Research into health equity and social determinants seeks to understand disparities and influence real change, yet the investigators in the national data collection systems they rely on for their work are incomplete and equipped for structural racism, Shel Wong, MDhe told the tenth annual attendance Colorado Institute of Clinical and Translational Sciences Academic Summit on September 14th.
In her talk, “Mental Health Equity: How Is Data Policy Shaped?” Wong addressed the challenges of using data to inform policy and described how the policy affects data collection.
Wong provided a brief overview of the Farley Center for Health Policy at the University of Anschutz Medical Campus, where she and her colleagues work to develop and translate evidence to advance social policies to improve health, equity, and well-being.
“Many of the disparities that exist are due to structurally flawed systems that create barriers to care,” Wong said. “The way we see it, local, state, and federal policies are responsible for and have some power to reshape and dismantle systems of structural racism because the policies may prevent individuals and communities from living their healthiest lives.”
Wong shared key findings from the groundbreaking report, “The economic burden of mental health inequality12 by the Farley Center for Health Policy, the Satcher Institute for Health Leadership and the Robert Graham Center.
“This study aims to answer two questions: How many lives and how many dollars could be saved if we tackled racial inequality?” She said.
In the five-year study period, racial disparities in mental and behavioral health caused the premature deaths of nearly 117,000 Aboriginal and people of color in the United States, and in addition, racial inequality generated more than $278 billion in additional cost burdens.
“While these numbers are shocking and will get some attention, what may be more important is what we missed and couldn’t see,” Wong said.
It also revealed that national estimates and publicly available data sets excluded at least 5.8 million people – many of whom bear the brunt of mental behavioral problems: prisoners; Non active military housing; and those in nursing homes, assisted living and psychological facilities.
When the report’s authors analyzed the published literature, a gross misrepresentation of the actual burden of these disparities was revealed. The authors discovered an estimated $63 to $92 billion in annual excess costs from mental illness and substance use disorder among incarcerated and unincarcerated.
Policy to advance justice and improve data collection
Wong said comprehensive principles must be established to begin balancing behavioral health inequalities through policy.
“If you look at existing policies, you will find stigmatizing language throughout this language that needs to be systematically removed and reprocessed when new policies are written,” she said. “There is a choice – either you maintain the policies that perpetuate inequality, or you take new policy actions to reduce it.”
As a multiracial individual, Wong said most public health screens force her to choose one category, known as “Asian.” However, Asia includes more than a dozen countries, each with unique cultural origins and differences.
“We lose privacy when we rank for relevance,” she said. “When we start to categorize the data – down to cultural identity and intersection – we can start to come up with solutions where we can make a difference.”
Wong said the policy could be leveraged to improve data collection at the NIH level. This includes requesting changes to what is being asked, collecting and reporting it, aligning with census data, and navigating to a much deeper level, such as language preference and country of origin.
“Then we can actually ask better questions and improve our results because the policy uses big data, but the equity is local,” she says. “We have to have the courage to invoke the fact that we were doing it wrong, that we can do more, and we can do better.”
Policy principles for balancing mental health inequalities
As part of the report “The Economic Burden of Mental Health Inequalities,” the Farley Center for Health Policy conducted an evidence-based environmental analysis and survey of state and national policies. The report presented many policy proposals, from very large investments required, to small ideas that can be implemented immediately to meet current and future needs.
Here is a summary of the recommendations:
- Invest in rebuilding and maintaining equitable mental health and behavioral health systems over the long term to ensure access to the right care in the right place and at the right time.
- Start with prevention, early intervention and identification to provide a continuum of services including treatment and crisis needs.
- Develop comprehensive health equity standards and quality measures for accessible health systems, fund research to study mental/behavioral health equity, evaluate policies and track measures.
- Target interventions that build on community strength and resilience, address unmet needs, and involve those affected in policymaking.
- Ensure that language-aligned services are individual, community and cultural centered.
- Systematically examine existing policies and laws to remove stigma language and ensure that it is excluded in new legislation.
- Recognize the impact of political and systemic power disparities on historically marginalized societies to enable policy actions towards just cultural transformations.
Guest Contributor: Jessica Ennis is a freelance writer specializing in healthcare and academic medicine.