All my life I’ve witnessed how inequalities of race and ethnicity, gender and class pervade just about every corner of our society.   As a mother, physician, medical patient and woman of color, I’ve personally experienced up-close just how profoundly inequities in opportunity and treatment block the path for millions of us to good health, good health care and to a good life itself. 

The code word is “disparities,” which technically means “the state of being different.”  However, when it comes to health and health care, “disparities” really means that if you’re not white and if you don’t have financial resources your overall wellbeing is at higher risk and you’re going to get a measurably lower level of health care.

How to close that gap is a formidable challenge that has long evaded workable solution.  Over time I’ve confronted it professionally as a doctor, MBA, clinical researcher, policy expert and, now, as part of the country’s biggest philanthropy dedicated to solving health and health care puzzles just like this one. 

After years of extensive evidence-gathering and investment in the quality field, what is crystal clear is the direct link between the deeply-rooted inequalities in health and health care and our society’s disappointing slowness in appreciably improving the quality of care and the health status of all our people.  We cannot fix one without fixing the other. 

Part of the problem is that up to now no one has quite figured out how to connect these two pieces of the puzzle.  To change that, we must address the multiple and interlocking social, clinical and economic determinants that affect both quality and equality – causal factors like one’s personal health behaviors; whether a person has health insurance; the environments where people work, live and play; whether we have a strong, capable and diverse workforce; and whether a person is receiving the right kind of care.  The dots already are out there; now we need to connect them.  But first we must assemble the evidence. 

Pay special attention to the new March/April issue of the journalHealth Affairs. The entire issue (which RWJF sponsored) is devoted to disparities.  The findings presented here – and they are striking – reveal in specific detail from a range of important perspectives how factors such as social determinants, disparities in the health care system, and the lack of diversity in the health professions coalesce to undermine the quality and fairness of our health and health care.    

To tell the truth, I couldn’t put this issue down.  The research and commentary confirm what my own life’s experience teaches me – that health care is a human right and good health is essential for society’s survival.  Establishing once and for all a health care system that is fair and equal for all is nothing less than a moral imperative. 

Let’s not fool ourselves, though.  The job ahead is tough and it is daunting.  America’s health problems will not be solved within the clinical care system as it is currently built, nor simply by addressing health care costs or expanding coverage.

Good health comes from healthy lifestyles, good choices, and a supporting environment.  Good health care comes by delivering the right care at the right time in the right way.  Neither will occur without deep, long-lasting transformational change in our systems, in our behaviors and in ourselves.

Getting us there is my passion and the Robert Wood Johnson Foundation’s mission.  This special issue of Health Affairs certainly helps illuminate our way forward.  My hope is that others will join us on our path and help establish quality and equality for everyone in our society.   The health and well-being of all of us in America depends on it.