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90 Days in 2020: COVID-19 Exposes Health Equity Opportunities

September 2020 Vol 13, No 4 - COVID-19, Perspectives
Byron C. Scott, MD, MBA
Adjunct Faculty, University of Massachusetts Amherst, Isenberg School of Management, and Adjunct Faculty, Jefferson University College of Population Health
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The first half of 2020 has been very thought-provoking and sobering in many ways, especially the 90 days that followed March 15. We have seen the COVID-19 pandemic, the heightened discussion of racial inequality, and the repeated debate of health inequities in certain ethnic populations, such as African Americans, American Indians, Alaska Natives, and Hispanic Americans. Reports on the large urban city of Chicago, IL, indicate that African Americans and other ethnic groups are disproportionately affected by the novel coronavirus, having the highest deaths related to COVID-19.1,2

For the readers of American Health & Drug Benefits, I want to challenge all of us to do what we can to continue improving healthcare for everyone and make healthcare more equitable for all demographic groups with health disparities. First, I want to say a special thank you to every healthcare worker who has been, and continues to be, on the frontline taking care of patients in our healthcare systems. Their personal and professional commitment and sacrifice are critical to keeping our healthcare system and society functioning.

This has been an unprecedented time in healthcare. I practiced emergency medicine during the time of the swine flu (H1N1) pandemic in 2009. I remember some of the challenges we had then, which were very minimal compared with the challenges we are facing now.

I could have never imagined then what has transpired so far in 2020 in the healthcare system in the United States and globally because of COVID-19. The mortality rate related to this disease has affected older populations and those with underlying medical conditions the hardest and in terms of death rate has affected African Americans and other ethnic groups disproportionately.3

As with many past pandemics, older populations have been the most affected group, because they are more likely to have a weakened immune system and a higher rate of comorbidities. But we do not want to see a striking variation in hospitalization rates among various ethnic groups.4 As a clinical and healthcare leader, I try to make decisions based on data and published evidence. We all have a unique opportunity right now to ask ourselves what we can do to make a difference going forward, especially if we think innovatively.

No matter what we do, I am optimistic that we can all make a difference, regardless of our profession, whether it be politician, health policy expert, healthcare provider, healthcare leader, community leader, educator, business leader, health plan leader, or philanthropist. Everyone involved in healthcare has some leadership role that can make a difference going forward.

I did not have a clinical role in the care of patients during the peak of the COVID-19 pandemic in Spring 2020, because I left clinical medicine more than 2.5 years ago to focus on healthcare leadership roles. However, I did witness and participate in some amazing innovation by various leaders behind the scenes, helping to support patients and frontline healthcare workers. Let me highlight 5 critical activities that are needed to survive healthcare challenges, such as pandemics and healthcare inequity, including leadership, innovation, volunteerism, networks, and philanthropy. The complexity of our healthcare system and government often leaves gaps that must be filled in other ways.

Direct Relief

One of the leadership roles I have the privilege of having is serving on the board of directors for the organization Direct Relief (www.directrelief.org). This is a global humanitarian aid organization, with a mission to improve the health of those affected by poverty or emergencies. One of the healthcare sectors that Direct Relief has historically supported is federally qualified health centers in the United States. Although this system of clinics in the United States is critical and serves more than 28 million people at more than 12,000 delivery sites, it is not talked about enough.5

Direct Relief has had a critical role of taking care of many vulnerable patient populations in our country, and many of the ethnic populations that are disproportionately affected by COVID-19 and by chronic diseases. During the COVID-19 pandemic, Direct Relief was entrusted by so many wonderfully generous corporations and individuals who wanted to do something to help the populations that were severely affected by this disease. This philanthropic generosity allowed Direct Relief to give out almost $28 million in grants to more than 500 nonprofit community health centers in May 2020, which were predominantly federally qualified health centers.6

This is just one of thousands of stories of philanthropy in the United States and around the world. I highlight this information because philanthropy, great and small, along with volunteers, are needed to help combat the gaps of healthcare inequity, because our government cannot do it alone.

In Spring 2020, I also had the pleasure of virtually meeting an incredible physician, Nana Afoh-Manin, MD, MPH, who took it on herself, with the help of the nonprofit organization Shared Harvest Foundation, to provide COVID-19 testing in communities where health inequalities exist.7 I was able to support her cause by connecting Direct Relief to the Shared Harvest Foundation so it could receive a donation of personal protective equipment for the volunteers who staff these various testing sites. This would not have happened without someone in my network reaching out to me and my willingness to follow up.

It is a simple reminder that even if you cannot do something yourself, you may know someone who can.

How Can You Help?

As alluded to before, it will take a group effort to solve our societal and healthcare challenges. It will require small businesses and corporations to ask themselves what they can do to make a difference in the healthcare of the communities they serve.

If you are on the board of an organization or a C-suite leader, what else can you do in terms of corporate citizenship or corporate social responsibility? If you are a health plan or another payer, what else can you do to design or improve benefit design to close more of these healthcare equity gaps? If you are an academic leader or a researcher, what else can you study and publish to drive healthcare policy and system changes? As an educator in healthcare, what else can you do to improve the curriculum to develop compassionate future clinicians and healthcare leaders in terms of health equity? As an individual, how can you volunteer your time to help vulnerable populations? I may have left out a few groups, but I think everyone gets the point.

Let me leave you with a few final thoughts. These days, my career is spent teaching healthcare quality to my students and being a strategic advisor to various organizations as a board member. In my various roles, I can teach and influence others about one of the Institute of Medicine’s 6 aims (ie, safe, effective, patient-centered, timely, efficient, and equitable) of healthcare quality, which is “equitable.”8 According to the Institute of Medicine, equitable means “providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.”8

We can and will do better on health equity if we all remember leadership, volunteerism, innovation, networks, and philanthropy. These 5 activities will help us succeed with the challenges of this pandemic, healthcare inequality, and any other future healthcare challenges, which will happen.

References

  1. City of Chicago. Latest data. Coronavirus Response Center. www.chicago.gov/city/en/sites/covid-19/home/latest-data.html. Accessed July 15, 2020.
  2. Webb Hooper M, Nápoles AM, Pérez-Stable EJ. COVID-19 and racial/ethnic disparities. JAMA. 2020;323:2466-2467.
  3. Wortham JM, Lee JT, Althomsons S, et al. Characteristics of persons who died with COVID-19—United States, February 12–May 18, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:923-929.
  4. Centers for Disease Control and Prevention. COVID-19 in racial and ethnic minority groups. Updated June 25, 2020. www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html. Accessed July 13, 2020.
  5. Health Resources & Services Administration. Health Center Program: impact and growth. August 2019. https://bphc.hrsa.gov/about/healthcenterprogram/index.html. Accessed July 13, 2020.
  6. Direct Relief. Direct Relief aids community health centers with $27.9 million in grants: outpouring of support to boost America’s nonprofit healthcare safety-­net enables largest donation in 55-year history of community Health Center Program. May 30, 2020. www.directrelief.org/2020/05/direct-relief-aids-community-health-centers-with-27-9-million-in-grants/. Accessed July 13, 2020.
  7. Shared Harvest Foundation. CovidMD Telehealth App. https://covidmd.org/. Accessed July 13, 2020.
  8. Institute of Medicine Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.
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Last modified: September 17, 2020
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