Equity in Motion at CMS Health Equity: Dr Aletha Maybank Shares AMA Advances for Justice

Chief Health Equity Officer and Senior Vice President Aletha Maybank, MD, MPH, of the American Medical Association (AMA), delivered a powerful plenary session last week at the CMS Health Equity conference. She reflected on the journey toward equity over the last 5 years, noting significant turning points that came in the aftermath of George Floyd's public murder and the spread of COVID-19 sparking changes.

Aletha Maybank, MD, MPH | Image Credit: LinkedIn

Maybank acknowledged the initiatives the AMA has implemented since, centering the voices of the people who have been most marginalized in the country, and specifically in the health care system. Then, she emphasized that the work needs to go beyond acknowledgment to advance the state of health equity in the US.

“I'm very cautious in [making acknowledgments] at the same time because I don't think we can be very flippant in just saying we're doing an acknowledgment; you need to be committed to the work as individuals and as institutions and have actions that actually demonstrate that,” Maybank said. “There are always a lot of conflicts to that in terms of institutional actions because sometimes the values may not fully align or the actions may not fully align, but it is critical, I think, still to center the experiences of those who have been most marginalized.”

Before 2020, discussions of racism within institutions were often avoided, she explained. However, the murder of George Floyd catalyzed a nationwide reckoning with racial injustice. For those engaged in equity work, Maybank recalled that this tragic event opened doors that had previously been shut. There was a pressing need to capitalize on this momentum and push for systemic change before the opportunity slipped away.

Referring to health equity work as a marathon, as inequities exist and the efforts need to endure, Maybank believes there are times during the race to adapt the pace, to relay, or to pass the baton to another when rest is needed.

“Sometimes, we do need to sprint. We have to speed up because of the urgency of the moment,” she said. “And I know many of us have been sprinting over the last 4 years to get done what we needed to get done.”

Historically, the AMA has a complex relationship with racial justice,¹ having excluded Black physicians for over a century and remaining silent during key moments of desegregation, Maybank explained. However, in the wake of George Floyd's murder, the AMA made a bold move by acknowledging its past and committing to an explicit stance against racism.

Key policies emerged, such as eliminating racial essentialism and recognizing race as a social construct rather than a biological determinant.² According to Maybank, these policies have had a profound impact on medical education, research, and clinical practice, driving significant changes across the health care system.

Institutions like the AMA have provided platforms for Black physicians and equity leaders, elevating their voices on national stages. Collaborations with leaders and publications in prestigious outlets have amplified the message of equity and justice. Within the last 4 years, Maybank has contributed to and published a pair of articles in JAMA, focusing on restructuring the US health care system after the COVID-19 pandemic³ and eliminating harmful race-based clinical algorithms.⁴

Internally, the AMA has made strides in embedding equity within its organization. Building a team dedicated to health equity and implementing strategic plans have been pivotal steps.⁵ These plans are aimed at internal accountability, equity action plans, and a comprehensive framework to track progress, contributing another rubric to those of other institutions that can be replicated.

“I also realized, being at AMA, the influence that it has had across the health ecosystem on the policies…” Maybank explained. “And thanks to the young physicians, the young folks, the med students, who put forward these policies to kind of really solidify that I could—and anybody else who was doing work on behalf of AMA, and speaking on behalf of AMA could—explicitly talk about racism.”

The creation of tools and educational resources, such as the Health Equity Education Center, has equipped health systems and professionals with the knowledge to address inequities.⁶ Moreover, partnerships with organizations like the CDC have facilitated the development of frameworks for equity in crisis preparedness and response.

Despite the progress, she stated that the work has not been without resistance. Efforts to promote equity often encounter significant pushback, both from within institutions and the broader public, with “dominant, malignant, and false narratives” that maintain the status quo. For instance, initiatives such as the AMA's Guide to Language, Narrative, and Concepts⁷ have faced criticism, with Maybank personally receiving threats, illuminating the contentious nature of equity work.

"Our opportunity at this given time, not only within health care but in our country, is a need for all of us to understand what are those dominant narratives, malignant narratives, false narratives—whatever term you want to use—that are not working to advance equity within this country and within the systems that we have,” she said.

Focusing on the future of health equity in the US, Maybank concluded that the progress of the past few years demonstrates when commitment, vision, and strategy align, significant change is possible. However, it also serves as a reminder that the fight for equity is ongoing, and the efforts to roll back progress are just as relentless. The urgency of the moment demands moving beyond the metaphor of a marathon and acknowledging the need for sprints—times when rapid, decisive action is necessary.

References

1. Madara J. Reckoning with medicine's history of racism. AMA. February 17, 2021. Accessed June 4, 2024. https://www.ama-assn.org/about/leadership/reckoning-medicine-s-history-racism

2. Civil and Human Rights. Policy H-65.953. AMA. 2020. Accessed June 4, 2024. https://policysearch.ama-assn.org/policyfinder/detail/racism%20social%20construct?uri=%2FAMADoc%2FHOD.xml-H-65.953.xml

3. Metzl JM, Maybank A, De Maio F. Responding to the COVID-19 pandemic: the need for a structurally competent health care system. JAMA. 2020;324(3):231-232. doi:10.1001/jama.2020.9289

4. Cleveland Manchanda EC, Aikens B, De Maio F, et al. Efforts in organized medicine to eliminate harmful race-based clinical algorithms. JAMA Netw Open. 2024;7(3):e241121. doi:10.1001/jamanetworkopen.2024.1121

5. The AMA's strategic plan to embed racial equity and advance health equity. AMA. Accessed June 4, 2024. https://www.ama-assn.org/about/leadership/ama-s-strategic-plan-embed-racial-justice-and-advance-health-equity

6. Health Equity Education Center. AMA Ed Hub. Accessed June 4, 2024. https://edhub.ama-assn.org/health-equity-ed-center

7. Advancing health equity: a guide to language, narrative and concepts. AMA Center for Health Equity. Accessed June 4, 2024. https://www.ama-assn.org/about/ama-center-health-equity/advancing-health-equity-guide-language-narrative-and-concepts-0