The COVID-19 pandemic has shined a light on a social problem that has been part of the American landscape for generations: Healthcare continues to fail people of color. We hear that social determinants of health are the culprit for such disparities. Experts estimate that medical care accounts for under 20% of health outcomes. While that is true, a mantra has taken hold across the health care industry that the rest are social influences out of our control.
Sadly, that mantra is hindering health systems, insurance companies, pharmaceutical companies and policymakers from positively impacting these social factors in the communities with the greatest challenges. This must change. For large health systems specifically, we need to leverage our power to meaningfully reduce health disparities.
Look no further than life expectancy data and you will understand the issue. Americans’ life expectancy dropped by nearly two years between 2019 and 2020, according to the Centers for Disease Control and Prevention. However, marginalized communities have been hit the hardest. Black life expectancy dropped the most, 2.7 years, to the lowest level since 2001, and Latinx life expectancy declined by 1.9 years, according to the CDC.
While COVID-19 certainly drove this decline, the problem predates the pandemic and will last long after it unless we act now.
An endless cycle of poverty, which disproportionately impacts people of color, is what’s driving health disparities. According to the U.S. Census Bureau, roughly 1 in 12 whites live in poverty, but that rate doubles for Hispanics and is nearly 2.5 times the number for black families, with a shocking 1 in 5 living in poverty. Poverty manifests in inadequate access to healthcare, substandard housing, limited access to high-quality food, lack of transportation and dead-end jobs.
The urgency of disrupting this cycle is now being recognized at the highest levels of government. The Biden administration in April announced sweeping new initiatives to address health inequities, including a plan for the Department of Health and Human Services to expand enrollment in low-cost health insurance in communities of color and improve maternal health among Black, American Indian and Alaska Native people. While Biden’s effort is certainly good news, we believe major health systems should play a unique role by adopting a social impact strategy with four main pillars:
The first is access. Many health systems have invested in telehealth and worked with partners to mitigate the digital divide, which the pandemic exacerbated. But we also need to continue to meet people where they are. For instance, we can’t ignore the patients who lack access to transportation or who can’t afford to miss work to see a doctor. At Atrium Health, our clinics that serve a high percentage of uninsured and patients on Medicaid saw a 20% decrease in no-show rates through the use of virtual care during the pandemic. We also bolstered mobile health offerings and home-based care and opened clinics in underserved areas, which reduced disparities and the overall cost of care.
Next is quality and outcomes. Health systems must invest in health equity analytics technology and use the data they collect to standardize goals for improving equity across all quality initiatives. Atrium Health embraced this strategy during the pandemic, deploying a nationally recognized model of integrating Geographical Information System data with mobile medical care. We used GIS data to identify virus hotspots in underserved communities, then established mobile testing and vaccination sites in those areas. We ultimately vaccinated 180,000 people in those neighborhoods. This same technology should be used to guide health systems on community-based investments and disease-prevention efforts.
The third pillar is related to addressing acute social needs. Many patients have social challenges that prevent them from managing chronic illnesses, so they don’t seek out care until they’re facing an emergency. Health systems must improve their ability to standardize social care, so we can better help our patients to self-manage diseases. One way systems can accomplish this is to ask all patients about their social needs during routine visits and then connect patients to housing, food, financial assistance programs and more.
Finally, health systems should lead the way in prioritizing underlying social determinants of health. Community partnerships are vital here. At Atrium Health, we are focusing on employment, affordable housing and food security—the most urgent issues that prevent some of our neighbors from reaching their highest levels of health. For example, we have invested in affordable housing and partnered with community organizations to deliver thousands of healthy meals to people who can’t afford nutritious food. One positive result, our research found, was that when combined with clinical interventions, these initiatives produced meaningful improvements in diabetic A1C and blood pressure control for African-American patients.
But we are just one health system. Others are also doing similar work, but we need more to join us. Regulators, payers and pharmaceutical companies also need to lock arms with health systems to reach our greatest impact. Health disparities constitute a national emergency—one that demands the attention of the public and private sectors, including our entire health ecosystem. Together, we must commit our resources and collective strengths to solve our health equity crisis.
