A parallel set of cultural issues has emerged alongside the pandemic: renewed attention to racial discrimination issues and the need for far greater diversity, equity, and inclusion throughout the healthcare system. Economic pain and job loss have impacted minority populations disproportionately.
The healthiest communities in the country are also among those with the lowest rates of COVID-19 infections—further highlighting the direct link between social determinants of health and the pandemic, according to a new study from U.S. News & World Report and Aetna Foundation. The two organizations released their annual ranking of the healthiest communities in the U.S. alongside an analysis of the novel coronavirus's impact on these regions.
They found that the 500 healthiest communities ranked in the list had a COVID-19 case rate 40 percent lower than other counties. According to the report, the healthiest communities averaged 889 cases per 100,000 people, compared to an average of 1,493 cases per 100,000 people elsewhere.
Addressing Marginalized Populations.
Based on the National Collaborating Centre for Determinants of Health, marginalized populations are defined as “groups and communities that experience discrimination and exclusion (social, political and economic) because of unequal power relationships across economic, political, social, and cultural dimensions.”
Women, the elderly, adolescents, youth, and children, persons with disabilities, indigenous populations, refugees, migrants, and minorities experience the highest degree of socio-economic marginalization. Marginalized people become even more vulnerable in emergencies as the global pandemic so clearly demonstrated.
This is due, in part, to factors such as their lack of access to effective surveillance and early-warning systems, and health services. For example, social determinants of health account for 60 percent of health outcomes.
Every facet of the healthcare industry will be working harder to address social determinants of health. While COVID-19 shone an even brighter light on health's social detriments, the question remains whose responsibility is it to address them?
Collaboration and Community.
In 2021, it will take a village. Providers and health systems; Medicaid, Medicare and Exchange Market plans; government and local community agencies will all have to find more opportunities to collaborate. Multi-step, multi-channel, and multi-player strategies will be necessary for the industry to take serious action. Fortunately, improvement is already being made on a variety of fronts.
A Deloitte study found that nearly 90 percent of hospitals and health systems have been attempting to screen for at least some social needs. Social determinants of health programs now account for at least $2.5 billion of annual investment by health systems alone, the bulk of which focus on housing and employment needs. Other areas of focus include education, food availability, and transportation.
Other efforts underway include:
- Recent integrations of social needs and scheduling tools into electronic health records.
- The connecting of program enrollment for food insecurity and transportation needs into patient/member portals.
- Developing geospatial dashboards based on data such as the number of chronic conditions in an area and where avoidable emergency department visits are frequently occurring and using them to identify neighborhoods where resources are needed.
- The HHS now requires laboratories to collect demographic data like race, ethnicity, and sex when reporting test results. This new HHS guidance standardizes reporting to ensure that public health officials have access to comprehensive and nearly real-time data to inform decision making.
There remains, however, significant room for improvement and efforts to further close health disparity gaps. For example, according to Dr. Hank Drummond, Chief Clinical Officer and SVP at Cross Country Healthcare, “We have known for roughly a decade that community health workers, for example, can improve outcomes. There is strong evidence that their presence leads to a better experience, less avoidable utilization, and better patient engagement. Yet not all organizations have implemented this innovative care model in their communities, and only a handful of states reimburse for such services.”
Another area needing improvement is that of contact tracing. Many clinicians, policy makers, and others hoped that traditional contact tracing would contain or at the least slow the pandemic. However, those efforts fell short due to a number of factors, including unaddressed social determinants. For example, many low-income workers avoided even free medical care, testing or tracing for fear of financial burdens. Others avoided testing because of practical logistical barriers.
Much More Work to Do.
The disparate impacts of the global pandemic, recent and ongoing incidents of racism, and other factors have shone a bright light on health and health care disparities. However, these disparities have existed for decades and illustrate structural and systemic inequalities. Mitigating and preventing further widening of health disparities is critical to the future of healthcare, the country’s overall health and wellbeing and in curbing unnecessary healthcare costs.
To assist the healthcare community with these and other post-pandemic recovery efforts, Cross Country Healthcare has created an extensive, evidence-based guide – Forever Altered: Adapting to a Post-Pandemic Healthcare Landscape. Download your copy today.