North Star
Health Equity
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A just health system gives every person a fair chance to live a long, healthy life, no matter where they live, the color of their skin, their gender, or their disability status.
Ten Ten Ten exists to help dismantle the structural barriers that drive avoidable suffering and cost, and to replace them with transparent standards, real accountability, and measurable improvement.
The gaps we must close
Geography (rural vs. city)
Rural Americans face higher mortality and shrinking access to care. By 2019, age-adjusted mortality was 20% higher in rural areas than urban ones. Rural hospital closures continue: since 2010, 182 hospitals have closed or converted away from inpatient care; 46% of rural hospitals operate in the red and 432 are vulnerable to closure. These closures create “care deserts” that worsen outcomes and costs.
Historically marginalized racial and ethnic groups
Disparities persist across life expectancy, infant and maternal outcomes, and coverage. In 2022, life expectancy was 77.5 years for white people versus 72.8 for black people and 67.9 for American Indian/Alaska Native (AI/AN) people. AI/AN adults also had markedly higher mortality and far higher uninsured rates. Black infant mortality, at 10.9 per 1,000, is more than twice that of the white rate, 4.5 per 1,000.
Gender and maternal health
The U.S. maternal mortality rate remains the highest among peer nations. Black women die from maternal causes at 49.5 per 100,000 live births, more than 2.5× the rate for white women, 19.0 per 100,000. Encouragingly, the overall rate is falling slightly, but large racial gaps remain and require sustained action.
Disability
Over 61 million U.S. adults, about 1 in 4, live with a disability. Working-age adults with disabilities report substantial access barriers: roughly 1 in 4 lack a usual source of care, and 1 in 4 had an unmet care need due to cost in the past year. These barriers drive preventable complications, higher spending, and inequity.
Our commitment
01. Name and measure structural inequities
We will surface where the system falls short, on outcomes, access, safety, and affordability, and break results down by geography, race/ethnicity, gender, and disability status. Then, we’ll provide detailed, practical playbooks for healthcare solution providers, employers, and health plans to implement changes that measurably close the gaps.
02. Set clear, public targets
We encourage alignment with Ten Ten Ten’s North Star, Top-Ten outcomes, Ten Percent of GDP, in Ten Years. We will publish “what good looks like” for equity, e.g., closing rural-urban mortality gaps; significantly reducing black/white maternal and infant mortality gaps; expanding timely primary care to underserved counties.
03. Back what works locally
We prioritize interventions with evidence of equity impact: primary-care-first models, integrated behavioral health and SUD (Substance Use Disorder) services, maternal safety bundles, site-neutral pricing, drug value tied to clinical benefit, navigation and community health workers, and data transparency.
04. Require transparency and accountability.
Partners seeking the Ten Ten Ten Certification must share stratified results (including equity measures), publish improvement plans with timelines, and demonstrate year-over-year progress.
05. Protect access in rural and underserved communities
We advocate to stabilize essential services, prevent avoidable closures, and eliminate “care deserts,” especially for maternity and emergency care.
How we’ll measure and report
The Ten Ten Ten Index
(Roadmap) The Index will track outcome, access, safety, and affordability metrics with equity breakouts.
Open Methods
We publish sources and methods so anyone can validate, reuse, and improve them.
Annual Equity Report
Summarizes gains and gaps; highlights communities and organizations achieving measurable, equitable improvement.
What you can do now
Individuals
Get covered, establish primary care, keep preventive care up to date, and advocate for equitable services in your community.
Employers & purchasers
Require transparent, stratified performance in contracts; pay for access, outcomes, and safety, not volume.
Clinicians & health systems
Integrate primary care, behavioral health, and maternal safety bundles; expand disability-inclusive access; share stratified results.
Policymakers
Stabilize rural care, enforce site-neutral prices, fund data transparency, and align incentives to reward equitable outcomes.
Together, we can replace structural inequity with structural opportunity, making measurable, equitable health the standard everywhere in America.
