Advancing President Biden’s Fairness Agenda — Classes from Disparities Work

As of January 20, 2021, the United States will have a national policy to combat systemic racism. On his first day in office, President Joe Biden signed an executive order to Promote Racial Justice and Support Underserved Communities. Under the ordinance, every federal agency is required to assess, as part of a “nationwide justice agenda,” whether its programs and policies maintain systemic barriers that affect the skin color and other underserved groups.1 In health care efforts to reduce inequalities have typically addressed individual clinicians without holding institutions or systems accountable.2 Biden’s Executive Order provides the opportunity to learn lessons from research on health disparities that target systemic racism.

The new executive order repeals former President Donald Trump’s September 2020 executive order with regard to diversity training. This policy prevented federal agencies and their contractors from running diversity and inclusion training programs based on what the Trump administration viewed as racial “stereotyping” or “scapegoat” such as: B. White privileges and systemic racism. Federal government-funded companies that failed to comply with Trump’s order would have faced fines, lawsuits and contract terminations. Hundreds of organizations – including the American Medical Association, the American Nurses Association, and the American Hospital Association – denounced policies of obstructing efforts to combat discrimination. On December 22, 2020, the U.S. District Court for the Northern District of California issued a state-wide injunction preventing the Office of Federal Contract Compliance Programs from enforcing the executive order.

Biden’s Executive Order contains a definition of justice that can be viewed as somewhat contradicting. According to the regulation, equity refers to “the consistent and systematic treatment of all persons in a fair, equitable and impartial manner, including those belonging to underserved communities who have been denied such treatment, such as, B. Blacks, Latinos, Indigenous and Native American people, Asian Americans and Pacific Islanders, and other people of color; Members of religious minorities; Lesbian, gay, bisexual, transgender and queer (LGBTQ +); People with disabilities; People living in rural areas; and people otherwise affected by persistent poverty or inequality. “1 The first part of this definition emphasizes the equality of all people, while the second part draws attention to certain underserved groups. To promote justice, the Biden administration should distribute resources differently to help groups who are persistently disadvantaged.

The ordinance outlines duties for senior government officials. For example, the U.S. Home Affairs Council needs to coordinate with federal agencies to identify the federally underserved communities and develop guidelines to support justice. The director of the Bureau of Administration and Budget and the heads of the agencies are required to conduct assessments to classify barriers to access to federal benefits, services and contracts and to assess justice based on race, ethnicity, religion, income, geography, Gender identity and sexuality measure orientation and disability. You also need to investigate strategies for increasing investment in underserved communities. Because some federal datasets are not broken down by variables such as race, ethnicity, gender, disability, income, and veteran status, an Interagency Fair Data Working Group (the Data Working Group) must work with the Domestic Policy Council to identify deficiencies in data collection and potential Solutions.

In the future, the Biden government could take several steps to improve the effectiveness of the executive order. First, a single data management system with updated variables could be implemented across all federal agencies. The Agency for Research and Quality in Healthcare publishes an annual disparity report as part of the congress mandate. Reporting for the Health Care Costs and Usage Project relied on a method that combines race and ethnicity into one variable using definitions from 1977. When states report Hispanic ethnicity separately from race, the analysis prioritizes Hispanic ethnicity over racial categories to allow for consistent coding. However, the Minority Health Office advises organizations to collect data on race and ethnicity separately as part of its guidelines for further developing national standards for culturally and linguistically appropriate health care and health care services. Both agencies use binary options for gender in their polls and don’t allow people to choose multiple options for sexual orientation, which is consistent with the idea that sexuality is fluid. Updating identity-related variables would be the data working group’s responsibility to refine data to measure equity and capture diversity

Second, administration could use variable disaggregation to model the way different groups are defined by intersectional identities or related affiliations to different groups, defined by race, ethnicity, gender identity, sexual orientation, class, or other factors that contribute to privilege, face disadvantage and power, or lead to discrimination and disadvantage. Due to the limited sample size, disparity researchers usually present the results using univariate analyzes that include race, ethnicity or gender, without taking into account intra-group or intersectional differences.3 Studies are often unable to identify interaction effects, but federal data sets with nationally representative ones Data samples have sufficient power to reveal interactions. Performing multivariate analyzes that include race, ethnicity, gender, sexual orientation, and income, and examining the interactions between these variables, could capture lived experiences more accurately than univariate analyzes. Black homosexuals face different barriers to health care than, for example, black heterosexuals, and in assessing equity one should examine barriers that are based on intersectionality rather than individual identity variables.

Third, the administration’s justice agenda should be brought into line with the current understanding of systemic racism, conceived as the way in which interconnected social institutions reinforce discriminatory beliefs, practices and the allocation of resources. The researchers have proposed different definitions of systemic racism, but all indicate how societies discriminate against underserved populations through inequitable and mutually reinforcing systems of housing, education, employment, the economy, health care, and criminal justice Law, medicine, public health and social sciences. Links between increasing segregation of housing between minorities and higher police activity, more criminal complaints and poorer health outcomes

An equity agenda can reveal interactions between barriers in different agencies and social sectors. The coordination between agencies and the exchange of data could reveal patterns of inequality clusters that could influence the development of new interventions. The federal government could take cross-sectoral approaches, such as reforming drug and immigration policies, to reduce incarceration and improve access to health services.2 It could regularly hold institutions and systems accountable through Section 1557 of the Affordable Care Act, which funded the state Institutions prevent people from discriminating on the basis of age, skin color, disability, national origin, race or gender.5 Any health care provider or government agency that receives funding from the children’s health insurance program, Medicaid or Medicare is then subject to the statutory provisions Actions when people from underserved communities are discriminated against.

Fourth, the administration should be in contact with the public. The executive order directs agency officials to communicate with community organizations and civil rights groups.1 However, it does not include any plans to contact direct service providers or state and local officials running federal programs. Ignoring the contributions of these players would be a missed opportunity to learn from the individuals and organizations that provide federal services, benefits, and contracts. The order also does not mention whether the results of equity assessments will be published. Disparity researchers use methods such as community-based participatory research to involve various stakeholders. Such approaches are critical to building trust, setting priorities, and fostering support for reform. The National Institutes of Health involve members of the public on study departments and advisory boards, a mechanism that could be extended to other agencies.

Biden’s stock agenda will only take effect if it is included at every step. To achieve this goal, the government can democratize data collection and analysis, hold agencies accountable by publicly disseminating the results, and develop cross-sectoral interventions to break cycles of systemic inequality. These strategies are in line with the work on health inequalities, which aims to build trust among underserved communities. According to the executive order, “promoting justice requires a systematic approach to embedding fairness in decision-making processes.” 1 The government should strive for transparent processes while at the same time implementing evidence-based strategies against systemic racism.