Introducing: Health Equity Rounds

In its founding charter, the World Health Organization emphatically stated that “the highest standards of health should be within reach of all, without distinction of race, religion, political belief, economic, or social condition.”¹  The long history of efforts to improve health equity with only modest successes demonstrates how central this is to high-quality health care and how slow progress has been. More recently, health equity has evolved from a theoretical discussion to a call to action. Countless studies, including those showing a nearly threefold higher maternal mortality rate in non-Hispanic Black women (when compared with non-Hispanic white women) and a threefold higher mortality rate for Black newborns (compared with white newborns), which improves with physician–patient racial concordance, have brought health inequity to the center of the conversation.^2,3  These findings force health care providers to acknowledge the substantial impact of health disparities on patient outcomes.

To bring these disparities to the forefront and galvanize action to reduce them, pediatric trainees and faculty at Boston Medical Center developed Health Equity Rounds as a curriculum to teach trainees to identify and address inequities in patient care through case study. We are fortunate to have several of the founders on our debut article here by Rainer and Lim et al.⁴  In addition to teaching trainees, Health Equity Rounds also provided an opportunity for attending providers and members of the interdisciplinary care team to practice working as a team to tackle complex socioeconomic barriers to equitable care.

Given that many pediatric health disparities involve hospitalized children,⁵ Hospital Pediatrics is excited to publish the first in a series of a new and soon to be regular article type, Health Equity Rounds. In “Structural Racism in Behavioral Health Presentation and Management,” Rainer and Lim et al present a case where systemic and interpersonal racism leads to a Black child being repeatedly diagnosed with disruptive behavioral disorders, such as oppositional defiant disorder and conduct disorder.⁴  These diagnoses both mask the underlying posttraumatic stress disorder that the patient exhibits because of adverse childhood trauma and influence treatments she receives for these episodes. As articles in this series in the future will do, the authors provide concrete steps that institutions can take to mitigate the impact of racism on health.

As we launch this new article type, we invite multidisciplinary groups, particularly trainees, to investigate adverse outcomes in cases involving hospitalized patients through a health equity lens. Articles should anchor a discussion of inequity in a case of hospital care (or the antecedents to hospital care) of an infant, child, adolescent, or young adult, and in specific biases/root causes that contributed to inequitable care and/or outcomes. This can and usually should include personal, systemic, and historical drivers. As presented in our inaugural piece, the discussion should include relevant literature and present evidence-based or other promising interventions to reduce the inequities discussed. Because stories shared through previous Health Equity Rounds conferences inspired this new article type, we would be particularly excited to receive submissions led by pediatric residents and fellows who have successfully shared stories in these venues.

Although cases presented at Health Equity Rounds are often focused on inequitable care, we also invite authors to present cases in which their institutions used evidence-based interventions or instituted policies that promoted equitable care and resulted in a positive outcome for the patient and family/caregiver. By providing examples of best practices, we hope that such exemplars will provide actionable steps to improve health equity at local institutions. Finally, presentations and health inequities explored need not be limited to cases where racial and ethnic disparities exist; we invite cases that explore all areas of inequities, including, but not limited to, gender identity, gender expression, sexual orientation, insurance status, language, and ability status, as well as those with intersectionality.

This article type will present a unique opportunity to explore cases where well-meaning health care teams failed to address inequities and promote the lessons learned along the way. Additionally, it will also provide a forum to review cases where interdisciplinary teams that were able to successfully navigate these challenges can improve patient care and provide structured learning points for readers to use in their practice. By presenting these cases from across the country in an accessible format, we hope to push this work further and allow us to learn from each other’s successes and failures on this difficult yet profoundly important journey.