Orleans, T., Proctor, D., & Plough, A. (2017). What is health equity? And what difference does a definition make? Princeton, NJ: Robert Wood Johnson Foundation.  https://www.rwjf.org/content/dam/farm/reports/issue_briefs/2017/rwjf437393

Overview: The report The Road to Achieving Equity, commissioned by Robert Wood Johnson Foundation (RWJF), concluded  that while the term health equity is widely used, its meaning often lacks a shared understanding.  This report aims to foster discussion and promote consensus on the definition of health equity and its actionable  implications within RWJF’s Culture of Health Action Framework. The goal is not to standardize the definition of health equity but to identify key elements that drive effective action. This report is the first in a series addressing critical challenges in advancing health equity. In this context, ‘health’ refers to health status itself, distinct from health care, which is just one of many factors influencing health. The concepts discussed are grounded in widely accepted ethical and human rights principles and informed by evidence from the health sciences.

Commonwealth Fund. (2024). Advancing racial equity in U.S. health care. https://www.commonwealthfund.org/publications/fund-reports/2024/apr/advancing-racial-equity-us-health-care

Overview: A recent report from the Commonwealth Fund, Advancing Racial Equity in U.S. Health Care: The 2024 State Health Disparities Report, highlights persistent racial and ethnic disparities in health care access, quality, and outcomes across the U.S. The analysis reveals stark divides in premature deaths, with Black Americans and American Indians disproportionately affected by preventable and treatable conditions, even in states with high-performing health systems. Using 25 measures, the report evaluates state performance across health care access, service quality, and outcomes for Black, white, Hispanic, American Indian and Alaska Native (AIAN), and Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations. It provides a comprehensive state-by-state overview of how health care systems serve diverse communities. The tool is designed to help policymakers, health system leaders, and community stakeholders assess the impact of current and past health policies on different racial and ethnic groups and guide efforts toward creating a more equitable health care system for the future.

Institute of Medicine. (2003). Unequal treatment: Confronting racial and ethnic disparities in health care (B. D. Smedley, A. Y. Stith, & A. R. Nelson, Eds.). Washington, DC: National Academies Press. https://doi.org/10.17226/12875

Overview: Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients’ and providers’ attitudes, expectations, and behavior are analyzed. Unequal Treatment also offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider-patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.

Satcher Health Leadership Institute, Morehouse School of Medicine. (2022). The economic burden of mental health inequities in the United States: Report. https://satcherinstitute.org

Overview: This report summarizes evidence demonstrating how decades of systemic health inequities have yielded significantly worse outcomes for racial and ethnic minoritized, marginalized, and under resourced populations.  The study discussed aims to address a critical gap in behavioral health and health equity research related to mental health inequities. Building on three landmark reports published over 20 years ago, this study seeks to illuminate the economic impact of the nation’s failure to invest in behavioral health interventions, services, treatments, supports, and programs.

Articles

Abraham, P., Williams, E., Bishay, A. E., Farah, I., Tamayo-Murillo, D., & Newton, I. G. (2021). The roots of structural racism in the United States and their manifestations during the COVID-19 pandemic. Academic Radiology, 28(7), 893–902. https://doi.org/10.1016/j.acra.2021.03.025

Brondolo, E., Love, E. E., Pencille, M., Schoenthaler, A., & Ogedegbe, G. (2011). Racism and hypertension: A review of the empirical evidence and implications for clinical practice. American Journal of Hypertension, 24(5), 518–529. https://doi.org/10.1038/ajh.2011.9

Halfon, N., Russ, S. A., & Kahn, R. S. (2022). Inequity and child health: Dynamic population health interventions. Current Opinion in Pediatrics, 34(1), 33-38. https://doi.org/10.1097/MOP.0000000000001087

Hines, A. L., Brody, R., Zhou, Z., Collins, S. V., Omenyi, C., Miller III, E. R., Cooper, L. A., & Crews, D. C. (2022). Contributions of structural racism to the food environment: A photovoice study of Black residents with hypertension in Baltimore, MD. Circulation: Cardiovascular Quality and Outcomes, 15(11), e009301. https://doi.org/10.1161/CIRCOUTCOMES.122.009301

Mohottige, D., Davenport, C. A., Bhavsar, N., Schappe, T., Lyn, M. J., Maxson, P., Johnson, F., Planey, A. M., McElroy, L. M., Wang, V., Cabacungan, A. N., Ephraim, P., Lantos, P., Peskoe, S., Lunyera, J., Bentley-Edwards, K., Diamantidis, C. J., Reich, B., & Boulware, L. E. (2023). Residential structural racism and prevalence of chronic health conditions. JAMA Network Open, 6(12), e2348914. https://doi.org/10.1001/jamanetworkopen.2023.48914

Williams, D. R., Lawrence, J. A., Davis, B. A., & Vu, C. (2019). Understanding how discrimination can affect health. Health Services Research, 54 (Suppl 2), 1374–1388. https://doi.org/10.1111/1475-6773.13222

Whitman, A., De Lew, N., Chappel, A., Aysola, V., Zuckerman, R., & Sommers, B. D. (2022). Addressing social determinants of health: Examples of successful evidence-based strategies and current federal efforts. Department of Health & Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Health Policy.  http://resource.nlm.nih.gov/9918589885806676

Wisner, K. L., Murphy, C., & Thomas, M. M. (2024). Prioritizing maternal mental health in addressing morbidity and mortality. JAMA Psychiatry, 81(5), 521–526. https://doi.org/10.1001/jamapsychiatry.2023.5648

Publicly Available Resources

National Academy of Medicine Culture of Health Program. (2021). Acknowledging structural racism’s direct and negative impact on health. https://www.nam.edu

Overview: As the National Academy of Medicine (NAM) Culture of Health Program (CoHP) moves into its second phase, the NAM is highlighting statements from past CoHP reports that acknowledge structural racism’s direct and negative impact on health – and in particular the disproportionate effects on the health and well-being of Black, Indigenous, and people of color.

