Health inequities are not only produced by access barriers and social determinants. They are produced at the point of care by the organizational culture of the institutions delivering it. This white paper applies Cultural Current Theory and the Bridge-Shield Paradox to healthcare, arguing that organizational culture is an unmeasured social determinant of health that operates through the suppression of clinician authenticity, the depletion of Bridge-Shield health workers, and the direct degradation of patient outcomes. Grounded in concordance research, burnout data, and health equity science, this paper gives health system leaders a four-step framework for culture-aligned equity leadership.