HEALTH EQUITY
TJC’s mission to ensure that our laws, policies and programs reflect and honor the value and potential of every human being, regardless of income, age, gender, sexuality, ability or race, is rooted in the goals of health equity. For over 24 years, TJC has worked to elevate the needs of marginalized groups – including, low-income families, seniors and people with disabilities – and make Tennessee’s policies more just and compassionate. This work must center health equity as its touchstone and confront racism as a systemic barrier to the equitable allocation of resources among different groups.
WHAT IS HEALTH EQUITY?
Health equity is achieved when every person, regardless of race, income, education, gender or other demographics, has access to what they need to be as healthy as possible. If there were equitable access to resources, including health care, housing, transportation and food, then a person’s zip code would not be a predictor of their life expectancy. The goal of health equity is to eliminate health disparities, such as higher rates of infant and maternal mortality, higher rates of chronic conditions and lower life expectancy, that are prevalent for people of color and are not due to genetic predispositions.
HISTORICAL CONTEXT
“For all of the widespread changes in the health care system…racial inequality has proven remarkably resilient.” – Gordon Bonnyman, TJC Co-Founder & Staff Attorney
Prior to the enactment of Title VI of the Civil Rights Act of 1964, racism was explicit in health care facilities across the South, and de facto segregation commonly occurred across the country. Explicit racism was eradicated by conditioning federal funding through the Medicare and Medicaid programs on desegregation in hospitals. From then until today, it has been evident that the problem of unequitable access to health care persists.
Black and Latinx Americans are less likely to have health insurance, and even when they do gain access to health care, they are subject to racial discrimination that causes poorer health outcomes. Some health care providers still have long-held beliefs that black people have a higher tolerance for pain and other physical attributes that influence their medical judgment and clinical approach. Such provider bias, along with numerous, egregious medical assaults – such as the Tuskegee syphilis experiment and the story of Henrietta Lacks – has seeded a well-founded distrust of the health care system among Black Americans. Other discriminatory laws and policies, like redlining, cause segregation to persist even to this day and confine certain populations to under resourced communities that lead to lower life expectancy. Today’s challenge is to recognize the transgressions of the past while forging a path forward to end racial inequality through better policies and programs that uplift rather than oppress people of color.
SOCIAL DETERMINANTS OF HEALTH
According to the Centers for Disease Control and Prevention (CDC), social determinants of health are the conditions in the places where people live, learn, work, and play that affect a wide range of health risks and outcomes. Improving these conditions is part of the work to achieve health equity. If you have ever experienced health disparities or health inequities, please fill out this brief survey. TJC wants to share your experiences to educate people about these issues and get them to take action to fix the problems in our healthcare system.
COVID-19 and Health Inequity
The black community is disproportionately disadvantaged by the impact of COVID-19. A longstanding history of racial bias and inequity in healthcare access puts black people at higher risk of untreated chronic illnesses, as well as at higher risk of being underserved in times of crisis. There have been severe health disparities shown by the percentage of black people diagnosed with, hospitalized with, or dead from COVID-19 compared to the size of the black population in Tennessee. For example, earlier this year in Tennessee, approximately 30% of COVID-19 deaths are in the black community which accounts for only 17% of the state population.
LGBTQ HEALTH IN TENNESSEE
Lesbian, gay, bisexual, transgender, and queer people often experience significant obstacles in obtaining health care and health coverage, and our state’s healthcare system is no exception. In fact, in Tennessee, the LGBTQ community faces a range of barriers to access while also lacking critical protections against discrimination. For example,
- Tennessee does not ban conversion therapy;
- Tennessee does not have a law that bans health insurance providers from excluding coverage for transgender specific care;
- Tennessee does not have a law that upholds nondiscrimination regarding sexual orientation and gender identity for private health insurance companies.
- Tennessee is one of only 12 states that expressly bans access to coverage for gender-affirming care under our Medicaid program
The LGBTQ community also includes minority groups, meaning that many people in this community stand at the intersection of multiple groups who are underserved and underinsured. The need for additional protections for LGBTQ individuals in health care, housing, employment and other factors that impact health outcomes is obvious.
If you are having problems with your TennCare or other public benefits programs applications or have been denied due to discrimination, call us for free assistance: 615-255-0331. For a list of organizations centered around improving LGBTQ health in Tennessee, click here.
