January 23rd, 2020
By Summer Tebalt
This October will mark 10 years since AccessHealth Spartanburg opened its doors and introduced a new collaborative model to improve health care access and health outcomes to the community. Over the ensuing decade, the AHS story has been one marked by continual iteration. Along the way, AHS has evolved from an organization whose mission was not very well understood initially to one that today is recognized nationally as a model for both its innovation and impact.
As our team has grown from four to more than 20 care navigators, community health workers, nurses and support staff, we have applied what we have learned along the way, improved processes and embraced best practices. While the learning never stops, it only matters if you have the courage to apply what you learn and evolve.
As we look ahead not only to 2020 but to the next decade, I am convinced that the next step for AccessHealth Spartanburg is to become a leader in applying a racial equity lens to health care access and outcomes. As a nurse who has worked in the healthcare field for more than 20 years, I knew there were inequities in healthcare, but I assumed they could be chalked up to socioeconomic differences. My eyes have been opened over the past couple of years.
The first moment of awakening for me was when Dr. Kathleen Brady released the Spartanburg County Racial Equity Index in 2018. The takeaway for me was nothing short of alarming. It was the first time I had ever seen verifiable data evidence of racial inequities in health care.
For example, the data shows that a black woman with an advanced degree is more likely to lose her baby in its first year of life than a white woman with less than an eighth-grade education. And though the rate of diabetes is significantly higher among blacks than whites, a much higher proportion of whites are admitted for in-patient treatment at local hospitals. The data is clear: putting aside all other factors, white people have a much higher chance of being treated for the same disease.
Later that same year, The Road to Better Health hosted the Racial Equity Institute (REI) Groundwater presentation, an intensive introduction to racial inequities on a national level. Examining the inequities across a number of metrics — health, education, economic, etc. — the Groundwater approach utilizes a compelling metaphor for systemic racism and racial inequity:
“If you notice a fish floating belly-up on the top of a lake, you wonder what happened to the fish. If you notice 1,000 fish floating belly-up on top of the lake, you wonder what’s wrong with the lake. If you clean the water in the lake and make sure it is healthy, but another 1,000 fish die, you know that there is a groundwater problem – the poisoning is happening from far below. It is a system problem.”
The next step in my journey was attending REI in Durham, N.C., in March 2019. I’ve said several times, I can’t unlearn what I learned there, and it has changed the way I look at everything! I now understand race is its own social determinant of health that has to be considered when we (AHS) are looking at health outcomes.
We must view health outcomes, health care access and our work to improve both through a racial equity lens. Every program we implement, every policy and practice we implement must include answering a question:
Who experiences the benefit and who experiences the burden of this action?
The mission of AHS is to improve access to equitable healthcare and we must be intentional in partnering with like-minded organizations in this mission. For me, this means in addition to connecting people to resources (“feeding the fish”) we must also address the social determinants of health and work to improve housing, food security, employment, and more, all of which addresses the health of the lake.
But if we are going to reach the next level and fully realize our mission and goals, we must also ask: What can AHS do to address the groundwater? This remains an open question, but I think it starts with continued education and heightened awareness with staff, providers, clients and the community.
This includes but is not limited to sending our staff to REI trainings, implicit bias trainings, and other community efforts that address racial equity. It also includes more active and intentional advocacy to ensure both our policies and laws are designed to address and improve equity.
We are fortunate to be in a community where all of this is currently on the front-burner. Racial equity is a front-burner issue here thanks to the leadership of many organizations, including Spartanburg Regional Healthcare System, USC Upstate, United Way of the Piedmont, The Spartanburg County Foundation, Mary Black Foundation, Spartanburg Regional Foundation, and the City of Spartanburg. The Road To Better Health has brought REI to Spartanburg twice and is working on doing so a third time. Spartanburg is fully engaged in the work of improving the health of our lake and groundwater.
Ten years from now, I believe we will look back at this moment as one of deep transformation in our community. I encourage you to join us in this work.