Over the years, much has been written and studied about population health efforts and the social determinants that influence our communities. Never before has it been more apparent that population health needs to be viewed holistically across all measures—from social and economic equity to nutrition, healthcare, housing, education and racial bias. COVID-19 has created a perfect storm where all these issues intersect as we see the profound impact that it has had on those with low-income, seniors and communities of color. This tipping point is helping to draw national attention to health and social inequities and hopefully a newfound resolution to finally take steps to begin to solve some of these issues.
Here are a few of the approaches and activities that have been surfacing in recent months:
Community Collaboration and Partnerships
Jimena Loveluck, Health Officer for the Washtenaw County Health Department in Michigan, recently recounted the herculean and collaborative efforts made by government officials, community leaders, health care providers and non-profits to mitigate the negative outcomes for our most at-risk citizens. In her opinion, the first-hand experience and the collaborative efforts of all these groups has brought a profound awareness of the issues and is resolved to find ways to prevent the outcomes of the first wave from ever occurring again. She believes that strengthening of the partnerships formed to address this pandemic should continue and include members of the communities at-risk, to ensure they have a seat at the table and their voices are heard.
A study from the University of Kentucky’s School of Public Health suggests that preventable death rates may be more than 20 percent lower in communities that offer a variety of interconnected programs targeting the social determinants of health and other population health concerns. The research suggests that the network is the key element that led to the reduction. The communities within the study, offered services across the spectrum to monitor health, promote wellness and connect people with needed care. However, those communities that were jointly invested in population health programs saw the greatest reduction in preventable death rates.
Implicit Bias Training for Medical Professionals
There is a growing awareness that implicit bias, either conscious or unconscious is influencing the medical outcomes of communities of color. Studies consistently recognize the role of implicit bias in worsening health outcomes, increasing health care costs, and exacerbating health disparities, not just in maternal health, but also for a variety of other health outcomes and populations, such as substandard pain management for black patients, unequal cardiovascular testing for women, lesser mental health services for patients with mental illness, and mistreatment and avoidance of obese patients.
Exacerbating this problem is the fact that formal medical education and training often lacks curriculum on identifying and reducing implicit bias in clinical practices. This led The EveryONE Project from the American Association of Family Physicians (AAFP) to introduce its comprehensive Implicit Bias Training Guide to promote awareness of implicit bias among primary care physicians and their practice teams, and provide resources for instructing health care professionals on how to reduce its negative effects on patients.
In further support for implicit bias training, Michigan Governor, Gretchen Whitmer, recently issued an executive order that all medical professionals within the state will take implicit bias training. “COVID-19 has had a disparate impact on people of color due to a variety of factors, and we must do everything we can to address this disparity. The evidence shows that training in implicit bias can make a positive difference, so today we are taking action to help improve racial equity across Michigan’s health care system.
Bringing Services into Communities
People of color often live in areas where access to healthy, fresh foods are in short supply. ShopRite operator Brown’s Super Stores found a profitable market expansion opportunity by establishing grocery stores to reach lower-income people of color in Philadelphia-area food deserts. The company offered customized food items and expanded its offerings to include complementary services that were lacking, such as health clinics.
Cigna, a commercial health insurance company, collaborated with a local health care system in Memphis, Tennessee, to promote breast cancer screening among its Black customers living in neighborhoods with limited access to screening facilities. Efforts like these contributed to elimination of the breast cancer screening rate gap for Black patients, originally identified in 2012 and 2013 data.
No one would ever say that COVID-19 is a good thing. However, it has brought awareness and engaged new audiences in understanding the important link between the health of a community and the quality of their healthcare, nutrition, housing, education and environment. Hopefully, this will facilitate more collaborative efforts to make significant changes.