Q&A: Getting Everyone to Finish the Race: Ana Núñez on Health Care Equity

For the United States to reach its full potential, the College of Medicine’s Ana Núñez believes that everyone must have attainable access to the same medical care.

“Achieving basic health, as a human right, would afford us the most productive populace, which helps our society,” Núñez, PhD, said. “The tiered system of ‘have and have not’ is ‘breaking the bank.’ If we continue to pretend that we can ignore our most vulnerable, they will continue coming into health care systems late, extremely ill and requiring a vast amount of money for care — with much of it quietly charged to everyone in terms of taxes.”

Núñez is Drexel’s dean for urban health equity, education and research and has spent her career working on the impact that cross-cultural issues have in providing health care.

For that work, Núñez will receive this year’s Herbert W. Nickens Award from the Association of American Medical Colleges. The award is given to those who have made “outstanding contributions to promoting justice in medical education and health equity in the United States.”

In advance of receiving the award at a black tie gala this month, Núñez discussed the state of public health in the United States with DrexelNow and what can be done in the future to improve it. 

Your award is for advocating for medical education and health equity. How important is it to draw attention to health inequity now?

The wealth gap, the exploding cost of care becoming a national security issue despite poor outcomes, lives “mattering” or not, the never-ending loss of lives to gun violence — I don’t think we can wait any longer to advocate for health equity. The need for attention to health equity and its barriers are related.

People often mistake addressing health inequities with caring about “someone else’s problems.”

But I have yet to hear from any patient getting health care that interacting with the system was easy and seamless. When we improve health care for our most vulnerable, we improve it for everyone. 

Are there any concrete steps that you see for the short-term that could improve everyone’s ability to get quality health care?

We need to use our political voices — we all need to engage and use our right to be well represented. In the United States, as a democracy, we have a voice that can result in change — yet too few people use it. More people vote on shows like “Dancing With the Stars” than vote in elections! 

We need to ask questions about the things we care about and insist on concrete answers, not vague party-laden platitudes. I think people want cost-effective solutions to their health care and there is a role for government to facilitate that happening.

But we can’t just hope something happens: We need to pay attention and get involved — from keeping up about what is happening in health care, to using groups or societies to help convey ideas to meeting candidates and asking questions.

We must also support improvements in the Affordable Care Act for actual health reform. We need to improve it from modest health care financing reform that decreases the uninsured to actual health care reform is needed. 

Promoting health advocacy and technology are also key. We need to work to help individuals so that they can advocate for their health. Electronic portals have their advantages, but if health literacy is an issue, it may merely be another source of confusion.

Many people assume that there is interconnectivity between electronic medical records. They think, “If I go to Hospital X, my doctor across town will get an electronic message and know about it.” Not so.

Do you feel the country has taken any recent steps backward in health equity?

The lack of “doing the people’s work” in government is a huge detriment and worsening health disparities. During the time of my health policy fellowship, I learned that good ideas that the people need can come from “both sides of the aisle.” For example, one person may value an initiative because it promotes jobs. Someone else can support it because it helps eliminate health inequities.

But the hyperpartisan nature and the lack of work bringing forth bills in government just compounds our problems. If elective officials never show up to work or collectively refuse to move forward bills, nothing gets done. In 1946, Congress earned the title of the “Do-Nothing Congress” by passing only 906 bills. The current 113th Congress passed fewer than 150!

If we want a change, we have to share with our representatives that this is unacceptable instead of being collectively cynical and apathetic.

What do we have to ask ourselves when we think about providing everyone with quality health care?

I think the first question needs to be, “What does it take, as an industrialized society, for us to collectively value health as a human right?” When we compare per-person health expenditures, we spend $8,508 per person, while industrialized countries spend $4,385 on average. But when ranked by quality of care, we rank last. More is clearly not better. 

By and large, we in the United States deny supporting class-based systems seen in other countries, but that’s exactly what we have: “money” versus not. If your deductible is $5,000, your monthly medicine costs are $800 and you don’t earn a living wage, you don’t have access to health.

When it comes to equity, think about this: If I have four children running a race, with one in a wheelchair, one with a leg in a cast, one on crutches and the last with no limitations, who will cross the finish line fastest? We assume that it will be the child with no limitations. However, when it comes to health, shouldn’t our question really be, “How do we get all the children across the finish line?”

Equity doesn’t mean equal — equity means doing what needs to be done to get everyone closer to health. We can’t expect everyone to “pull themselves up by their bootstraps” — some don’t even have shoes.