- Get help navigating Vanderbilt’s LGBTQ health program and connect with providers here
- The Vanderbilt Clinic for Transgender Health offers hormone therapy and surgical services for transgender patients
- Positively Living & Choice Health Network offers antiretroviral medicines for uninsured and insured patients who are at high risk of HIV to take preventative measures to stop the virus from infecting. Its locations in Knoxville, Memphis, Upper Cumberland, and Chattanooga offer HIV care, STI/STD testing, and other referrals at a low cost
- Planned Parenthood in Nashville and Knoxville, provides hormone replacement and HIV services and STD testing, treatment, and vaccines for patients and accepts Medicaid
- The Campaign for Southern Equality has created a Trans in the South Guide, which includes 400+ trans-affirming medical and legal service providers in Southern states
- The Tennessee Equality Project is a statewide LGBTQ rights advocacy organization that provides education and opportunities to advocate for LGBTQ communities in Tennessee
- TJC has created a list of LGBTQ health focused organizations across the state
- National Suicide Prevention Lifeline: https://www.crisistextline.org/ Other ways to contact the hotline (US and Canada): Text HOME to 741741 to connect with a Crisis Counselor
- Anti-Hunger Hotline, call: 1-866-3-HUNGRY or text 97779 to be connected to the closest food resource to you
- The National Suicide Prevention Lifeline has an online resource containing an archive of hotlines, LGBTQ advocacy organization pages, and tips for suicide prevention and mental health mindfulness here.
- The National Suicide Prevention Lifeline provides confidential suicide prevention services 24/7. Number to call: 1-800-273-8255
- The Trevor Project is a confidential lifeline that provides suicide prevention services to LGBTQ youth 24/7. Number to call: 1-866-488-7386
- National Help Center’s LGBT National Youth Talkline provides confidential and online one-to-one chat, telephone, and email support to LGBTQ youth. Number to call: 800-246-7743
TJC SPOTLIGHT
We are proud to be part of a community of leaders, movers and shakers who work to achieve health equity in our area and around the nation.
Do you want to learn more about pursuing health equity in your work? Click here to learn more.
HEALTH EQUITY DATA
TRENDS IN TENNESSEE’S CHILDREN’S HEALTH SAFETY NET
RURAL HEALTHCARE DESERTS
LEARN MORE
- For leading, up to date, information on Rural Health data in TN and nationwide visit Rural Health Info
- Check-out this map highlighting the disparities in health outcomes by region
- The Tennessee Department of Health has created an online resource providing guidance to access resources for rural communities here.
- Rural Health Info keeps continually updating here
- A report on the risk facing rural hospitals
- Uninsured Healthcare Provider Address List for TN here
- Read the Healthy Smiles Initiative on improving dental access across TN
- If you have ever experienced health disparities or health inequities due to your racial identity, please fill out the brief survey below.
- 2020 report from the Center for the Study of Social Policy sheds light on the racist roots of work reporting requirements for families in need of public benefits.
- Blacks/African-Americans make up only 17% of the population, but comprise 32% of COVID-19 related deaths. READ THE REPORT HERE.
- Community Catalyst report: Congress Must Respond to Deep Health Inequities for Black People During COVID-19: Medicaid is the Lever
- The Equity Alliance Our Fair Share 2020 report: Covid-19 Nashville/Davidson County Community Needs Assessment.
- The American College of Physicians produced a report describing the causes of and the disparities for minorities. Please find the report here.
- Report: Low-Income and Communities of Color at Higher Risk of Serious Illness if Infected with Coronavirus
- The European Review of Social Psychology October 2013 report details that healthcare disparities among racial/ethnic minorities represent a serious problem in the U.S even when controlling for income.
- The CDC’s is the pre-eminent data collection agency on racial equity and their health equity page
- Within TN, the Tennessee Department of Health has an office dedicated to reducing health disparities in TN
- Uche Blackstock, is tweeting about the important work of health disparities.
- Kinika Young, Senior Director of Health for the TJC, writes an Op-Ed in the Tennessean describing Tennessee’s maternal mortality issues and focuses on disparities in minority communities
- Kinika Young reacts to the expansion in post-partum coverage with more facts and findings on Tennessee’s mortality issues
- American Progress has become a leader in helping lead the policy directives which can decrease Maternal health disparities. Find out how
- Read the report: National Health Law Program has a new report about “Building A Successful Program for Medi-Cal Coverage For Doula Care: Findings From A Survey of Doulas in California.”
- Standardizing Care is the most recommended policy to decrease maternal health disparities. American Progress published a report to decrease mortality disparities is to create standard processes for all patients to eliminate in treatment.
- Data from American Health Rankings details with clarity a summary of 2019 health disparities for minority women
- National Partnerships Black Women’s Maternal Health Report
- The CDC has created the Active Pregnancy Mortality Surveillance System to track and report on the current disparities in pregnancy mortality
- Read the policy brief: The American Rescue Plan Will Significantly Address LGBTQ Poverty
- LGBT people experience disproportionately higher rates of food insecurity, even prior to the pandemic: Read the report here.
- The ACA, which was upheld by the Supreme Court in June 2021, created massive gains in protections and insured rates for the LGBTQ community: Learn more.
- Read the CDC’s Health Disparities Among LGBTQ Youth report here.
- Check out this list of clinics and non-profits across the state that provide low cost and emergency dental services to uninsured residents
- Read the Healthy Smiles Initiative on improving dental access across TN