To Vincent Guilamo-Ramos, the monumental costs of health inequity—declining health outcomes and escalating financial expenditures—are on a collision course to finally break the U.S. health care system, so staying that course simply isn’t an option.
“After decades of hand-wringing, our country’s health care system must finally be reformed. We pay far more for our care than other developed nations, yet we suffer from higher morbidity and mortality overall and a widening gap of inequity in who gets care and who doesn’t,” says Guilamo-Ramos. He points to the business consulting group Deloitte’s estimate that $320 billion per year—or $1,000 per taxpayer—is spent on inequitable care, a figure that’s expected to climb to perhaps $3,000 per taxpayer by 2040. That’s unsustainable for a nation already experiencing a disturbing drop in life expectancy across the board and for individuals and families who are finding health care more and more unaffordable.
So, in setting the course for the Institute for Policy Solutions at the Johns Hopkins School of Nursing, Guilamo-Ramos, the Institute’s first director, is less focused on relitigating the problems within our health care system than on identifying and scaling up solutions that significantly improve population health and advance health equity.
Equitable, whole-person care for all Americans. No “buts.”
Guilamo-Ramos says, “Health should be one of our unalienable rights, but there is this notion that if we lift certain communities up, that conversely, we must take something away from other communities. That’s an artificial debate in our society that is so destructive. In reality, when we lift up the most marginalized communities, it actually improves things for everyone. Because communities that are left behind become increasingly unhealthy and increasingly expensive to treat in what we call “bad, inequitable care” because it maintains the status quo—increasingly prevalent chronic disease; misalignment in health care access and distribution of services; escalating, preventable, exorbitant costs; and limited attention the underlying social and economic drivers that influence these negative health outcomes.”
“There’s a larger purpose here,” he says. “We can do better.”
“As a nurse, researcher, and advocate, I’ve come to see that we need a redesigned health care system with a more expansive scope. One that recognizes the value of addressing harmful social determinants of health, promotes prevention and health promotion, and looks upstream from clinics and hospitals to deliver whole-person care in non-traditional settings like communities and homes,” Guilamo-Ramos says. “I believe nursing holds the keys to such reform and that our depth of capacity as expert clinicians, paired with the power of policy, will help us achieve health care redesign that works for everyone.”
The opportunity to apply a career’s worth of experience as a researcher and health care provider to local and national policy that can finally support the redesign of our current health care system is why he decided to join the Johns Hopkins School of Nursing to lead the policy institute.
Widely regarded as an expert, scholar, and thought leader in a number of health care arenas including health equity, dynamic mitigation of harmful social determinants of health, nurse-led models of care, HIV/AIDS and adolescent and young adult sexual and reproductive health, Guilamo-Ramos is also the founding director of the Center for Latino Adolescent and Family Health, which he started at New York University and then moved to Duke University and now to the Johns Hopkins School of Nursing.
For more than two decades, he has been the principal investigator of numerous National Institutes of Health, Centers for Disease Control, Health Resource Service Administration, and other federally funded research grants, and has implemented several large-scale randomized controlled trials in community and clinic settings. He has published extensively in high-impact scientific journals such as Nature Medicine, the Lancet Infectious Diseases, the Lancet HIV, Clinical Infectious Diseases, JAMA Pediatrics, Pediatrics, and the American Journal of Public Health and has earned coverage from the New York Times, NPR, and the Washington Post, among other media outlets.
Guilamo-Ramos currently is an Aspen Health Innovators Fellow, a program designed to develop a community of energized, values-driven leaders committed to finding viable solutions to address U.S. health care’s problems. In addition, he serves as a member of the Health and Human Services (HHS) Presidential Advisory Council on HIV/AIDS, where he provides advice, information, and recommendations to the HHS secretary. In addition, he serves on the Unequal Treatment Revisited Consensus Study of the National Academies of Science, Engineering and Medicine (NASEM). He is a fellow of both the American Academy of Nursing and the American Academy of Social Work and Social Welfare and he received the Hispanic Health Leadership Award from the National Hispanic Medical Association. Guilamo-Ramos is a graduate of the 2016 class of Presidential Leadership Scholars, an initiative that draws upon the U.S. presidential centers of Lyndon B. Johnson, George H.W. Bush, William J. Clinton, and George W. Bush to develop leaders committed to solving society’s most challenging problems. He sits on numerous non-profit boards including, UnidosUS, the nation’s largest civil rights organization advancing opportunities for the Latino/Hispanic community.
Still, even for a thought leader who’s already made great impact, the opportunity to leverage his skills and experience with that of his new colleagues at the Johns Hopkins School of Nursing via the Institute for Policy Solutions at was irresistible. For despite all of his personal and professional successes, Guilamo-Ramos is on a mission to end health inequities.
