Allison Bryant Mantha Q&A: Making Clinical Care More Equitable
Allison Bryant Mantha, MD, MPH, is a champion for equity in health care. In her role as associate chief health equity officer at Mass General Brigham, she leads clinical and community health equity efforts under United Against Racism. This is an organized effort to confront racism in health care and transform Mass General Brigham into an anti-racist system. Dr. Bryant also practices maternal-fetal medicine at Massachusetts General Hospital.
In this Q&A, Dr. Bryant talks about her work challenging racism in health care with United Against Racism.
Q: Why is it hard for patients to talk about racism in their clinical care?
Bryant Mantha: We’ve all used different terms to skirt around the issue of racism. We’ve talked about implicit bias and other ways to frame what’s happening to patients. But it truly is a legacy of structural—and sometimes interpersonal—racism, and it’s been so pervasive that sometimes people don’t call it what it is.
There is often a hierarchy in medicine between patients and their health care providers. Often, we as providers don’t create welcoming spaces for patients to share their stories with us. That’s something we’re trying to change and build time for, so we can really hear what peoples’ experiences have been and learn how to treat them better in the future.
Patients aren’t always comfortable speaking up in the moment when they are faced with racism. Sometimes people come back to tell us about their past experiences with racism or discrimination. There is a public conversation about inequitable health care and treatment taking place, and it’s helping a lot of people feel empowered to speak up after the fact—but not always at the exact moment of care.
Q: How is United Against Racism addressing racism in health care?
Bryant Mantha: United Against Racism is Mass General Brigham’s way of acknowledging our history and recognizing that the care that we deliver has not always been equitable.
It’s a way to move us to becoming an anti-racist system. It’s a thoughtful approach to addressing the things we do that affect the health of our patients and community members.
Through United Against Racism, we address three large questions:
- How do we build anti-racism into the way we show up to work every day and into our work environment?
- How do we care for our patients and work toward the best outcomes for everyone while recognizing the legacy of structural racism and its effect on health outcomes?
- How can we recognize and change inequities in health outcomes for the communities we serve?
Q: How do patients’ communities affect their health?
Bryant Mantha: Our health outcomes are about so much more than the care we receive. The social determinants of health—the conditions in the communities where we learn, live, and work—play a key role in our health.
For example, housing stability and employment have a lot to do with your health outcomes and the things you’re able to prioritize. Different communities have various levels of access to nutritious food. Patients may not be able to take time off work to go to health care appointments. They may not have childcare. They may be forced to choose between paying for their insulin, their rent, and/or their health care appointments.
One of our jobs under United Against Racism is to understand the assets in their communities that help make them well and also those social “determinants” that they may need help with to become their healthiest selves. We ask questions like “How are you doing in terms of access to healthy foods? Do you need help with transportation? Do you need help with more resources for education?” And then, when patients are interested in receiving some of those resources, trying to build them into routine care.
Hopefully, we’ll get to a place where we can routinely help all patients mitigate social risk to improve their health outcomes.
Q: Can you share some of the race equity work you’ve done in your career?
Bryant Mantha: A lot of my earlier work at Mass General Hospital was about promoting awareness of inequities among our providers.
When our department would meet to review our statistics around cesarean deliveries, readmission, or hemorrhage, for example, we would take time to highlight differences in these outcomes by patient factors. We’d say, for instance: Here is the risk of readmission for our Black patients, our white patients, our Latinx patients, our non-English-speaking patients.
That got people comfortable—or uncomfortable—with the fact that our care wasn’t really equitable and that this inequity presented a threat to our overall care quality.
We started baking more about the lived experiences of our patients into our presentations of adverse health outcomes: What did the patient look like? What was their race and ethnicity? What was their language preference? What kind of insurance did they have? That made people start to think about the possible roles of those variables in the patient’s treatment.
We also started a process for anonymous reporting of experiences of racism or discrimination in the daily lives of some of our work community members. That project has links to work we’re doing now, under United Against Racism, to build a culture of reporting and trusted responses to instances of racism.
Q: What’s on the horizon for United Against Racism?
Bryant Mantha: One of our signature programs that’s really getting off the ground now is bringing our high-quality care closer to our communities with mobile care. Hypertension and substance use disorder are two equity priorities for Mass General Brigham—so providing that kind of care in a mobile setting helps us offer better access for our patients.
A lot of the work we’re doing under United Against Racism is about language access. We hope to communicate with our patients in their preferred language in a consistent, quality way. That might mean offering care from bilingual staff who have been certified to offer care in certain languages or using trained medical interpreters and making sure people have ready access to them.
I am so proud of our digital access coordinator program, which provides our patients with lower digital literacy with at-the-elbow support to use our patient portal and important digital tools for their health.
The work we’re doing around social determinants of health will give patients and our communities much needed tools to achieve health and we expect to expand this in the coming few years.
I’m truly excited that Mass General Brigham has invested in making equity in health care a priority. We hope that our work can serve as a model, at the same time as we continue our learning from other organizations around the country.
