How Health Systems Can Maintain a Commitment to Health Equity in 2026

In 2025, political and social shifts created real uncertainty for health systems committed to advancing health equity. Federal actions targeting diversity, equity, and inclusion (DEI) programs, funding rollbacks, and language changes have left many hospitals asking: Can we still do this work—and how?

A new Innovation Report from the Institute for Healthcare Improvement (IHI), “Maintaining a Commitment to Health Equity: Guidance for Health Systems,” offers timely answers.

Based on a structured literature review and interviews with 27 health system leaders, clinicians, researchers, and community partners, the report outlines practical strategies for sustaining health equity, even amid intensifying external pressures.

Health Equity Is Not the Same as DEI

One of the report’s most important clarifications is that health equity and DEI are not synonymous. While DEI often focuses on workplace culture and employee diversity, health equity centers on eliminating disparities in health outcomes based on factors like race, ethnicity, language, geography, disability, and socioeconomic status.

Neither is illegal. Yet confusion between the two has led some organizations to overcorrect—canceling or scaling back equity initiatives out of fear.

The IHI report argues that health equity remains deeply tied to quality improvement, patient safety, and compliance requirements.

A Three-Part Framework for Maintaining Health Equity

At the heart of the report is a practical framework built around three domains.

1. Sustaining Core Tenets (“The Work”)

Health systems should continue to:

• Identify disparities using REAL (race, ethnicity, language) data.
• Address differences in health outcomes.
• Provide health equity training.
• Align with existing policies and certifications that require disparity reduction.

Even amid policy changes, requirements such as CMS readmission programs, Community Health Needs Assessments (CHNAs), and Joint Commission certifications continue to incentivize disparity reduction. The message is clear: quality improvement and equity remain interconnected.

2. Sustaining External Practices

Organizations are also encouraged to:

• Publicly acknowledge continued commitment to improving outcomes.
• Thoughtfully adjust language without abandoning the work.
• Reframe equity as a strategic and financial imperative.
• Use data infrastructure to build the business case for reducing disparities.
• Seek informed legal guidance to avoid unnecessary overcorrection.

Several interviewees noted that shifting the language from “health equity” to “health access” or “fair outcomes” was less important than continuing the underlying work.

3. Sustaining Internal Practices to Support Staff

The report also addresses an under-discussed issue: moral injury among staff leading health equity efforts. Rapid policy shifts, canceled funding, and organizational silence can create feelings of betrayal, burnout, and demoralization. To counter this, leaders are encouraged to:

• Communicate transparently about changes.
• Create safe spaces for dialogue.
• Offer flexible work schedules where possible.
• Provide historical perspective and long-term vision.

Supporting staff well-being is not peripheral—it’s central to sustaining equity work.

Data Remains the Anchor

Across interviews, one theme was universal: start with the data. Health systems that invested in collecting and analyzing REAL data and in understanding the social determinants of health were better positioned to justify ongoing initiatives. Disparities that can be measured are harder to ignore.

As one respondent put it: “You can’t act on what you can’t see.”

The Bottom Line

The IHI report does not minimize the challenges facing health systems in 2026. But it also highlights resilience, adaptability, and strategic creativity across the field.

Health equity work is evolving—not disappearing.

And in a time of shifting language and political scrutiny, the most durable strategy may be this:
Stay grounded in data.
Anchor equity in quality and safety.
Support the workforce.
Communicate clearly.

The path forward may be complex—but abandoning the work is not the answer