National Committee for Quality Assurance & Janssen Scientific Affairs, LLC. (2020).   Social determinants of health: Resource Guide. https://www.ncqa.org/wp-content/uploads/2020/10/20201009_SDOH-Resource_Guide.pdf

 Overview: This resource guide explores strategies used by health plans and clinically integrated networks (CINs) to address social determinants of health (SDOH). CINs—collaborative networks of health care providers—leverage financial incentives to deliver higher-quality, better-coordinated, and more efficient care. The guide highlights how health plans and CINs use data-sharing, care coordination, and partnerships with community-based organizations to connect patients with resources that address social needs. Motivated by evolving payment incentives, many organizations have adopted SDOH strategies to improve outcomes for Medicare and Medicaid populations. To understand these efforts, NCQA surveyed 56 organizations and conducted interviews with 19 health plans and CIN representatives. The guide includes case studies, practical tools (e.g., health risk assessments and care management resources), and answers to common questions about implementing and evaluating SDOH initiatives. Whether you’re determining where to start, what questions to ask, or how to measure the impact of SDOH interventions, this guide provides actionable insights to help organizations improve care by addressing patients’ social needs.

Articles

Goddu, A. P., O’Conor, K. J., Lanzkron, S., Saheed, M. O., Saha, S., Peek, M. E., Haywood, C., Jr., & Beach, M. C. (2018). Do words matter? Stigmatizing language and the transmission of bias in the medical record. Journal of General Internal Medicine, 33(5), 685-691. https://doi.org/10.1007/s11606-017-4289-2

Phelan, S. M., Salinas, M., Pankey, T., Cummings, G., Allen, J.-S. P., Waniger, A., Miller, N. E., Lebow, J., Dovidio, J. F., van Ryn, M., & Doubeni, C. A. (2023). Patient and health care professional perspectives on stigma in integrated behavioral health: Barriers and recommendations. Annals of Family Medicine, 21(Suppl 2), S56-S60. https://doi.org/10.1370/afm.2924

Publicly Available Resources

Casau, A., & Beach, M. C. (2022). Words matter: Strategies to reduce bias in electronic health records. Center for Health Care Strategies. https://www.chcs.org/media/Words-Matter-Strategies-to-Reduce-Bias-in-Electronic-Health-Records_102022.pdf

Overview: Biases and stigmatizing language in electronic health records (EHRs) often appear as negative physical or behavioral descriptors related to race and ethnicity. Such language can perpetuate inequalities and negatively impact patient care across providers. This tool offers practical guidance for writing EHR notes that foster patient-centered care and uphold dignity.

Primary Care Collaborative. (2022). Relationships matter: How usual is usual source of (Primary) Care? https://www.graham-center.org/content/dam/rgc/documents/publications-reports/reports/pcc-evidence-report-2022.pdf

Overview: This evidence report underscores the consistent research findings on the benefits of having a usual source of care (USC), whether it’s a person or place you can rely on for health concerns—most often primary care. A strong evidence base shows that individuals with an ongoing relationship with primary care experience better health outcomes, more equitable care, and lower healthcare costs across all demographic groups. This continuity, often called the “secret sauce of primary care,” fosters trust, strengthens clinician-patient relationships, and enables providers to better understand patients’ needs and preferences, ultimately enhancing satisfaction and care quality.

Articles

Baker, R. & Wynia, M. K. (2021). Living histories of structural racism and organized medicine. AMA Journal of Ethics, 23(12), E995-E1003. https://doi.org/10.1001/amajethics.2021.995

Foronda, C., Baptise, D-L, Reinholdt, M. M., & Ousman, K., (2015). Cultural humility: A concept analysis. Journal of Transcultural Nursing, 27(3).    https://doi.org/10.1177/1043659615592677

Moore de Peralta, A., Gillispie, M., Mobley, C., & Gibson, L. M. (2019). It’s all about trust and respect: Cultural competence and cultural humility in mobile health clinic services for underserved minority populations. Journal of Health Care for the Poor and Underserved, 30(3), 1103-1118. https://doi.org/10.1353/hpu.2019.0076

Scharff, D. P., Mathews, K. J., Jackson, P., Hoffsuemmer, J., Martin, E., & Edwards, D. (2010). More than Tuskegee: Understanding mistrust about research participation. Journal of Health Care for the Poor  and Underserved, 21(3), 879-897. https://doi.org/10.1353/hpu.0.0323

Yeager, K. A., & Bauer-Wu, S. (2013). Cultural humility: Essential foundation for clinical researchers. Applied Nursing Research, 26(4), 251-256.     https://doi.org/10.1016/japnr.2013.06.008

Publicly Available Resources

Stubbe, D. E. (2020). Practicing cultural competence and cultural humility in the care of diverse patients. Focus, 18(1), 49-51. https://doi.org/10.1176/appi.focus.20190041

Overview: This article emphasizes the need for healthcare systems and providers to be aware of and responsive to patients’ cultural perspectives and backgrounds. It discusses how cultural competence and patient-centered care intersect to improve healthcare delivery.