Health systems can and should do more to address health inequalities

The COVID-19 pandemic has shed light on a social problem that has been part of the American landscape for generations: Health continues to fail people of color. We hear that the social determinants of health are to blame for these differences. Experts estimate that health care is less than 20% of health outcomes. While this is true, the rest of the healthcare industry has adopted a mantra that says social influences are beyond our control.

Unfortunately, this mantra prevents health systems, insurance companies, pharmaceutical companies, and policymakers from positively impacting these social factors in the most challenging communities. This needs to change. When it comes to large health care systems, specifically, we need to harness our power to significantly reduce health inequalities.

You will look at more than the life expectancy data and understand the problem. Life expectancy for Americans fell by almost two years between 2019 and 2020, according to the Centers for Disease Control and Prevention. However, marginalized communities have been the hardest hit. The life expectancy of blacks fell the most, by 2.7 years, since 2001, and the life expectancy of Latinos fell by 1.9 years, according to the CDC.

Although COVID-19 pushed for this decline, the problem is pre-pandemic and will last a long time if we don’t act now.

The endless cycle of poverty, which affects people of color in moderation, leads to health inequalities. According to the U.S. Census Bureau, approximately 1 in 12 whites lives in poverty, but this rate doubles for Hispanics and is nearly 2.5 times the number of black families, and 1 in 5 lives in poverty. Poverty is reflected in inadequate access to health care, inadequate housing, limited access to high-quality food, lack of transportation, and end-of-life jobs.

The need to interrupt this cycle is now being recognized at the highest levels of government. The Biden administration announced new initiatives in April to address health inequalities, including a plan by the Department of Health and Human Services to expand enrollment in low-cost health insurance in color communities and improve maternal health among Black, American Indian and Alaska Natives. people. While Biden’s efforts are certainly good news, we believe that major health care systems should play a special role in adopting a four-pillar social impact strategy:

The first is access. Many health systems have invested in telehealth and have worked with partners to alleviate the digital divide exacerbated by the pandemic. But we need to keep coming together where people are. For example, we cannot exclude patients who do not have access to transportation or patients who cannot lose their job to see a doctor. At Atrium Health, our clinics, which do not have Medicaid insurance and serve a high percentage of patients, saw a 20% drop in non-presentation rates using virtual care during the pandemic. We also increased our mobile health care and home care, and opened clinics in low-care areas, which reduced inequality and the overall cost of care.

Next up is quality and results. Healthcare systems need to invest in health equity analysis technology and use the data they collect to standardize equity improvement goals in all quality initiatives. Atrium Health adopted this strategy during the pandemic and expanded a nationally recognized model for integrating Geographic Information System data with mobile healthcare. We used GIS data to identify virus sites in minimal communities, and then established testing and vaccination sites in those areas. Eventually, we vaccinated 180,000 people in these neighborhoods. This same technology should be used to drive health-based investments in community-based investments and disease prevention efforts.

The third pillar is to address the pressing social needs. Many patients face social challenges that prevent them from managing chronic illnesses, so they do not seek care until they are faced with an emergency. Healthcare systems need to improve their ability to normalize social care so that we can better help our patients self-manage their illnesses. One way the system can achieve this is to ask all patients about their social needs during regular visits and then connect patients to housing, food, financial aid programs, and so on.

Finally, health systems should be pioneers in prioritizing social determinants underlying health. Community partnerships are essential here. At Atrium Health, we are focusing on employment, affordable housing, and food security, the most pressing issues that prevent some of our residents from reaching the highest levels of health. For example, we have invested in affordable housing and partnered with community organizations to provide thousands of healthy meals to people who cannot afford nutritious food. One positive result, our research found, combined with clinical interventions, was that these initiatives resulted in significant improvements for African American patients with diabetic A1C and blood pressure control.

But we are the only health care system. Others are doing similar work, but we need more to join us. Regulators, payers, and pharmaceutical companies also need to connect with health systems to achieve our greatest impact. Health inequalities form a national emergency that requires the attention of the public and private sectors, including our entire health ecosystem. Together, we must commit our resources and collective strengths to resolving our health equity crisis.

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