Earlier this year, Health Gorilla Chief Medical Officer Dr. Steven Lane invited Dr. Medell Briggs-Malonson, Chief of Health Equity, Diversity, and Inclusion at UCLA hospital and Clinic system, to join him on an episode of the TreeTop podcast.
The result was an insightful discussion between colleagues about the intersection of health IT and equity, social determinants of health (SDOH), and why the concept of data justice must be built into modern frameworks.
Backgrounds Shaping Perspectives
Dr. Briggs-Malonson's career has been dedicated to innovative healthcare system redesign to advance health equity within diverse communities. Her work includes health disparities research, lectures on social drivers of health, and advocacy to recruit and retain more women and people of color in academic medicine. She is also the founder and CEO of Contour Health Solutions, an advisory firm that partners with health technology organizations to improve the quality, safety, and efficiency of medical services for diverse populations.
“Knowing that we live in such a digital world and knowing that everyone – of all backgrounds, race, ethnicity, gender, identity, socioeconomic status – has access to various different forms of technology,” Briggs-Malonson asked, “how can we use that technology to improve people's overall health and well-being?”
Dr. Lane, who has over 30 years of experience as a primary care provider and a background in clinical informatics, emphasizes the importance of remaining curious and open to learning about the experiences and feelings of oppression that others face. His perspective is shaped by his upbringing and career as a physician in large public academic and non-profit health systems.
Understanding Health Equity, Healthcare Equity, and Health Data Equity
Dr. Briggs-Malonson explains that health equity is the ability for everyone to have a fair and just opportunity to achieve optimal health. This involves addressing social drivers of health, including economic stability, access to high-quality care, the physical environment, food security, community and social context, access to healthcare services, and technology.
Healthcare equity, on the other hand, focuses on the delivery of healthcare services based on an individual's or a population's needs to ensure they have a fair and just opportunity to achieve optimal healthcare outcomes. This involves providing a certain level of care to one person and ensuring the same level of care is provided to the next person based on their needs.
Health data equity, or data justice, ensures that all data collected and utilized is done in an equitable manner. This involves centering the people that we serve and ensuring that the data collected is not used inappropriately.
“We have to proceed with intention and caution,” said Dr. Briggs-Malonson. “How are we really centering the people that we have to serve and making sure that this data that we’re collecting is not used in an inappropriate way so that it’s not inadvertently actually causing more marginalization of some of our most vulnerable populations?”
The conversation then shifts to the role of SDOH in achieving health equity. Dr. Briggs-Malonson prefers to use the term "social structural drivers of health" as it combines both the social aspects and the structural aspects that contribute to health. These drivers are dynamic and can be modified, changing from day to day or month to month.
“I think that this is such an important conversation,” she said. “The reason why I like to use the term drivers versus determinants is when you use that word to describe these factors that directly influence health and overall well-being [that determinants] are fixed and static and you can't change them. When it comes to the social structural drivers … drivers can be modified, drivers may change. I also think that there's a glass-half-full kind of mantra behind drivers.”
Dr. Briggs-Malonson identifies seven primary social structural drivers of health: economic stability, overall access to high-quality care, the physical environment, food security, community and social context, access to healthcare services, and technology. She emphasizes that technology is a significant SDOH that is often not focused on enough.
The Importance of Data Sources
The podcast concludes with a discussion on the importance of data sources in understanding and addressing SDOH. Dr. Briggs-Malonson acknowledges the overwhelming number of data sources available today, from personal health records to public health data. She emphasizes the need to look at patients more holistically to address their healthcare needs and the social factors that contribute to their health outcomes.
She also spoke about the “health equity by design” piece of the Trusted Exchange Framework and Common Agreement (TEFCA).
“I really think that TEFCA is going to be a wonderful lever in order to continue to advance this work by adding structure and clear guidelines and created with keeping equity in mind,” Briggs-Malonson said.