Leavitt Partners Future Frame Series: Strategic Approaches To Reducing Health Disparities At The State Level

Leavitt Partners’ CEO Andrew Croshaw recently moderated a discussion between Patricia Doxey and Dulce Diez, the Director of the Office of Health Disparities (OHD) for the Utah Department of Health, highlighting key opportunities to reduce health disparities. The panel discussed the market flaws revealed by COVID-19 and Utah OHD’s framework for addressing health inequities, which includes high-impact strategies to reduce disparities during this period of increased attention and funding.

Flaws & Opportunities

Dulce Diaz began by identifying one major flaw: that we don’t have a good understanding of what health equity is and what we can do to address it. Dulce described how health equity vs. equality can be understood in terms of riding a bike. Equality would be supplying everyone with the same bike. Equity would be supplying everyone with a bike based on their needs. In that vein, one major opportunity would be for states to adopt or leverage health equity frameworks that articulate how to distribute resources to communities and individuals based on their needs.

Patricia identified another major flaw that exacerbated health disparities during the pandemic; too many people see health as something isolated to a specific medical condition that needs to be cured rather as a holistic view of health. She identified two major areas of opportunity:

  1. Focusing our healthcare spend on more prevention and value-based reimbursement. She highlighted a thought piece written by her Leavitt Partners colleague, John Poelman, about why the next few months are a crucial time of disruption and to move the market toward value. (Read more here.)
  2. Addressing political determinants of health. In his recent book on the topic, Daniel Dawes discusses how political determinants of health create and/or perpetuate the social conditions that affect all dynamics of health; these conditions include unhealthy physical environment, inadequate transportation, unsafe neighborhoods, and lack of healthy food options. Identifying these determinants, understanding their origins and their impact on the distribution of opportunities and resources will better equip leaders to develop actionable solutions to close the health gap.

Health Equity Framework

Dulce presented a framework developed by the Office of Health Disparities to describe how healthcare stakeholders can categorize layers of health determinants. To illustrate these layers, Dulce returned to the bike analogy, which can be summarized as follows.

  • Much as a personalized bike can be ridden on smooth or bumpy pavement, an individual’s health determinants can be addressed to varying degrees with employment, transportation, housing/the built environment, and social connectedness.
  • Taken together, the bike and the pavement are the social determinants of health – the specific needs of the individual and the community that surrounds them.

Utah’s framework is addressing the structural-, systemic-, and political-based determinants of health, including the distribution of wealth and resources, community participation in the decision-making process, structural discrimination, and gaps in power.

A robust health equity approach will address all three layers creating more opportunities for individuals and communities to be healthy, productive, and empowered.

High-impact Strategies to Invest in Health Equity

Andrew Croshaw pointed out the public and private attention to health equity is translating to real investment. Recently, the CDC released two grant-funded initiatives for state and local health departments to mitigate COVID-19 related health inequities, with a combined estimated $2.5 billion in program funding. This new funding is in addition to federal initiatives already put into place to bolster the nation’s public health infrastructure, and the private sector investing in partnerships with public health and in efforts to alleviate health inequities.

Patricia proposed a few key areas where dollars could be spent to directly alleviate health inequities within states. These areas include developing a health equity strategy, evaluating multi-sector collaborations and alliances, designing a sustainable community health worker program, deploying rapid community assessments, improving race and ethnicity data flow, and evaluating the COVID-19 response in priority populations.

For more details on these strategies, see the blog post here.

While nationally targeted initiatives are needed to alleviate health disparities across the country, there are many interventions that need to be implemented at the state and local levels. In every state, partnerships with payers and providers must align on improving health outcomes and reevaluating reimbursement practices. Incentivizing prevention and reducing policy barriers are essential for the long-term health of our communities. This is a call to action to work across agencies—between the public and private sectors—and within our own states to identify and tackle barriers to health, both social and political determinants.

To see all the projects the OHD is working on, visit health.utah.gov/disparities. If you were unable to attend the LinkedIn Live discussion on May 25, or would like to share it with a colleague, you can view the recording here.


Our mission at Leavitt Partners is to advance value to make health care more affordable, sustainable, and effective. We invite community members and industry experts to join us in future dialogue on the healthcare climate. View our upcoming schedule of Future Frame discussions here and join us for our next broadcast on Thursday, June 24, 2021 on LinkedIn Live.