Advancing Health Equity: A Safety Net Hospital Perspective

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Abha Agrawal, MD, FACP, FACHE


Equitable care has been recognized as one of the six core components of quality for over two decades, yet scant attention has been paid to understand and address healthcare disparities in the US. There is long-standing evidence of substantial health disparities and poor health outcomes along race, ethnicity and income levels in the US. The COVID-19 pandemic both exacerbated and exposed these inequities and catalyzed a national imperative to achieve equitable healthcare. The objective of this article is to provide a case study of a resource-challenged safety net hospital’s journey to advance health equity in Chicago. Humboldt Park Health (HPH) is a 200-bed independent community teaching hospital located on the West side of Chicago serving a multiracial, multilingual and socioeconomically disadvantaged population. Our journey started with the formation of a multidisciplinary health equity committee in 2021, reporting to the Board of Trustees, that was charged with formulating a strategy, developing an evidence-based framework and priorities for action, and implementing the action plan. We addressed four groups of stakeholders: our patients, our people, our organization, and our community. Our actions to advance equity have included (a) collection of patients’ demographic data such as race, ethnicity, language, sexual orientation, and gender identity; (b) assessment of social determinants of health (SDOH) along with connecting patients with social services; (c) the development of health disparities dashboards for various ambulatory preventive measures for stratification of quality data along race, ethnicity and language; (d) focus on LGBTQ+ community’s access to well-informed and sensitivity-trained behavioral health service providers, and (e) organization-wide training to embed the concepts of diversity, equity and inclusivity in the fabric of the organization. Other initiatives include the building of a community wellness center and a 100-unit affordable housing complex in the community. Digital health equity is an important domain that is being addressed by the launch of a patient portal to empower patients by providing them access to their information, and remote patient monitoring solutions. The next phase of our work involves evaluation studies to understand the impact of our interventions on health disparities and outcomes in our community.

Keywords: health equity, social determinants of health, health outcomes, health disparities, US healthcare, quality of care

Article Details

How to Cite
AGRAWAL, Abha. Advancing Health Equity: A Safety Net Hospital Perspective. Medical Research Archives, [S.l.], v. 11, n. 2, feb. 2023. ISSN 2375-1924. Available at: <>. Date accessed: 01 oct. 2023. doi:
Research Articles


1. Institute of Medicine (U.S.). Committee on Quality of Health Care in America. Crossing the quality chasm: A new health system for the 21st century. National Academy Press; 2001:xx, 337 p.
2. World Health Organization. Social determinants of health: Key concepts. January 21, 2023.
3. Healthy People 2030. Social determinants of health. January 23, 2023.
4. Wyatt R, Laderman M, Botwinick L, Mate K, Whittington J. Achieving Health Equity: A Guide for Health Care Organizations. 2016. IHI White Paper.
5. Healthy People 2030. Health Equity in Healthy People 2030. January 21, 2023.
6. Centers for Disease Control and Prevention. Minority Health and Health Equity. January 21, 2023.
7. 2022 National Healthcare Quality and Disparities Report. 2022. October 2022.
8. National Center for Health Statistics. Health, United States, 2011. 2011.
9. McDonough P, Duncan GJ, Williams D, House J. Income dynamics and adult mortality in the United States, 1972 through 1989. Am J Public Health. Sep 1997;87(9):1476-83. doi:10.2105/ajph.87.9.1476
10. Ansell DA, Fruin K, Holman R, Jaco A, Pham BH, Zuckerman D. The Anchor Strategy - A Place-Based Business Approach for Health Equity. N Engl J Med. Jan 12 2023;388(2):97-99. doi:10.1056/NEJMp2213465
11. Turner A. The Business Case for Racial Equity, A Strategy for Growth. April 2018.
12. Peter G. Peterson Foundation. How does the U.S. healthcare system compare to other countries? January 8, 2023. Accessed January 8, 2023.
13. Organisation for Economic Co-operation and Development. OECD Health Statistics 2022. January 21, 2023.
14. Schroeder SA. Shattuck Lecture. We can do better--improving the health of the American people. N Engl J Med. Sep 20 2007;357(12):1221-8. doi:10.1056/NEJMsa073350
15. Papanicolas I, Woskie LR, Orlander D, Orav EJ, Jha AK. The Relationship Between Health Spending And Social Spending In High-Income Countries: How Does The US Compare? Health Aff (Millwood). Sep 2019;38(9):1567-1575. doi:10.1377/hlthaff.2018.05187
16. Misa NY, Perez B, Basham K, et al. Racial/ethnic disparities in COVID-19 disease burden & mortality among emergency department patients in a safety net health system. Am J Emerg Med. Jul 2021;45:451-457. doi:10.1016/j.ajem.2020.09.053
17. Kirby T. Evidence mounts on the disproportionate effect of COVID-19 on ethnic minorities. Lancet Respir Med. Jun 2020;8(6):547-548. doi:10.1016/S2213-2600(20)30228-9
18. Chicago Department of Public Health. January 14, 2023.
19. Yancy CW. COVID-19 and African Americans. JAMA. May 19 2020;323(19):1891-1892. doi:10.1001/jama.2020.6548
20. The Death of George Floyd Reignited a Movement. What Happens Now? The New York Times, . April 20.
21. The Joint Commission. New requirements to reduce healthcare disparities. January 25, 2023.
22. Sinai Urban Health Institute. Sinai Community Health Survey 2.0, “A Look at Humboldt Park” 2019.
23. Schanzenbach D, Pitts A. Estimates of food insecurity during the COVID-19 crisis: Results from the COVID Impact Survey, Week 1 (April 20–26, 2020). May 13, 2020.
24. Illinois Health and Hospital Association. Racial equity in healthcare progress report. Guidance Document for the Racial Equity in Healthcare Progress Report. June 2021.
25. Robert Wood Johnson Foundation. Achieving Health Equity. Why health equity matters and what you can do to help give everyone a fair shot at being as healthy as they can be. January 21, 2023.
26. American Academy of Family Physicians. Social needs screening tool. January 21, 2023.
27. The Trevor Project. 2022 National Survey on LGBTQ Youth Mental Health. 2022.
28. Healthy People 2030. Objectives. January 21, 2023.
29. National Committee for Quality Assurance (NCQA). Comprehensive diabetes care. January 21, 2023.
30. Gentrification's effects felt by community residents and their hospitals. Modern Healthcare2021.
31. Health Affairs Health Policy Brief. Housing And Health: An Overview Of The Literature. June 7 2018.
32. Richardson S, Lawrence K, Schoenthaler AM, Mann D. A framework for digital health equity. NPJ Digit Med. Aug 18 2022;5(1):119. doi:10.1038/s41746-022-00663-0
33. Medicaid and digital health: Findings from the Deloitte 2018 Survey of US Health Care Consumers. January 8, 2023. Accessed January 8, 2023.