Health Equity Sits at the Center of the Quadruple Aim

John Conley, MD Lecturer on Medical Ethics encourages a change in perspective, removing the us and them stigma, to improve health equity.


J. Nwando (Onyejekwe) Olayiwola, MD, MPH
J. Nwando (Onyejekwe) Olayiwola, MD, MPH

Most physicians are probably familiar with the quadruple aim in healthcare—enhance the patient experience, improve the overall health of the population, reduce costs, and improve the work life of healthcare providers.

What you may not realize is that health equity sits right at the center of those four goals—like a bullseye. J. Nwando (Onyejekwe) Olayiwola, MD, MPH, chief health equity officer and senior vice president at Humana, will outline the importance of health equity at Sunday’s John Conley, MD Lecture on Medical Ethics. Her presentation, “Health Equity as the Bullseye of the Quadruple Aim: A Social and Moral Imperative,” is 2:00 – 3:00 pm (PT).

Dr. Olayiwola said that while equity in healthcare may be a recent topic of conversation, the idea behind it has always been an important one.

“Health equity isn’t now important,” she said. “It’s always been essential. The increase in interest in the subject is because we’re now reckoning with our historic neglect of equity as we confront the consequences of both collective inaction and intentional, discriminatory actions. More Black and brown bodies are dying younger from conditions that are entirely preventable, like poor housing, environmental racism, and barriers to jobs and education.”

Dr. Olayiwola said you cannot serve the quadruple aim without taking equity into consideration.

“Equity sits directly at the center of the quadruple aim,” she said. “We cannot support better patient care that’s affordable and sustainable, and clinician wellness that speaks to why so many healthcare professionals entered the work of healing, without first confronting the drivers of poor patient outcomes and rising rates of clinician burnout.”

The numbers bear out the existence of inequity in healthcare, Dr. Olayiwola said. Five percent of the total population accounts for a full 50% of healthcare costs. And that 5% is disproportionately comprised of individuals who are historically underserved—communities of color and those denied access to resources, education, and jobs.

“When we invest in healing and housing that 5%,” she said, “There’s no question of the economic benefit. That said, we need to widen the aperture of what we count as 'return' on this investment by interrogating the social benefit to communities when we care for every body—every Black body and brown body and non-English-speaking body and differently abled body. In healthcare, our job is to comprehensively and compassionately care for every life we encounter. And the cost of not treating every part of our community is far greater than the price of providing that care.

Dr. Olayiwola said that too often, when clinicians speak of health equity, they employ the language of us and them: those communities, those people.

“Here’s my challenge to you,” she said. “As you hear the language of social determinants of health, try using ‘I’ or ‘my’ or ‘we’ instead of ‘they.’ If we can’t pay for our kids’ medication, what does that mean for how our children will fare in school or in life? If we can’t get jobs with a living wage, how can we afford rent and utilities? If we can’t afford electricity, how can we refrigerate some of the very medications necessary to keep us healthy? When we flex the muscle of empathy, we find ourselves in the shoes of all those individuals cast as ‘they.' That shift in perspective changes everything.” 

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