What is the Future of Health Disparities After COVID-19?
PART ONE OF A TWO-PART SERIES
On August 11, 2020, I was honored to give a special lecture on The Future of Health Disparities after COVID-19 at the second annual Best Practices Conference entitled “Reconsidering Health Care in the Era of Pandemics” hosted by Healthfirst and the Icahn School of Medicine at Mount Sinai. I ask myself how can we solve our country’s healthcare disparities every morning when I wake up. I feel tackling this issue is my duty and highest calling as an employee at Healthfirst, the largest non-profit health plan in New York. We have the honor and privilege to provide high quality healthcare to over 1.5 million members in New York.
While my fellow colleagues and I were sent to work from home on March 17th due to the pandemic, not all the members we serve found themselves to be so fortunate. Our membership looks much like my parents who came to America in the 1970s. Healthfirst members are resilient, ethnically diverse, native and immigrant New Yorkers that do not always speak English as a first language. Many are essential workers, whom on average earn less than New York State’s minimum wage ($15/hour). Many work in industries that are the least likely to be done while working from home, representing families in New York City that live together in close proximity, in housing complexes that do not lend themselves to proper social distancing.
It Was the Worst of Times
Since working from home, within the Healthfirst virtual halls and Zoom calls, we have said that the COVID-19 pandemic is the worst thing that has ever happened to us.
The sheer volume of deaths and sickness that overcame many of our members was heart wrenching and eye-opening. We witnessed firsthand the disproportionate share of COVID-19 cases and death rates impacting Black and Hispanic populations across the country within the communities we serve, from the South Bronx to Elmhurst, Queens (Hooper, Napoles, Perez-Stable, 2020).
We also saw, in stark reality, that the survival rates for our fellow New Yorker with COVID-19 depended more on their zip code of residence rather than their overall health. For example, Manhattan, which has more hospital beds per person than the outer boroughs like Queens (5:1,000 vs. 1.8:1,000), experienced exponentially less COVID-19 cases (16 cases per 1,000) as compared to the outer boroughs, like the Bronx (33 cases per 1,000). Even if you were fortunate enough to be in Manhattan at the time of contracting COVID-19, your chance of survival then depended on whether you arrived at a private hospital (11% mortality rate) or a public one (22% mortality rates) (Rosenthal, Goldstein, Otterman, Fink, 2020).
Lastly, during this unprecedented season of suffering, we saw unemployment skyrocket. And with it, increases in food insecurity and rent burden that disproportionally impacting the same communities hit hardest by COVID-19. These job losses impacted our communities different than the past. While foreign born workers have historically participated in the labor market more than their native born counterparts (61.8% vs. 59.6%), COVID-19 disproportionately impacted the labor sectors where immigrants found themselves working the most; restaurants, daycare centers, home care agencies, and retail/clothing stores (U.S. Department of Labor, 2020).
It was the Best of Timing
These factors were so overwhelming that as New York slowly climbed out of being the epicenter of this worldwide pandemic, on June 8, 2020, the New York City Health Department declared racism a public health crisis (Chasan, 2018). Despite this, COVID-19 also became the best-timed wake-up call for our industry because it laid bare healthcare disparities for all the world to see. What we witnessed in New York raised acute awareness of the importance of both health equity and the social determinants of health. It also renewed the health care industry’s commitment to eradicating health disparities once and for all. For example, the Centers for Disease Control and Prevention (CDC) will now focus even more on community health, cultural competence, and health equity for minority communities (Heath, 2020). Key members of the United States Congress demanded Secretary Azar of Health and Human Services (HHS) to outline his strategy of addressing racial disparities in health care access and outcomes, which is required by the Affordable Care Act (Warren, 2020). Lastly, health plans across the country committed hundreds of millions of dollars to addressing social determinants of health and health equity (Anthem, 2020; Centene, 2020; & Humana, 2020). Even here at Healthfirst, we refocused on digital tools to tackle food insecurity and improve access to health coverage through our latest mobile app release that combines the virtual visits of Teledoc and community resources of NowPow seamless through one platform. (Raths, 2020).
However, reducing health disparities is not just an altruistic pursuit for only the kindhearted. Reductions in disparities directly equate to longevity and wellbeing for many minorities in America who have not come to know or experience the same health quality I am privileged to have as an employee of Healthfirst. In economic terms, efficiency gains in lower disparity rates mean the United States could save over $230 billion in direct healthcare costs and over $1 trillion dollars in indirect costs driven by reductions in premature deaths and avoidable hospital admissions (LaVeist, Gaskin, Richard, 2011).
However, the big question remains, how do we do it?
I answer this question in Part two of this series. Click Here to Read It
Chasan, A., (2020). NYC Health Department calls racism a ‘public health crisis’. Pix11 News. Retrieved on July 30, 2020 from https://www.pix11.com/news/local-news/nyc-health-department-calls-racism-a-public-health-crisis
Heath, S., (2020). CDC Unveils Health Equity Plan for COVID-19 Response. Patient Engagement HIT. Retrieved on July 30, 2020 from https://patientengagementhit.com/news/cdc-unveils-health-equity-plan-for-covid-19-response
Hooper, M., Napoles, A., Perez-Stable, E., (2020). COVID-19 and Racial/Ethnic Disparities. JAMA. 2020;323(24):2466–2467
LaVeist TA, Gaskin D, Richard P., (2011). Estimating the economic burden of racial health inequalities in the United States. Int J Health Serv. 41(2):231-238.
Raths, D., (2020). Insurer Healthfirst Speeds Release of Mobile App to Meet COVID Needs. Healthcare Innovation. Retrieved on July 29, 2020 from https://www.hcinnovationgroup.com/population-health-management/mobile-health-mhealth/article/21147853/insurer-healthfirst-speeds-release-of-mobile-app-to-meet-covid-needs
Rosenthal, B., Goldstein, J., Otterman, S., Fink, S., (2020). Why Surviving the Virus Might Come Down to Which Hospital Admits You. New York Times. Retrieved on July 29, 2020 from https://www.nytimes.com/2020/07/01/nyregion/Coronavirus-hospitals.html
U.S. Department of Labor. Bureau of Labor Statistics. (2020). The Employment Situation. Retrieved on July 29, 2020 from https://www.bls.gov/news.release/pdf/empsit.pdf
Warren, E., Pressley, A., (2020). Letter to the Honorable Alex M. Azar II Secretary U.S. Department of Health and Human Services. Retrieved on July 29, 2020 from https://www.warren.senate.gov/imo/media/doc/2020.07.14%20Letter%20to%20HHS%20re%20missing%20racial%20disparities%20report.pdf