Working Towards Health Equity

Q&A with Mahshid Abir

Mahshid Abir

Mahshid Abir is an emergency physician and senior policy researcher at RAND, and fall 2021 health equity fellow in the RAND Center to Advance Racial Equity Policy. She spent her fellowship developing the Health System – Community Rise Program (HCRP) for African-American/Black Children and Young Adults in the state of Michigan.

How would you describe your current thinking about racial equity, and how has your thinking changed since your fellowship at the center?

As an emergency physician, I have witnessed the adverse impacts of racial inequities in healthcare settings both on providers and patients. As a health services researcher, my perspective on health equity has always been one of working to identify actionable strategies and policies to help close care access, quality, and outcomes gaps. Many of the challenges with lack of diversity, equity, and inclusion in health system settings are rooted in systemic racism, therefore there are no quick-fix solutions. Through the center fellowship I learned that conducting research in the diversity, equity, and inclusion space requires time and patience to understand and develop an equity lens to apply to all aspects of the work as a first step. Further, this equity lens and the motivations for the work need to be clearly explained to the community in order to build trust and produce impactful work.

As part of the fellowship process, you applied the equity principles of reflexivity, context, and equity framing, and the development of action-oriented, inclusive outcomes. How did these equity principles impact and/or inform the development of your project?

Applying the equity principles of reflexivity, context, and equity framing during my fellowship was instrumental to designing and conducting the project and reporting on the results. The goal of the project is to develop a blueprint for a program geared at increasing representation from Black/African-American people in health systems. The primary outcome of this evidence-informed blue-print is increasing both the numbers and quality of experience of Black/African-American learners in such settings so they aspire to education and careers in health care. We included team members from diverse backgrounds in the project; including Black/African-American physicians and members of other historically marginalized communities. Our qualitative work included interviews with members of the Black/African-American community, including healthcare providers, youth educators, local leaders in the community/grassroots community organizations, parents, and activists. The forthcoming project report reviewers include some of the above individuals to ensure that the results are delivered in a manner that resonates with the community and to help make the report maximally useful for the community.

What does it mean to have a commitment to health equity? How have you demonstrated that commitment through the HCRP for African-American/Black Children and Young Adults you are currently developing at the center?

A commitment to health equity means the ability to set aside past beliefs about how research is supposed to be conducted and an openness to acknowledging that the very methods that we’ve historically used may be creating barriers to truly equitable processes in research—from methods for recruitment for clinical trials, inclusion of only peer-reviewed literature in academic work, lack of diversity in research teams, only to name a few examples. Further, a simple understanding of existing health inequities and a passion to develop and implement solutions for change are not enough. The purpose of the research and research design needs to be rooted in both existing evidence and to rigorously incorporate the community voice in a way that critically examines the history of racial inequities and racism in the United States. This acknowledgement has to come first, and should be considered within the methodological frames before any data is collected or intervention designed.

How has your fellowship prepared you to effect change in health equity policy going forward?

Because of the training I received during my center fellowship, I know how to apply the equity lens to my work and will be more likely to produce impactful work that informs equity policy, especially in health system settings. I understand how I need to frame the research from step one and that this framing needs to carry through all steps of the research project through methods and results dissemination.

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