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For Natasha Smith, Head of Diversity, Equity & Inclusion at Sanford Health, equity has always been personal. From a family of Mexican-American immigrants, she understood from a very early age what a difference equitable systems make for vulnerable populations. Natasha has used this life experience to help build the processes and systems necessary for Sanford to be the premier provider of equitable health care in rural communities. The Council recently caught up with Natasha to learn more about the health equity journey at Sanford.

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QUESTION: How long have you been with your organization and what’s been your journey to your role?

ANSWER: I have been with Sanford Health since March, coming to the organization with a background in corporate social responsibility and corporate philanthropy. Prior, I oversaw the philanthropic efforts of the Wells Fargo Foundation for a few states here in the Midwest and much of that work was centered around nonprofit partnerships that provided programming that benefited marginalized communities. I worked to create leadership buy-in and a strategic plan to shift the organization from ‘check writing’ to ‘problem solving’; cultivating and supporting grassroots, BIPOC-led initiatives to combat systemic inequities. Coming from a family of Mexican-American immigrants myself, I understood from a very early age what a difference equitable systems and focuses make for underserved and under-represented populations. I’m excited to be in the health care space now, focusing on equitable outcomes in our workforce and in our communities.  

Q: Disparities in health care have always existed, but in your view, how have recent events – like the COVID-19 pandemic and the murder of George Floyd – impacted health equity work and where it is headed?

A: I believe that the pandemic exacerbated existing disparities and accelerated the need for organizations like Sanford Health to expand response. It was important for us to partner with organizations outside our walls to reach patients and provide care how and where they felt comfortable receiving it. We know that the pandemic has not impacted all populations equally, and as such, not all populations will rebound equitably. Demographics that had existing barriers to employment, quality child care, access to food and transportation were disproportionately set back by the COVID-19 pandemic. After social uprising in 2020, employees who previously may not have been directly involved in equity work are increasingly reaching out to ask how they can be a part of the solution within our organization and in their communities. There is ample opportunity for us to seize this moment and enhance education and awareness as a trauma-informed organization. Additionally, public health work has taken a main stage as we work swiftly to educate these disproportionately impacted populations on the safety and efficacy of the COVID-19 vaccine and continue to encourage folks to seek routine, preventative care amid this uncertain time.

What are some of the biggest barriers you see in delivering equitable care and what are steps that health plans can take to better connect with BIPOC communities?

A: There are barriers to accessing care such as transportation and interpreter services that health care organizations can continue to work at combating. Sanford Health Plan as the MCO for North Dakota Medicaid expansion, has been providing transportation to Medicaid recipients to lower barriers and increase access to care.  Allocating appropriate resources to interpreter services and increasing intercultural awareness at the point of care will increase the trust we build in BIPOC communities. We are working to expand commitment to understanding social determinants of health to address the social conditions that produce patterns in health equity, and this really starts with educating our workforce on the importance of collecting this data and building trusting relationships with our communities of color and other marginalized demographics.

Q: What specific initiatives (committees, taskforces, work groups, cabinets, etc.) have been created at your organization to address health equity? And given these initiatives, what progress has been made in terms of making care more equitable?

A: At Sanford Health, one initiative that I can share focused on maternal-fetal outcomes by combating anemia in pregnancy. We found that access to iron rich foods and gaps in resources for iron supplements increased risks of post-natal hemorrhage, particularly with our Native American populations. Additionally, we are looking to increase awareness and education around inclusive health care as we work with the Transformation Project, a South Dakota based nonprofit serving the transgender population to provide a joint summit. This summit will focus on being an inclusive health care provider and improving outcomes in the LGBTQ+ community by driving comfort and inclusivity at the point of care. In late 2020, Sanford Health also provided a $3 million donation to Feeding South Dakota and other rural food banks across the Minnesota footprint to combat food disparities amid the pandemic. We are finding such passion in our markets around this work from our clinicians and leaders.

We have also increased focus on identifying and addressing social determinants of health and launched initiatives in our markets to build a partnership with food insecurity organizations to meet our patients’ needs beyond the medical needs that present themselves in our clinics.

Q: What role do you see partnerships (with the community, with the state, with others in the health care ecosystem, etc.) playing in advancing health equity efforts?

A: As mentioned above with the Transformation Project, partnering with nonprofits serving marginalized communities is key to building sustainable relationships that drive trust and allow our organization to take on a problem-solving role in our communities.

Q: What role does organizational culture and diverse staffing play in health equity? How can health plans use cultural competencies to improve health outcomes?

A: We know that when our workforce represents the diverse communities that care is provided in, health outcomes for diverse communities improve. Having diverse representation in our care providers and other patient facing roles is critical to achieving quality of care for BIPOC communities. Additionally, working to staff our organization holistically, in a way that reflects the community, creates a sense of belonging and loyalty. When everyone sees the organization as a place to thrive and build a career, we are enriching our community and increasing access for our employees to reach their full potential.

Q: Distrust in the health care system continues to be a huge challenge when it comes to health equity, which has been laid bare by lower COVID vaccination rates in communities of color, but impacts other care, also. How do we rebuild trust in BIPOC communities?

A: I think we touched on many of the key initiatives that can drive trust in our communities, to include BIPOC communities. Partnering with organizations that serve under-represented populations, building a workforce that represents the unique communities we provide care, and taking exceptional care of our care providers are all ways we can work to systemically build trust in our backyard and be the premier provider of health care in rural communities.