How psychologists can help achieve equity in health care: Advancing innovative partnerships and models of care delivery

A new special issueopens in new window of American Psychologist aims to inspire psychologists to think expansively and boldly about research, policies, practices, and prevention efforts meant to dismantle health inequities. Guest editors Idia Binitie Thurston, Margarita Alegría, Kristina B. Hood, Gregory E. Miller, Leo Wilton, and Kisha B. Holden share key takeaways about psychologists’ role in fostering health equity.

What is the special issue about?

The 14 articles in the special issue explore why psychologists are well positioned, well trained, and needed to champion health equity through innovative partnerships and models of care delivery. They show psychologists how to engage and maintain a focus on health equity in advocacy, research, education, training, and practice efforts. Psychologists and readers are invited to reimagine their existing and forthcoming work through a health equity lens. More broadly, the special issue brings together articles across four core themes: (a) integration of care, (b) intersections of social drivers and determinants of health, (c) intersecting social systems, and (d) advocacy for health equity.

What is the significance of the issue?

Health equity—the assurance that everyone should have a fair and just opportunity to attain their best health—has long eluded U.S. society. The special issue highlights the need for new conceptual models to guide research, education, and practice; the importance of engaging in transdisciplinary partnerships; and the urgency of collaborating with community members in cross-system alliances to change the social drivers of health, structural racism, and contextual risks that perpetuate health inequity. The stunning disproportionality of the COVID-19 response may have finally shocked psychologists and the country into recognizing the unequal burden of suffering and the ways that health in American society is stratified by race, class, location, gender, sexuality, ability, and other salient features of identity.

For this special issue of American Psychologist, we selected articles that explored what psychologists can do to understand and alleviate these inequalities. We sought to deepen understanding and inspire the development of innovative strategies that psychologists can use to identify and mitigate health inequities. We highlighted gaps in psychological science, progress in conceptual framework development, and new methodological approaches that need to be implemented to achieve health equity. Psychologists are uniquely positioned to investigate causes of inequality, develop health equity interventions, and advocate for related policy changes. However, as six scholars who have worked on health equity for many cumulative years in many different settings, we believe that the field’s voice and vision have largely been missing from the broad national dialogue around these issues, which physicians and social scientists from other disciplines have dominated.

Tell us about a few key takeaways.

This special issue offers novel articles that examine psychology’s role in fostering health equity. Among the topics of special focus are the following:

• integration of care: how individual and community health access, quality, literacy, shared decision-making, technology, telehealth, and mobile health drive, maintain, and can be harnessed to dismantle mental and physical health inequities
• intersections between social determinants of health: how structural forces—as reflected in policies and practices around debt, housing, built environment, food, and employment—work through psychological processes to initiate and maintain health inequities
• intersecting societal systems: how criminal justice, immigration, environmental, and public health systems work through psychological processes to dehumanize communities and drive and maintain health inequities
• health equity advocacy: how work with individuals, families, and communities in the field of psychology must be culturally responsive when addressing multilayered structural inequalities

What are some practical implications of the articles featured in the issue?

• Overall, the articles provide innovative frameworks that enable psychologists to champion health equity in all their work, thus offering a road map for how psychologists can move the needle on health equity. We contend that all psychologists can be health equity scholars and show how to do so.
• To illustrate gaps that psychologists can fill, several articles showcase roles psychologists can inhabit within interdisciplinary teams and novel models psychologists can implement to advance health equity in low-resource settings, patient-centered medical homes, and rural settings.
• Other articles highlight the ways in which social drivers and determinants of health interact and drive health inequities across multilevel systems of oppression and within immigrant and migrant communities. The authors provide practical ways to use this knowledge to address trauma and structural violence that result from social drivers of health.
• Strategies for how psychologists can make changes within intersecting societal systems are underscored. Among the suggested strategies are actionable ways to engage in multilevel advocacy, workforce development, nonexploitative community partnerships, reductions of hospital-based violence, the implementation of liberation psychology, climate change solutions, therapeutic interventions as alternatives to policing, and trauma reduction.
• Finally, a task force report outlines concrete steps psychologists can take to integrate health equity into research, practice, education, and advocacy.

This article is in the Health Psychology and Medicine topic area. View more articles in the Health Psychology and Medicine topic area.

Thurston, I. B., Alegría, M., Hood, K. B., Miller, G. E., Wilton, L., & Holden, K. (2023). How psychologists can help achieve equity in health care—advancing innovative partnerships and models of care delivery: Introduction to the special issue. American Psychologist, 78(2), 73–81. https://doi.org/10.1037/amp0001153opens in new window

Idia Binitie Thurston, PhD, is a licensed clinical psychologist and associate professor of psychology and public health at Texas A&M University. She directs the CHANGE Labopens in new window, where she collaborates with scholars and community members in health equity science. Her body of work explores how race, ethnicity, social class, gender, size, and sexuality intersect and influence health and well-being in adolescents and their families.

Margarita Alegría, PhD, is the chief of the Disparities Research Unit at Massachusetts General Hospital and the Mongan Institute; the Harry G. Lehnert, Jr. and Lucille F. Cyr Lehnert Endowed Chair at the Mass General Research Institute; and a professor in the Departments of Medicine and Psychiatry at Harvard Medical School. She has spent her career examining how to reduce health disparities for populations of color, immigrants, and linguistic minorities. Alegría devotes her time to leading innovative multimethod research projects that can improve policies, programs, and/or practices that bring equity for minoritized communities.
 
Kristina B. Hood, PhD, is an assistant professor whose research focuses on how the social determinants of health influence sexual and reproductive health outcomes among Black folks and rural communities. Hood’s work also examines how bias (systemic, institutional, and interpersonal), stigma, discrimination, consent, and survivorship influence reproductive and sexual health and wellness. One of her research goals is to promote sexual and reproductive health equity using an intersectional lens.

Gregory E. Miller, PhD, is a Louis W. Menk Professor of Psychology at Northwestern University. His research has two connected goals: to identify the mechanistic origins of health disparities in childhood and leverage that knowledge to develop interventions that promote health equity.
 
Leo Wilton, PhD, MPH, is a professor in the Department of Human Development in the College of Community and Public Affairs at the State University of New York at Binghamton. His primary research interests include health inequities in HIV prevention and care, Black psychological development and mental health, critical community-based participatory research, and mixed- and multimethod research. His research on the HIV epidemic focuses on the intersectionality of race, gender, and sexuality, as situated in macro- and micro-level inequalities in communities of color.

Kisha B. Holden, PhD, MSCR, a counseling psychologist, is the Poussaint-Satcher Endowed Chair in Mental Health and associate director of the Satcher Health Leadership Institute at Morehouse School of Medicine (MSM). Also at MSM, Holden is a professor and the director of research and scholarship for the Department of Psychiatry & Behavioral Sciences and a professor in the Department of Community Health & Preventive Medicine. Holden is an adjunct professor in the Department of Psychiatry and Behavioral Sciences at the School of Medicine of Emory University and chair of the Health Equity Committee of the American Psychological Association.