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• W4377019571 abstract "We are “and.” Physician and parent. Woman and Asian. Boricua and American. Each of us lives in the intersection of “and.” Therefore, health equity must be inherently intersectional because health is shaped by the complex combination of many factors, including, but not limited to, race, socioeconomic strata, ethnicity, income, education, age, geography, access to care, and trust in the health care system [1López N. Gadsden V.L. Health inequities, social determinants, and intersectionality. Discussion Paper, National Academy of Medicine, 2016: 1-15Google Scholar]. Although access to and quality of care have frequently been studied as factors impacting health outcomes, they account for only 20% of the outcome variation[2Hood C.M. Gennuso K.P. Swain G.R. et al.County health rankings: relationships between determinant factors and health outcomes.Am J Prev Med. 2016; 50: 129-135Abstract Full Text Full Text PDF PubMed Scopus (328) Google Scholar]. To promote health equity and reduce health disparities, we must explore how these upstream and downstream factors impact overall health, specifically health in the radiology care spectrum. As the COVID-19 Public Health Emergency declaration ends, this focus issue aims to reflect on the lessons learned during the pandemic and use them as a foundational framework to address existing and emerging health disparities. The pandemic has shown that radiology plays a central role in health care and public health. Therefore, as we move toward a better future addressing systemic barriers, radiology must embrace a leading role in advancing health equity. This leading role has been evidenced by the rise in radiology publications identifying and addressing health disparities. However, the road toward social justice is still ongoing, and infusing health equity into the existing pillars of our radiology practices is vital to foster sustainable and meaningful change. More importantly, addressing health disparities and advancing health equity have evolved from being “the right thing to do” to becoming a business imperative. Health equity considerations have emerged as critical components of strategic planning and organizational readiness, integrated into the strategic plan of many agencies and national organizations that impact our radiology practices, including the Centers for Medicare and Medicaid Services, the National Institute for Health, and the Joint Commission, among others. Thus, this focus issue aims to encourage everyone to get involved by presenting a continuously evolving body of literature that provides readers with a view of the many, often intersectional, factors that influence health equity in different aspects of our radiologic care. This focus issue contains six innovative articles exploring different aspects of health equity in radiology, including clinical practice, health services research and policy, and leadership and training. First, we start exploring the intersection of systemic discrimination, racism, and health outcomes, with Medrano et al providing a historical context for understanding race-based medicine and its impact on radiology [3Medrano D. Matsumoto M. Flores E. Dako F. Understanding race-based medicine and its impact on radiology.J Am Coll Radiol. 2023; 20: 623-628Abstract Full Text Full Text PDF Scopus (1) Google Scholar]. The authors offer tangible examples of how many aspects of our medical education and care delivery are embedded with the assumption without scientific validity of race as a genetic marker rather than a social construct. In this article, they discuss historical perspectives, examine various incriminated scenarios of race-based medicine, and offer mitigation strategies that are practical for radiology. Carlos’ introduction to the social genomics model of health disparities expands on the topic of race as a social construct and takes an in-depth exploration into understanding how ZIP code–related factors, including structural racism and racial discrimination, directly influence biological disease and lead to disparities in health outcomes that we see in radiology [4Carlos R.C. Social genomics model of health disparities.J Am Coll Radiology. 2023; 20: 629-633Abstract Full Text Full Text PDF Google Scholar]. Social genomics provides an evidence-based, scientifically rigorous framework to explore the intersection of racism and health outcomes by moving beyond race-based medicine toward race-conscious medicine [5Vyas D.A. et al.Hidden in plain sight—reconsidering the use of race correction in clinical algorithms.N Engl J Med. 2020; 383: 874-882Crossref PubMed Scopus (681) Google Scholar]. As the focus issue expands on exploring the intersection of structural barriers and the influence in radiology of factors related to social determinants of health, two scientific articles examine the impact of upstream factors on health outcomes among historically underserved populations. Mango et al present the impact of high neighborhood socioeconomic deprivation on access to accredited breast imaging screening and diagnostic facilities [6Mango V.L. Stoeckl E.M. Reid N.J. Miles R.C. Flores E.J. Weissman I.A. Narayan A.K. Impact of high neighborhood socioeconomic deprivation on access to accredited breast imaging screening and diagnostic facilities.J Am Coll Radiol. 2023; 20: 634-639Abstract Full Text Full Text PDF Scopus (2) Google Scholar]. Peña et al present an analysis of geographic accessibility of breast, lung, and colorectal cancer screening centers among American Indian and Alaskan Native Tribes [7Peña M.A. Sudarshan A. Muns C.M. Narayan A.K. González C. Neil J. et al.Analysis of geographic accessibility of breast, lung, and colorectal cancer screening centers among American Indian and Alaskan Native Tribes.J Am Coll Radiol. 2023; 20: 642-651Abstract Full Text Full Text PDF Scopus (1) Google Scholar]. These two articles identify care gaps in radiology caused by a complex combination of socioeconomic and geographic factors that compounds disparities in access to imaging care resulting in cancer screening deserts. Advancing health equity requires an active role that moves from only identifying health disparities (referred to by Lett et al as health equity tourism [8Lett E. Adekunle D. McMurray P. et al.Health equity tourism: ravaging the justice landscape.J Med Syst. 2022; 46: 17Crossref PubMed Scopus (57) Google Scholar]) and move toward taking actionable steps to advance health equity. Along these lines, this issue closes with two articles that discuss how to successfully navigate the intersection of ethics, justice, and health equity by providing practical examples in radiology. Abraham et al present an upstream reparative justice framework for improving diversity in radiology that focuses on how a diverse and inclusive radiology workforce is critical in providing high-quality care to an increasingly diverse population and driving equitable outcomes [9Abraham P. Chatterjee T. Flores E.J. Lightfoote J.B. Sepulveda K.A. Spalluto L.B. et al.An upstream reparative justice framework for improving diversity in radiology.J Am Coll Radiol. 2023; 20: 652-666Abstract Full Text Full Text PDF Scopus (1) Google Scholar]. The authors present an argument for the importance of taking an upstream, proactive approach to diversity and inclusion in radiology that considers the many factors that shape an individual’s opportunities rather than a downstream reactive approach. The purpose of this approach is to create sustainability in fostering a diverse radiology workforce, which is a key driver of health equity efforts among our radiology practices. Similarly, Blythe et al present justice and innovation in radiology, in which authors provide a practical approach to ethical considerations in implementing radiology innovation [10Blythe J.A. Flores E.J. Succi M.D. Justice and innovation in radiology.J Am Coll Radiol. 2023; 20: 667-670Abstract Full Text Full Text PDF Scopus (1) Google Scholar]. The authors expand on how innovation without a focus on justice can perpetuate health disparities and provide a framework to align institutional incentives to focus on justice-oriented innovation. We hope this focus issue helps amplify the importance of embedding health equity into regular radiology practice. There is a continued need to explore high-priority health equity topics in the scientific literature. The JACR will continue its leading role in advancing health equity efforts by instituting a new quarterly Health Equity in Practice column to underscore the importance of the sustained commitment to advancing innovative health equity topics and leverage this as a transformational catalyst for organizational change in radiology. This work was supported by the National Institutes of Health National Cancer Institute grant 1K08CA270430-01A1." @default.
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• W4377019571 title "Health Equity Is Intersectional" @default.
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