Social Determinants of Health: The Systemic Flaws We Can No Longer Ignore
June 8, 2020
In the nearly 90 days since communities across the U.S. began to shut down due to COVID-19, a tremendous number of heartbreaking events and hardships have transpired. Recently, an equally urgent crisis has again reared its ugly head alongside the pandemic: the stark reality of race relations in America and the strained relationship between law enforcement and minority communities. Coupled together, this has bought our country to a boiling point. Now, we face the question: What will we do with it?
The tragic killing of George Floyd has sparked an immediate wave of long overdue conversations and demonstrations around racism, privilege and equity. As calls for action and change erupt across the nation, one often-overlooked area of inequity falls squarely in the middle of both crises: social determinants of health.
Early Evidence of Inequities Associated with COVID-19
It is a fact that COVID-19 continues to hit hardest among minority communities, intensifying health consequences of socioeconomic disparities within our country. Beginning in April, the first sets of data revealed that the death rate of COVID-19 among minorities was nearly twice that of white Americans. NYC Health reported a death rate of 19.8 per 100,000 COVID-19 cases among African Americans and 22.8 per 100,000 cases among Hispanic Americans – compared with 10.2 per 100,000 cases among white Americans.
Since then, more data has come to light to support these initial findings. An ongoing investigation by the Washington Post shared that the non-white population in D.C. accounted for 89% of coronavirus-related deaths, despite only representing 64% of the city’s total population. An even more staggering statistic came from Johns Hopkins Medicine, where researchers found that in Milwaukee County, Wisconsin, African Americans accounted for 70% of COVID-19 related deaths but just 26% of the county’s population.
While in social and economic terms, we have all felt that COVID-19 knows no boundaries, it’s becoming clear that latent systemic issues are limiting both disease prevention and successful treatment outcomes within minority populations. Amidst the gravity of this revelation, there remains a glimmer of hope in the increased media attention around this topic as Americans realize that the situation can no longer be ignored.
History Repeated at an Exponential Rate
Sadly, it does not come as a surprise that minority communities are at the greatest risk during this public health crisis. Social determinants of health have been a consistent pain point in the healthcare system for years, attributed to a variety of factors.
Minority communities often suffer from lack of access to healthcare, little-to-no insurance coverage and limited health literacy or education. In addition, these communities face a higher occurrence of pre-existing health conditions, which can ultimately lead to costlier care down the road.
These problems demonstrated the critical need for change even prior to the pandemic, as noted by the Kaiser Family Foundation. The nonprofit healthcare news and policy organization estimated that disparities account for $93 billion in excess medical care costs annually, in addition to $42 billion in lost productivity and additional economic losses from premature deaths.
In 2016, G&S had the opportunity to support The Physicians Foundation as it launched a data-rich resource to highlight the impact of social determinants on healthcare costs. In his book Poverty and the Myths of Health Care Reform, the late Richard (Buz) Cooper, M.D. estimated that if the poorest areas utilized healthcare at the rate of the most affluent, overall utilization and spending could be as much as 30% lower. Even more strikingly, he reminded readers that life expectancy in poor neighborhoods is a full 10 years shorter than in the wealthiest.
Can the Current Crisis Spur Long-Awaited Progress?
You may be asking yourself what you can do. Historically, times of hardship and upheaval have brought forward innovations that benefit society in the long run. We need people to stand up and make change. Will you?
With the pandemic uprooting the healthcare system as we knew it, its disproportionate impact should drive leaders to focus their attentions on communities with the greatest need. At this point in the crisis, we are already beginning to see the positive impact of early initiatives:
Awareness inspires action. While you have likely heard about health inequities before the pandemic, the extremes associated with COVID-19 have shined the national spotlight on these issues needed to drive systemic change. As media attention has continued to highlight this issue, it can encourage business and healthcare leaders as well as influential public figures to put a stake in the ground and create real movement toward addressing these challenges.
Data collection is king. To commit to real change requires a full understanding of the scope of this problem. As healthcare leaders and policymakers strive to grasp the breadth of the situation, they are encouraging more states to report demographic data and more studies dedicated to COVID-19’s impact on minorities. Collecting data at scale can provide a more accurate picture of the current situation and the approach to change need.
Insights drive solutions. Analyzing this wealth of data will help bring forward transformative solutions. For instance, NowPow, a digital health company focused on connecting communities with care providers, partners with leading healthcare systems and payers to help connect members in need with basic resources, offering a local approach when available. The company’s COVID-19 interactive maps offer visualizations of data collected by ZIP code to show how they are changing resource availability for vital services over time.
Undoubtedly, there is more work to be done in this space as we continue to pursue progress both in healthcare and in social equity. While I am optimistic that the progress we’re starting to experience will continue for the long haul, as communicators, we have a responsibility to disseminate powerful perspectives and advances that maximize impact and encourage real change. I look forward to continuing to work alongside our partners to deliver on the mission of healthcare that serves all Americans with dignity and equity. I hope you will join me in this mission.