Local Leader Tackles Health Inequalities
Dear Leading Ladies,
Here’s a frightening statistic to try to swallow with your evening vitamins. Boston’s Back Bay residents have a life expectancy of 92 years while residents of Roxbury, just four miles away, can expect to live only 59 years. What we know is that factors such as access to health care, affordable housing, and clean air have a lot to do with the difference in these two outcomes.
One transplanted Bostonian is trying to do something about that. He’s Tom Sequist and he’s our new hero. We didn’t even know his name until last week, but we are now his biggest fans. Sequist is a member of the Taos Pueblo Tribe in New Mexico, where his mother was raised on the reservation. Over the years, Sequist has witnessed innumerable experiences of people having trouble accessing health care, suffering poor medical outcomes, and enduring a long list of injustices. As a result, he decided to commit his life and career to fighting inequity and fostering justice. And he’s doing it right here in Boston.
A man with a mission
To ready himself for his career, Sequist first studied chemical engineering at Cornell University and then received his M.D. from Harvard Medical School and his M.P.H. from the Harvard School of Public Health. He is now the chief medical officer at Mass General Brigham, after serving as chief patient experience and equity officer, leading system-wide strategies for improving patient experience, quality, safety, equity, and community health. His research interests focus on quality measurement and improvement, health care equity, patient and provider education, and the innovative use of health information technology. He has conducted health policy research to advance understanding of health care for Native American communities, served as director of the Four Directions Summer Research Program at Brigham and Women’s Hospital, and as medical director of the Brigham and Women’s Hospital Physician Outreach Program with the Indian Health Service.
In an interview last week on WGBH with Arun Rath and in a recent video for the ABIM (American Board of Internal Medicine) Foundation, Sequist spoke about the inequities of the healthcare system and the role of systemic racism in the perpetuation of such injustices. He pointed out that during COVID, many of us saw for the first time the longstanding effects of unequal health care access and delivery on Black, Latino and Indigenous people. Many more people became aware of social determinants of health outcomes. If there was a silver lining, he says, it was the realization that we needed to fight racism in medical care. The problems have existed for centuries, but the crisis of COVID – and the murder of George Floyd – made the issues more clearly evident, and to more people, creating a fundamental shift that led to new discussions.
Change will take time
The inequities Sequist describes range from things such as chronic disease outcomes and acute care to mental and behavioral health conditions. Because the issues have been long standing, solutions will not come quickly, Sequist warns. And they must be on several fronts. “What that means is that to be successful at this, we need true partnerships and collaboration between delivery systems, between public health organizations, between government organizations, and importantly, between community based leaders and organizations. We need to have those collaborations and coordination at scale.”
In addition, Sequist calls for programs and initiatives that can be measured for effectiveness and that take on real problems with tangible interventions and outcomes. “I think what we should be doing is we should take an evidence-based lens to this and ask ourselves what are the leading causes of inequity in health outcomes among our communities? If you look at that, it's very clear that one of the things that consistently is the cause of health outcomes, morbidity and mortality in many diverse communities is heart disease. How do we comprehensively address heart disease? How do we manage high blood pressure or high cholesterol? How do we manage patients who show up in the emergency department with a stroke or a heart attack? It's actually much bigger than that. We need to think about the fact that, let's say seven to 10% of people may experience cardiovascular disease in the form of a heart attack or a stroke. However, it could be the case that double or triple those numbers have high blood pressure or high cholesterol.”
Help from beyond hospitals
Furthermore, he points to the need to engage those beyond the health care world. “We have to do a better job of upstream managing food insecurity and employment security and housing security, because those things really predict the kinds of diets that people have, the ability to have time to exercise and adopt other healthy lifestyles, which will all contribute to better outcomes.” He points to the need for cooperation and coordination to institute programs “like mobile van programs, who can bring the care and the screening and prevention programs to people's doorsteps” and “transportation services so patients can get to their clinic visits” to have their blood pressure and other chronic conditions managed.
At MGH, Sequist oversees an organization with a strategic priority of ending racism in health care. This can only happen, he says, when the work is undertaken by everyone, not just those in the equity office; when achievable goals are set; when metrics are in place to determine success; and when time and dollars are dedicated to improving access to care, in-person and virtual; to providing preventive care; to translating services; to eliminating race in medical decision-making; and to making equity improvement a part of daily work.
Watching the video, and reading about Dr. Tom Sequist, gives us hope. Not only is he taking on the big problem of inequity in health care; he is looking at the big picture, at all of the various components that must be engaged to solve the problems. And he is seeking ways to intervene on small scales that will impact individuals and families in real ways, building their trust and improving their lives.
According to a Navajo saying, live your life for others to make it worthwhile. Clearly, Dr. Sequist does just that. Greater Boston’s BIPOC population is very lucky to have him working for them. As are we all.
And, by the way, a nod to Man’s Greatest Hospital (MGH) for making equity in medicine a priority throughout its network of hospitals, clinics, and departments in the Commonwealth and for hiring Dr.Tom Sequist to lead the charge. It’s great to have some good news to share, for a change.
Therese (she/her/hers)
Judy (she/her/hers)
Didi (she/her/hers)
Mackenzie (she/her/hers)
Leading Ladies Executive Team