Disruptive Innovations to Achieve Health Equity Through Healthcare and Research Transformation.

In order to achieve health equity, we must implement innovative health system, public health, and policy-level interventions to address the historical root causes of structural and institutional racism embedded in our medical and social systems. A history of unconsented medical and research experimentation on vulnerable groups and residual healthcare provider biases toward minoritized patients has led to patient distrust of medical systems and poor quality of care. Historical discriminatory housing and lending policies resulted in racial residential segregation and neighborhoods with inadequate housing, healthy food access, and educational resources, resulting in present-day social determinants of health (SDOH). To reduce these disparities and achieve health equity, four disruptive healthcare innovations are recommended: (i) infuse health equity principles into clinical workflows by implementing National Culturally and Linguistically Appropriate Services Standards; (ii) address poverty-related SDOH; (iii) deliver care and recruit for research in nonclinical settings to reach marginalized communities; and (iv) leverage health system subject matter experts to advocate for health equity policies. During the COVID-19 pandemic we leveraged the diversity of our workforce to deliver bilingual and culturally tailored COVID-19 testing, education, and vaccines to the Hispanic and Black communities in nonclinical settings, the primary marginalized communities served by our health system that were also disproportionately impacted by COVID-19 infections, hospitalizations, and deaths. Now that we understand the importance of using innovative health equity strategies to reach marginalized communities, we must continue to re-engineer our healthcare systems to deliver care outside of our brick and mortar to overcome barriers in access to care and mistrust in the healthcare establishment stemming from past abuses and remaining experiences of bias.