“The thing that I care most about is health equity,” Guilamo-Ramos explains. “The communities that don’t have access to care, that experience the worst distribution of health services and that live in the worst social conditions experience the greatest preventable morbidity and premature mortality. And these harms are compounded year after year because these communities have endured long-term, historical injustices.”
Born and raised in the South Bronx by immigrant parents, Guilamo-Ramos says, “I know firsthand what poverty looks like in an urban, people of color context.”
“The unwillingness of our society to grapple with so many social processes that negatively affect our health motivates me to make change. Take racism, which hugely shapes the provision of health care in our country. We have to look at racism not just in individual providers’ actions but also how racism implicitly and explicitly shows up in the clinical encounter, in the institutions people access for care, and in the health care policies and operating procedures people live under. As we at the Institute tackle health redesign, we also will call on society at large to value and prioritize structural changes that support those furthest from the opportunity for health, because that is the path to health care equity for all.”
The current health trends he’s seen all across America and all across the board make achieving health equity an imperative.
“If you look at the data in our country of adult individuals who have chronic disease, it’s overwhelming. The vast majority of adults right now in our country have one or more chronic conditions. And much of that is preventable. Obviously, aging plays a role, but it’s definitely not fully explained by aging. And if you look at the projections, more and more adult Americans will be living with multiple chronic conditions.”
He repeats, “From a health and a cost perspective, we must do better.” So, it’s here that he’s planting the flag.
More on his admittedly early vision for the Institute for Policy Solutions at the Johns Hopkins School of Nursing and his take on the present and future of health:
“One of my mandates for the Institute is to help the public see that to fix our long-broken health care system, we’ve got to go in a different direction. My colleagues and I at the Institute, along with our partners, will be pioneering a new course toward health equity that is fundamentally driven by the nursing profession. A large part of changing course means that in our country, every single individual and family has access to whole person health care—not care focused on a particular body part or condition—and care that prioritizes prevention and health promotion as much as clinical care of illness.” Additionally, Guilamo-Ramos says that people already living with chronic conditions should receive care he terms “restorative”: “It shouldn’t just manage their symptoms or maintain their current health status. He says, “our goal should be to help people optimize their health as much as possible, whether they are living with depression, substance use disorder, cancer, diabetes, hypertension, heart failure or any other condition.”
On life expectancy, “We’ve been going the wrong way. And we can’t simply blame COVID or the poly-substance epidemic. Yes, those things clearly had an impact. But there has been some evidence [he cites a recent article in the American Journal of Public Health] that life expectancy in the United States for some segments and communities has been going in the wrong direction … since maybe the 1950s.”
“We have evidence from Costa Rica and other countries that have prioritized universal preventative care and health promotion to prove how that really improves health outcomes, whether it be chronic disease or life expectancy. The literature shows that health care is more effective when it goes directly to where families are, is family-based, and draws upon individual and community strengths while being culturally responsive. Care is better when it leverages and maximizes the expertise of an interprofessional health care work force, or for our purposes, nurses—and then is locationally flexible. A good health care system doesn’t wait for you to get sick. It goes to you already aware of your individual biological and , family and community circumstances and says, ‘How are you? Let’s meet and check on your health status and figure out how we can keep you healthy’ vs. waiting for you to come into an acute care setting in an advanced state of illness that we’re then trying to treat at great cost and with lower probability of a good outcome.”
“The thing that excites me most about our mission at the Institute is that nursing is a logical solution to so many of the problems in our current health care system because of our clinical expertise and scale. The vast majority of health care across the globe, including the U.S., is delivered by nurses. When we start to marshal that power by deploying nursing in ways that are novel, away from acute care, and more along the entire health continuum, we will see radical improvements in outcomes and costs.”
“What I’m trying to convey is that the Institute will truly deliver on our promise to redesign our current health care system to embrace a new system that prioritizes achieving health for all versus the provision of healthcare and ends health inequities by being an incubator of scalable solutions. Yes, we will highlight what is unclear and what are the true underlying reasons we are experience inequities in society, but we won’t stop there. Being solutions-driven means we will go further and provide evidence-informed nurse led interventions and policies that we will then test, refine and disseminate.”
Then, “All the interventions that we develop as nurse scientists … the ones that prove to be efficacious can be incorporated into the infrastructure of health care delivery in the U.S. Our work will become part of the fabric of the way that health is achieved for every person, family and community in the United States and beyond. ”
“My job is to elevate that work, to shape the messaging so that people are mobilized for change and that nursing is an important actor in leading that change. My job is to help translate that work into something that elected officials and decision makers can practically adopt to improve health outcomes and reduce costs. I am humbled and so excited because I think this is the best job in the world!”