The legacy of racism plays out in damaging ways every day, but in the medical space it can have drastic consequences. “People of color often are not believed when they’re complaining about pain, so they don’t get pain medication,” says Dr. Nwando Anyaoku, chief health equity officer at Swedish Health Services.

A pediatrician by training, Anyaoku coleads Swedish’s Office of Health Equity, Diversity and Inclusion (OHEDI) with Chief Diversity, Equity and Inclusion officer Mardia Shands. Their goal is to give all their patients equitable, high-quality health care, regardless of race, ethnicity, language spoken, disability, gender identity or expression, sexual orientation, socioeconomic status, religion or age.

And validating every patients’ pain is just one part of it. When health care organizations don’t value equity, Anyaoku says, it results in “clinical decisions that are not based on science.” She points to criteria for glomerular filtration rate, a metric used to assess kidney function. Only recently, clinicians stopped a common practice of employing two different sets of criteria for Black and white patients.

“The result of that policy was that African American patients showed up with more advanced disease, in renal failure, and therefore had worse outcomes,” she says.

It speaks to a broader problem of equity across health care, one clinicians like Anyaoku are working to change. “Maya Angelou said ‘Do the best you can until you know better. Then when you know better, do better,’” she says. “And that’s what we’re trying to do now.”

To promote health equity, “doing better” means fostering culturally competent care, a diverse workforce, and a culture of inclusion in partnership with the local community, all of which can lead to improved patient outcomes and stronger communities.


Much of the work involves identifying and addressing health inequities, which are different from health disparities. “People will often say ‘I treat everybody the same’ and what I try to communicate is that there is a difference between health disparity and health inequity, because health disparities can occur for no particular reason,” says Anyaoku.

She uses breast cancer as an example: More women than men are diagnosed with it, but the reason is biological. Health inequity, on the other hand, “tends to stem from different preventable causes, often social determinants of health and issues of structural racism,” she says.

Hospital systems can address these disparities through educating employees; Swedish, for example, recently held a webinar on birth inequity, which manifests in disproportionate rates of maternal and infant mortality and morbidity among Black and Indigenous women.

Upper management can promote “a diverse pipeline of clinicians,” as Anyaoku describes it, so hospital staff reflect the communities they serve. At OHEDI, this involves partnerships like one with Meharry Medical College, a historically Black medical school in Nashville. OHEDI has also partnered with community-based organizations like the Seattle Jobs Initiative.

But Mardia Shands says it wasn’t enough to recruit diverse hires. Health care organizations also need to retain and develop diverse employees, which means setting up paths to promotion and leadership. Anyaoku agrees. “If you bring a diverse hire, and they don’t see a path to growth … then you ultimately don’t keep them,” she says.

And retaining diverse staffing is crucial because it can mitigate health inequity. In creating routine, organic interactions between employees of all backgrounds, diverse staffing fosters cultural competency, says Shands.

“Diversity of thought plays a huge role in how you problem solve, and [brings] innovation and creativity because everybody is not into groupthink,” she says. In health care organizations, creative problem solving can be especially important. When it doesn’t happen, says Shands, “innovation is stifled.”

There’s also a business incentive, Shands says. “We know just from … research over the decades that the more diverse an organization is the more it outperforms more homogenous organizations.”

Still, she says, some organizations opt out of promoting diversity and inclusion. And it’s hard work, because “you’re asking people to change their mindset.”

She has some advice for organizations ready to take the plunge: “Health care organizations in particular have to be cognizant that when they ascend into this work around [diversity, equity and inclusion] that it has to be intentional. It’s going to stretch your organization; it’s going to stretch your people.”

At Swedish, we are committed to providing care to millions of patients each year. As the region’s largest not-for-profit health care provider, we take seriously our responsibility to deliver the care our community needs and to remain a community partner.