COVID-19 has revealed the ugly inequities of America’s health care system.
Race, class, geography and other social factors are causing large disparities in COVID infection rates and deaths. In Chicago and Louisiana, for example, African-Americans account for about 70 percent of COVID-19’s related mortality, despite making up just 32 percent of the population. And while the pandemic has exposed, in startling relief, our nation’s disparities — the reality of their consequences has long been known and experienced, delivering a devastating indictment of our nation’s broken health care system.
The United States spends $4 trillion a year on health care, yet disease rates continue to rise. The situation and, more to the point, health outcomes, will not improve till we address the “social determinants” of health — employment and housing status, transportation options, education levels, cultural norms and similar factors — that dictate whether people become sick or live healthy lives.
These disparities are a national emergency and demand a national response. What should that response look like? For starters, we need those addressing these issues to help develop — and implement — a new health care delivery model.
Essential in the model is addressing food insecurity, one of the key social determinants of health. Children without regular access to affordable, nutritious foods are much more likely to develop anemia, asthma and other chronic diseases that affect them through life. Food insecurity has exploded since the pandemic hit, now affecting one in five households. In Ohio, 1.75 million residents are food insecure.
The solutions can be as simple or complex as we are willing to make them. At our health and well-being system, ProMedica, we screen our patients for food insecurity, in addition to other social determinants, to better understand the external and societal forces individuals are facing, and how those forces affect health outcomes. We make the screening information gathered actionable by connecting patients with needed resources.
For example, we provide food-insecure patients with a three-day nutrition supply after they’re discharged from the hospital; we offer food-insecure outpatients food and nutrition education at our three food clinic locations; and we opened a non-profit grocery store in a Toledo, Ohio neighborhood that previously had none.
Education is also a key social determinant of health. Consider the effect of universal pre-kindergarten. Early learning doesn’t just improve disadvantaged children’s academic and social skills; it creates a level field and perspective for all children, establishing a pathway for success throughout their school years and into adulthood. Education programs also provide myriad other benefits, including access to immunizations, screenings, healthy meals and support for parents. The positive effects last a lifetime.
Boosting housing security would likewise slash disease rates. Homeless people have suffered immensely amid this pandemic, since social distancing is virtually impossible in closed, confined shelters.
The Louisiana Department of Health has pioneered a model that increases housing stability — and decreases incidence of disease, saving the state money. The department formed a partnership with the Louisiana Housing Authority to provide permanent housing to Medicaid enrollees. The program now boasts a 94 percent retention rate, and Medicaid’s acute care costs have fallen by 24 percent.
Each of these reforms and others are desperately needed. But a piecemeal approach will always fall short of what could be accomplished. That’s why we are championing the establishment of a national commission to redesign health care. We believe creating such a commission — comprising a broad cross-section of professionals from health care, business, social services and federal officials — is the best way to set national policies that will improve health care outcomes.
Such a group would work to develop and coordinate initiatives that address the social determinants of health that would tackle our national crises in infant mortality, mental health, healthy aging and substance abuse. It would emphasize the importance of public health, define a national target for health care expenditures and outline the path to achieve that goal.
And we will identify ways to better train and prepare future generations of health care providers to be more knowledgeable about current socioeconomic realities in all populations — including rural and frontier communities — and develop solid models to address them.
As we stand at a crossroads determining our country’s best way forward, many health care leaders from across the nation have called for this commission. The pandemic has laid bare America’s health and social inequalities. Until we address them, we will never solve our most pressing public health challenges.