This week, we spotlight state and local-level action to promote equity, global engagement to reduce inequities in care, and new national research that underscores the urgency of these issues. Protect Our Care is committed to making health care a right for every American.
Addressing systemic racial, ethnic, and other inequities in health care is among the most pressing issues in America. The causes of these inequities, and the corresponding actions needed to tackle them head on, are multi-faceted. As it stands, marginalized communities, including people of color, rural Americans, LGBTQ+ people, and people with disabilities, face worse access to quality, affordable health coverage, which contributes to dangerous health outcomes.
INITIATIVES
Noozhawk: New California Program to Help Promote Better Health Outcomes for LGBTQ+ Individuals. “More than 2.5 million Californian women identify as lesbian, bisexual, transgender and/or queer (LBTQ+), with a growing group of people identifying as nonbinary. However, that roughly 6% share of the population — which includes and intersects with some of the state’s most vulnerable communities — has historically been overlooked by healthcare programs. A new $17.5 million state-funded program will support a first step towards equitable access to health care for LBTQ+ women and nonbinary Californians. The California Department of Public Health’s (CDPH) LBTQ Health Equity Initiative provides a sizeable economic infusion for health services specifically aimed at this population. While prioritizing LBTQ+ women and nonbinary people, the initiative further emphasizes the intersections of historically excluded groups — where inequity is generally exacerbated — including increased aid to youth, the elderly and BIPOC communities. Funding is earmarked for four project areas: healthcare access demonstration, community education and outreach, service provider capacity building and LBTQ+ research.” [Noozhawk, 12/28/22]
The New England Journal of Medicine: The Success of Groups Using the Anchor Strategy to Promote Equity. “An anchor strategy is a place-based business approach to building community health and wealth by means of local hiring, investing, purchasing, and community engagement. In 2016, Rush University System for Health, an academic health system in Chicago, adopted an anchor strategy to tackle the 16-year life-expectancy gap between Chicago’s West Side and the Loop. In 2018, Rush was joined by 5 other health systems — AMITA (now Ascension) Health, Cook County Health, Lurie Children’s Hospital of Chicago, Sinai Chicago, and University of Illinois Health — to establish West Side United (WSU), a racial-equity collaborative aligning investments in economic development, education, health care, and the built environment to benefit Chicago’s 500,000 West Side residents. The combined assets of these health care anchors are larger than those of any Illinois corporation and create potential for major collective impact. Since 2018, WSU members and the American Medical Association have invested $10.8 million through community development financial institutions to finance businesses, nonprofits, and affordable housing; raised $3 million to establish four health care career pathways; launched interventions targeting hypertension and maternal and infant outcomes in West Side hospitals, clinics, and community-based organizations; hired more than 2000 West Side employees; and raised $1.9 million to support local businesses. WSU’s small business accelerator offers business-development support to 150 West Side businesses and 60 community-based organizations.” [The New England Journal of Medicine, 1/7/23]
Regulatory Affairs Professionals Society: Enhancing Diversity in Clinical Trials Can Reduce Inequities in Care. “Historically, many clinical trials have not been representative of the patients most likely to use a medical product upon its approval. There is frequent underrepresentation of people from diverse groups defined by factors such as race, ethnicity, sex, gender identity, age, socioeconomic status, disability, pregnancy status, lactation status, and comorbidity. The lack of diversity in trial participation has created gaps in the understanding of treatment safety and effectiveness across the different populations. Solving the issue cannot be achieved by one organization or stakeholder group. It will require the involvement and participation of the entire medical product development ecosystem. The collaborative discussion at the 2022 RAPS Convergence among FDA, Health Canada, and industry is one such endeavor of many toward this effort. The meeting resulted in greater understanding and appreciation of perspectives. It also revealed that, while stakeholders have different roles and responsibilities, their common goal is achieving health equity for all.” [RAPS, 12/31/22]
CHALLENGES
USA Today: People of Color Are Dying of COVID-19 At Much Higher Rates Than Data Suggests. “It’s not always easy to identify a COVID-19 death. If someone dies at home, if they have symptoms not typically associated with the disease or if they die when local health systems are overwhelmed, their death certificate might say “heart disease” or “natural causes” when COVID-19 is, in fact, at fault. New research shows such inaccuracies also are more likely for Americans who are Black, Hispanic, Asian or Native. The true toll of the COVID-19 pandemic on many communities of color – from Portland, Oregon, to Navajo Nation tribal lands in Arizona, New Mexico and Utah, to sparsely populated rural Texas towns – is worse than previously known. In Arizona’s Navajo and Apache counties, which share territory with Navajo Nation, COVID deaths among Native Americans drove nation-leading excess death rates in 2020 and 2021. In Portland, deaths from causes indirectly related to the pandemic went up in 2021 even as official COVID deaths remained relatively constant. Black residents were disproportionately impacted by some of these causes, such as heart disease and overdose deaths – despite a county-wide commitment to addressing racism as a public health threat. In Texas, smaller, rural counties served by Justices of the Peace were more likely to report potential undercounting of COVID deaths than larger, urban counties served by medical examiners. Experts point to several reasons for increased inaccurate death certificates among non-white Americans. These include resources available for death investigations, the use of general or unknown causes on death certificates, and how the race and ethnicity fields of these certificates are filled out.
Such barriers to accurate death reporting add on to existing health disparities that made non-white Americans more susceptible to COVID in 2021, despite widespread vaccination campaigns and health equity efforts.” [USA Today, 12/28/22]
Axios: Medical Debt is a Primary Driver of Health Care Inequities. “Black medical trainees were far more likely to carry a heavier debt burden than their peers in other racial and ethnic groups, a study published… in Health Affairs found. Led by the Icahn School of Medicine at Mount Sinai, researchers examined the association between race and debt among roughly 121,000 medical residents between 2014 and 2019. The study found trainees from nearly all underrepresented populations in medicine, including American Indian/Alaska Natives, Hispanics and Native Hawaiian/Pacific Islanders, were generally more likely to have debt compared to white and Asian trainees. Specifically, they found Black trainees were most likely to suffer a debt burden, with 96% reporting some type of debt including premedical education loans, medical education loans and consumer debt, not including mortgages, compared to 83% of trainees overall. 50% of Black trainees had some type of consumer debt, not including mortgages, compared to 25% overall.” [Axios, 1/10/23]
Patient Management HIT: Digital Health Literacy a Driving Factor in Disparities of Care. “New data is shedding light on the digital divide in healthcare, with researchers from The Ohio State University revealing that it’s not just broadband access stymying connectivity for marginalized groups. Rather, digital health literacy and language access will be necessary to support digital health equity. Access to digital health tools has become increasingly important in a modernized medical landscape, with the advent of digital health records, patient portals, and connected health changing the way consumers engage with their health. Looking at a Bhutanese refugee community near Columbus, Ohio, [OSU] researchers were able to zero in on the challenges faced by a traditionally underserved group exposed to numerous social determinants of health. Although this group was very low-income, with an average annual income at $35,000, nearly all had access to the internet (94.5 percent). Even still, folks included in the observational study weren’t utilizing online resources, indicating to researchers that it’s not access to hardware or broadband that’s driving the digital divide in healthcare. Language barriers, for example, were particularly onerous for study participants. Eight in 10 said they used the internet to communicate with family and friends and 68 percent utilized social media, but the internet was virtually useless for digital health engagement. Three-quarters of study participants said they never used the internet to access telehealth, despite having predispositions for certain chronic illnesses like cardiovascular disease and diabetes.” [Patient Management HIT, 1/6/23]