February 16, 2023
February is Black History Month and ACHP is committed to celebrating and highlighting the diversity within our membership and efforts being made to make real achievements toward health equity nationwide. With Black Americans facing disproportionately more barriers to care, there is clearly still much work to be done. Leaders like Joy Marsh, Vice President of Equity & Inclusion at UCare, are inspired by their lived experiences, which, in turn, encourages others to take that work to heart – this month and every other month – to leave a lasting impact on their communities and the health care system at large.
Tell us about yourself and your role at your organization.
I serve as UCare’s inaugural Vice President of Equity & Inclusion. I joined the company in 2021 and have been charged with building the Equity & Inclusion Department. I serve as a champion for UCare’s antiracism initiatives, including UCare’s work to advance health and racial equity for our members and the evolution of a culture focused on diversity, equity and inclusion. I work with stakeholders inside and outside UCare (staff and leadership) to identify and address health disparities, foster a more diverse, equitable and inclusive workforce environment and dismantle systemic racism in UCare policies and procedures. My team and I develop and implement strategies to identify, address and report health disparities across markets and populations and to measure progress over time and against identified targets to achieve equity in the health outcomes of members. We lead efforts to ensure our approach to health equity focuses on four levels of impact: individual, institutional, community and societal. Our work is rooted in enterprise-wide collaboration. Because what is measured is what counts, we focus on leveraging data to set clear goals for how we measure progress.
Can you tell us about an early experience that impacted your career path?
It was a bit accidental that I found myself in a career centered on addressing health disparities. Most of my professional career since leaving graduate school has been in leading large scale organizational change efforts in education, financial services, government and healthcare. While I was experiencing success at my job, I reached a point where I wanted to be living more of my personal and spiritual values in the world. After a period of spiritual discernment, I saw how working to change systems of oppression and expanding justice would enable me to live a more aligned life. I began saying yes to opportunities that would enable me to work towards justice. Initially, this looked like volunteer and board service roles in non-partisan community organizing for racial equity. During the day, I was leading major domestic and international systems change efforts at UnitedHealth Group. On the side, I was in the public arena developing people and working with them to shape policy to reverse the harm of structural racism at the local, state and national level. When an opportunity came along for me to lead institutional change through the lens of racial and health equity, I jumped on it, which is how I wound up as the Chief Equity Officer for the City of Minneapolis and eventually found my way back into health care in my current role at UCare.
How has your career and knowledge you’ve gained impacted or changed your world view? And relatedly, how has your world view impacted your career choices?
Considering the impact of social and structural determinants on health outcomes in marginalized communities, I am fortunate that I have been exposed to a number of sectors that contribute to these root causes of health disparities. My work at the systems level in education, healthcare, financial services and government enables me to approach my work with a complex and intersectional understanding of what it takes to drive transformational change. I understand how these systems operate and how power moves inside of them. I understand how siloed organizational approaches to solve for health equity will always lack the impact that collective action brings. I further understand the critical need for health care institutions to move upstream and address the root causes of health disparities (e.g. structural racism, classism, sexism and other systems of oppression). We will never truly achieve health equity in the communities we serve if this doesn’t happen.
Moving upstream calls for humility and a willingness to examine past and current practices with the desire to understand the implications for health outcomes today. It means that in a country with centuries of genocide and oppression of Black and Indigenous People along with marginalization of women, immigrants, LGBTQIA+ communities, people with disabilities and more, solutions to health equity can’t exclusively or even predominantly be rooted in behavior change at the individual level. Yes, connecting our members who are experiencing food insecurity to sources of food is important. However, if we don’t work collectively across sectors to address the absence of sources to healthy food in all communities, tackle income inequality, housing instability and other factors contributing to food insecurity, we will never run out of families in need of our support to connect them to food. Last but not least, the most impactful solutions to address health disparities are co-created with the voices of those most burdened at the center. Nobody is clearer on what they need to overcome barriers to health than those experiencing those barriers. Centering the voices of those most burdened in reducing disparities is a core value that shapes my work.
As far as how my expanded worldview has impacted my career choice, I accepted years ago that my goal will always be to have equity, antiracism and justice-oriented work at the center of my life. So long as I am working, I want my work to be in service to a more just and beloved community for everyone. My worldview shapes where my partner and I live, where I raised my children, the diversity of my social circle, where I volunteer my time and more. Developing people and shifting systems towards more equitable outcomes is how I show up everywhere I go, including through my job.
What does Black History Month mean to you?
It may sound cliché, but in my mind, every month is Black History Month. Our history as a people is American history. The stories of our contribution to the foundation of this country, democracy, science, art, industry and more are vast and under-told. The stories of the cost Black people have paid and continue to pay as a result of structural forms of oppression also ought to be told continually for the purposes of righting those wrongs in pursuit of equity and justice for all. The more we normalize celebrating Black history every day as a part of American history, and that of other racial, ethnic and cultural groups, the more inclusive our institutions and our democracy becomes.
As a leader in your community, what advice would you offer to those getting started?
Find peace with discomfort. Moving institutions and people towards more equitable ways of working requires changing how things have always been done, sometimes in deeply disruptive ways. This sort of change will almost always create discomfort. If you are comfortable in the discomfort, you can support others in their discomfort.
Be clear on what your contribution is to the work. You won’t eradicate health disparities in your lifetime – neither will the organization where you work. Build a practice in which you continually examine what your role is in this moment, the vision you have for yourself as a leader in this work and your opportunity to influence more equitable outcomes. When you feel overwhelmed or burnout creeping up, check back in with yourself and get re-aligned with that vision.
Understand how white supremacy culture shows up and how it isn’t about white people. White supremacy culture influences all of us, regardless of our race, and is a major obstacle on the road to health equity. Power hoarding, defensiveness, either/or thinking, a sense of urgency, focusing on individual behavior over systems change and other actions are signs of white supremacy culture and anyone can demonstrate these behaviors. Be alert to when these behaviors manifest so you can attempt to guide people back to a shared value of equity and work collectively to move forward.
Remain curious. We are all on a journey and there is a lifetime of learning to do when it comes to health equity. Be a consumer of information through books, community and any other ways in which you can deepen your understanding of people who hold identities different from yours.
Leverage a tipping point philosophy. Institutional and individual behavior change to center an equity lens in our work can feel daunting at the outset, particularly for those who are new to the work. When people don’t feel confident in equity-related language, don’t understand or lack data or aren’t in community with those who experience the greatest disparities, it can be difficult to even know where to begin. Make the steps for people as clear and accessible as possible. In doing so, people will begin to operate in more equitable ways and the culture change you seek will become a reality.
New from ACHP:
- ACHP Letter to Congress on MA Broker Payments
- PBMs are Clear as Mud: The Value of a Fee-Based, Transparent Model
- ACHP Letter to CMS on Broker Payment Reform
- ACHP’s MA for Tomorrow FAQ Sheet
- ACHP Letter to CMS on Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems
- ACHP Letter to CMS on Short-Term, Limited-Duration Insurance Plans