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The U.S. spends more on health care than any other nation in the world. Yet Americans’ health outcomes rank relatively low compared with other wealthy peer nations on Planet Earth, manifesting a low return-on-investment for this huge financial spend. Nowhere is this more evident than in America’s place in equity compared with nine countries, shown in the graph on health care system performance from The Commonwealth Fund’s perennial study, Mirror, Mirror – the latest version of which was subtitled, “reflecting poorly” on health care in the U.S.             Equity is an over-arching concept that the health care ecosystem has begun to embrace as a key metric for what looks good (or not) in U.S. health care. This week at the VIVE 2023 conference, the HLTH Foundation, collaborating with Ipsos, published a report on Techquity in 2023, analyzing survey data collected from 212 respondents from 200 health care organizations. For context in using this dataset, the folks responding to the study came from the HLTH and CHIME email lists; those on these lists may already be well aware of the concept of “techquity,” and certainly health equity. As a benchmarking survey conducted among a community of folks somewhat more clued-into the concepts being discussed, it offers us important insights into what this group of health industry leaders is thinking about — ahead of the mainstream, but directionally instructive for our understanding of the overall issues and where we are on the adoption curve of equity and its many layers — equity overall, health equity, and “techquity.”             Start with the definition set forth in the report: that techquity is the “intentional design and deployment of technology both to advance health equity and to avoid depending existing systemic inequities and health disparities.” Importantly and pragmatically, this definition includes both the technology deployed and the data practices implemented when using technologies. The concept of techquity is built on four pillars in this research: Trust in the technology Access to the technology Initial use or adoption of the technology, and Sustained engagement with the technology.             The term “techquity” was new to one-half of the respondents. Once the term was explained in the survey interviews, the majority of people understood the concept. However, as the first bar chart illustrates, techquity fell below other priorities on leaders’ minds — namely the high cost of care and the move to value, 4 in 5 people calling as “urgent” (net moderately + extremely). Second in priority for this audience was the slow adoption of information technology (among 71%), followed by cybersecurity threats which tied with health equity and techquity among about 2 in 3 respondents — still urgent, along with clinician shortage and burnout challenges which ranked a very close 5th place for urgency.                   Among those folks who have embraced techquity in their organizations, they tend to support a  specific group of people or a community – most notably, Medicare, Medicaid, rural geographies, and BIPOC communities. Key focuses of the techquity “pioneers” initiatives have addressed community partnerships, the user-friendliness of health technology, addressing literacy, educating via awareness campaigns, and ensuring data privacy and security. You can see other initiatives listed in the bar chart here. It is too early to assess the effectiveness of these initiatives. But we should be mindful in the current economic uncertain environment that investments in techquity may be constrained, an opinion held by over one-half of the survey respondents.           Health Populi’s Hot Points:  Trust is the first pillar of techquity: trust is also the precursor for patients’ health engagement, we’ve learned from the earliest research into patient engagement and activation, from the first Edelman Health Engagement Barometer to the research of Judith Hibbard and most recently, the Edelman Trust Barometer. Weaving together the data in the last chart from the Techquity report makes clear the value of equity-by-design. As I introduced the report above, I noted that VIVE and Ipsos bundle both the technology and data practices into the techquity-concept. This was embraced by about one-half of respondents who agreed with the survey question that “equity is integrated into our data strategy.” Human-centered design was also part of the thinking among two-thirds of respondents in this study. We have a lot of work to do on this: as the study was conducted among more of the techquity/health equity cognoscenti, equity-by-design and its tactical calls-to-action must be baked into the plans of those charged with delivering on the promise of health equity — from data strategy and capture to analysis and usability design. Thanks to the HLTH Foundation, #VIVE2023, and Team Ipsos for bringing these insights into the benchmarking research.

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The phenomenon of Deaths of Despair is the short-hand name for rising mortality among certainly people living in the U.S. due to overdose, accidents, and suicide. Angus Deaton and Anne Case published their first of many research papers on Deaths of Despair in 2015. Their research uncovered the risks of dying a Death of Despair to be higher among men, especially those between the ages of 25 and 64. But mortality isn’t only going in the wrong direction for those people most closely associated with the Deaths of Despair demographic: there’s another life-span line graph moving in the wrong direction, and it’s for young Americans under 19 years of age. s         NPR broadcast a Morning Edition story titled “Live Free and Die” on March 25th. Subtitled “the sad state of U.S. life expectancy,” The declining curve here represents U.S. life expectancy for all residents of all ages of 76.1, some 6+ years lower than comparable country averages the OECD has collected for Australia, Austria, Belgium, Canada,, France, Germany, Japan, the Netherlands, Sweden, Switzerland, and the U.K. For more on the Deaths of Despair in the U.S., you can search through the Health Populi blog for my various takes — starting with the milestone research of Deaton and Case discussed in this post. Now we turn to a JAMA viewpoint published on March 13 titled The New Crisis of Increasing All-Cause Mortality in US Children and Adolescents. Dr. Steven Wolf and colleagues write about, quote, “A nation that begins losing its most cherished population — its children — faces a crisis like no other.”             Here is the line graph Dr. Woolf et al. featured in their essay. This chart graphs the mortality rates per 100,000 people between ages 1 and 19 years old by five causes: COVID-19, transport accidents (i.e., death by car, bus, train, etc.), homicide, suicide, and poisoning. Death rates for young Americans increased across all five categories. Today I’m pointing to homicide, the solid aqua blue line, in the graph. Note that these data go to 2021, so do not include the life expectancy data for young Americans from 2022 or first quarter of 2023.     The increase in pediatric injury deaths was not caused by COVID-19 but due to injuries, the authors note. But the pandemic “may have poured fuel on the fire,” they observe. “Much of this surge involved homicides, which increased by 39.1%, and deaths from drug overdoses, which increased by 113.5%.”             Gains in kids’ life expectancy (say, for pediatric cancer and congenital disorders) improved young peoples’ mortality rates; we can see the graph’s declining mortality rates here, by cause. The mortality rates for people ages 1 to 19 continued to fall from 1999 until about 2013, when deaths due to injury took a turn up and to the right — especially among young males. “Firearms play a central role in this crisis,” one of the concluding paragraphs asserts. “They are the leading cause of death among youths aged 1 to 19 years old and accounted for nearly half of the increase in all-cause mortality in 2020.” Bullets, drugs, and automobiles are now causing a youth death toll sufficient to elevate all-cause mortality rates, they conclude. Health Populi’s Hot Points:  “Without bold action to reverse the trend, children’s risk of not reaching adulthood may increase.” That’s Dr. Woolf’s and colleagues’ last sentence of the succinct 2-page JAMA viewpoint. The piece was published on March 13, two weeks before yesterday’s Nashville mass shooting at the Covenant Presbyterian Church School killing three children and older victims.           Last week, I received a mailing from my local hospital system, Main Line Health. I cut out a phrase from the marketing piece that resonated with me — “Human care means seeing our neighbors.” This came to front of mind now as I wrestle and think about the data from the CDC, OECD, and the JAMA viewpoint on “losing our most cherished population:” our children. Human care really does mean seeing our neighbors. So does public policy and legislation. We are all health citizens, every day.

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