A New Activism Model for Health Equity

Malhaar Agrawal
Feb 21, 2019 · 4 min read

Earlier last year, the Centers for Disease Control released an eye-opening report announcing that the United States’ life expectancy in 2016 had fallen for the second year in a row, a loss of 0.1 years from 2015’s 78.7, the first two-year decline in longevity since 1963. Disturbingly, this decrease was most stark in non-Hispanic black males, whose death rate increased by 1% over 2015 numbers. To put these numbers into perspective, it amounts to 400,000 lost hours of life, more hours lost than during the entire Iraq War according to the Incidental Economist. It’s easy to discount this trend, but in fact it illustrates the worsening of one of the greatest social injustices our nation faces, the disparity in access to quality healthcare. Essentially, those of minority backgrounds die at a higher rate than the general population. Health disparities are especially stark when compared across races. For example, blacks get diagnosed with prostate cancer 32% more often than non-Hispanic white counterparts nationwide while dying at a 45% higher rate, as I reported in the Columbia Junior Science Journal. Similar conclusions were reached by a team from the Harvard Medical School and Harvard T. H Chan School of Public Health, who surveyed healthcare in 32 middle and high-income countries and concluded that the United States suffers from some of the worst self-reported income-based health disparities, ranking below countries like Slovenia and Russia. Although national policies like the Patient Protection and Affordable Care Act have focused attention and funding to combat health disparities, meaningful progress has been slow to come.

In our search for effective solutions, I propose we take a step back and examine practices employed in other industries which face similar institutionalized and pervasive challenges. The financial industry, in spite of its large footprint and beaurocracy, remains agile due to its culture of entrepreneurship. The recent rise in “activist investors” on Wall Street can teach us something about grassroots activism on Main Street, as they solve problems on the individual level while also making a meaningful impact on larger institutions. Community activists should take note of their success and apply their model locally.

Take billionaire investor Carl Icahn’s approach to his 4% stake in the American International Group (AIG). Following the financial crisis, AIG had been struggling, and Icahn’s investment seemed in peril. In addition to simply giving advice, which could potentially fall on deaf ears, he applied a simple four-step strategy: 1) “Even if I face headwinds, I don’t have to yield to the flow” 2) “I will not be afraid to use the rule of law to implement change” 3) “I will mobilize popular opinion to force change” 4) “I will hold executives’ feet to the fire”

Challenging conventional wisdom, Icahn advised AIG to break up into 3 separate companies to eliminate federally mandated oversight following the $182 billion dollar bailout in 2008. Then, he penned a letter to AIG’s management and posted it online in conjunction with official submission, ratcheting up the pressure on senior management and galvanizing other activist investors to join his cause. Following his letter, Icahn leveraged his shareholder status to force several face-to-face meetings with the CEO.

The activist approach proved effective. The “old guard” CEO was forced out and a series of progressive changes were instituted in AIG, such as splitting it into nine business units and spinning off its broker-dealer network, resulting in significant shareholder value creation in the long term.

Who’s to say this model should be sequestered to finance? Icahn’s model can inspire us to alleviate health disparities in a new way, relying on “individual activism” instead of our existing top-down approach where we entrust our politicians to enact policies to create an equitable healthcare system. Revisiting the 4 step model for investor activism, it is clear that much can be re-applied to our efforts in alleviating health disparities. 1) Rather than merely expect our government to solve health inequities, we need to take individual action to change our healthcare system from the bottom-up. Let’s speak to healthcare administrators about shortcomings in providing adequate care for all patients, rather than leaving it up to someone else. 2) We must hold our lawmakers accountable for inequities in health care access and outcomes in their districts. 3) Let’s start to harness social media and community gatherings to spread awareness about health disparities and inspire others to actively engage in improving the health of their community. Social media can also be used to highlight quality and outcome ratings of local healthcare facilities. For example, look to the success of the #IceBucketChallenge and its positive impact on ALS awareness nationally and the record- smashing donation year for the ALS Association. If we can replicate its success for health disparities, we can begin meaningful conversations across the country and bring about real solutions. 4) Finally, invest your time and resources to earn a seat at the decision table. If we all chip in money and manpower into our local organizations, only then can we begin to guide the health of our community in a meaningful away.

While we pursue these initiatives, let’s never forget to inspire our students, who are shareholders in the nation’s health, to join its management team. As they see the country’s health ratings plummet, they need to step up and direct effective responses, from their homes to the classroom.

Malhaar is a New York City high school student who educates students of color about health disparities through his 501(c)3 non-profit Health Disparity (healthdisparity.org)

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