Institutional practices
About
Institutional practices are the ways in which an institution’s members carry out their functions and responsibilities, often through established patterns of behavior and procedures. They can include decision-making processes and resource allocation established by historical precedent, communication protocols, performance evaluations and hiring and promotion practices.
Relationship to health and equity
How we carry out institutional practices helps create the community conditions that determine health and equity, and for whom. Marginalized populations such as the LGBTQ+ community continue to experience discrimination in hiring, living, and learning, despite federal laws preventing these actions. The health insurance industry’s practice of using artificial intelligence to review claims carries the risk of bulk denials with no medical practitioner review, resulting in individuals needing to pay more for or delay treatment. Denials are higher for those with lower-incomes, lower education and people of color. While inequities remain, communities can use collective power within institutions and in partnership with those most harmed to reimagine institutional practices that serve all.
Relationship to systems and structures
Institutional practices are one type of societal rule. These practices are typically put in place by decision makers at institutions, although groups with collective power (unions, employees, external influencers) can change institutional practices through organizing and advocacy. Institutional practices can be written rules, such as grievance policies at a place of employment, or the procedures put in place by organizations to implement laws passed by legislatures. They can also be unwritten rules/practices, such as not paying women and especially women of color the same pay as men in the same position.
Additional Reading
- Heller, J. C., Givens, M. L., Johnson, S. P., & Kindig, D. A. (2024). Keeping it political and powerful: Defining the structural determinants of health. Milbank Quarterly, 102(2), 351-366. https://doi.org/10.1111/1468-0009.12695
- Hoagland, A., Yu, O., & Horný, M. (2024). Social determinants of health and insurance claim denials for preventive care. JAMA Network Open, 7(9):e2433316 https://www.doi.org/10.1001/jamanetworkopen.2024.33316.
- Bishu, S. G., & Alkadry, M.G. (2017). A systematic review of the gender pay gap and the factors that predict it. Administration & Society, 49(1), 65-104. https://doi.org/10.1177/0095399716636928
- KFF. (n.d.) How history has shaped racial and ethnic health disparities: A timeline of policies and events. Medical exploitation of enslaved Black women. https://www.kff.org/how-history-has-shaped-racial-and-ethnic-health-disparities-a-timeline-of-policies-and-events/?entry=1808-to-1890-medical-exploitation-of-enslaved-black-women