Racial and ethnic inequities have underpinned disparities in health care for decades, but the COVID-19 pandemic shined a light on a broader range of dimensions that systematically impact both the quality and accessibility of health care for various people groups across the country. In addition to discrimination, social determinants of health, such as housing, income, and education, disproportionately increased the risk of severe illness and death from COVID-19 for racial and ethnic groups, according to the Centers for Disease Control and Prevention (CDC).
Improving disparities in health care is important from a human perspective, of course, but it’s also imperative for improving health and economics across the country. Health disparities are estimated to cost the U.S. nearly $93 billion in excess medical costs and $42 billion in lost productivity. Under the current administration, racial and health equity are priorities for which the Department of Health and Human Service (HHS) is executing by:
- identifying and sustaining systems and programs that promote equity
- leveraging community health workers to address the physical and social needs of communities of color
- training healthcare providers on cultural competence
Central to the success of improving public health and disparities at large is the engagement of community members to promote health within their own community. One way Providertech is helping to facilitate this locally is through a partnership with the Maricopa County Department of Public Health. Through a grant from the Office of Minority Health, we’re working to incorporate and expand the community health worker model within multiple Federally Qualified Health Centers (FQHCs) to execute an outreach initiative for socially vulnerable neighborhoods in Maricopa County. Our goal is to close gaps in care while also increasing the COVID-19 vaccination rates for underserved communities that are at a greater risk for racial and ethnic disparities.
What are disparities in health care?
The CDC defines health disparities as “preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.” Health disparities have long been rooted in historical structures, policies, and norms that tend to distribute advantages to some individuals while constructing unfair obstacles to health for others. Discrimination based on one’s racial and ethnic group is just one facet of this. Other dimensions linked to health disparities include an individual’s:
- racial and ethnic group
- gender and sexual identity or sexual orientation
- financial status
- mental health
- geographic location
All of these factors affect someone’s ability to attain and sustain the highest level of health possible. When disparities exist, data proves that there are notable increases in morbidity, mortality, and other measures of health.
How has the pandemic exacerbated disparities in health care?
Prior to the pandemic, disparities in health care persisted. Black people experienced higher rates of infant mortality and pregnancy-related deaths as well as a shorter life expectancy compared to Whites. Wealth and poverty affected health outcomes as well, with lower-income individuals faring worse. Both low-income populations and people of color were also less likely to have health insurance. The COVID-19 pandemic has only heightened the need to address health disparities.
Recent data highlight health disparities for American Indian and Alaska Native (AIAN), Black, and Hispanic populations who experienced disproportionately higher rates of illness and death related to COVID-19. And although vaccination rates are increasing across all racial and ethnic groups, people of color (POC) are less likely to be vaccinated than White people, further widening the health disparities gap across the country.
COVID-19-related health disparities are not limited to coronavirus fatalities and vaccination rates. Since the height of the pandemic, one-third of the population delayed or skipped medical and mental health care, resulting in worsening health outcomes, especially for low-income individuals. For example, researchers report that nearly 20% of parents with kids under 19 skipped or delayed multiple types of health services for their children, compared to approximately 11% of parents with higher incomes. In another study, breast cancer screening utilization across 32 community health centers serving low-income patients dropped 8%, despite significant utilization increases leading up to the pandemic. The decline translates to 47,517 fewer mammograms and 242 missed breast cancer diagnoses in that population alone.
How can we start addressing health disparities?
Health equity ensures that all people have equal access to resources and opportunities to achieve health. However, many social and economic factors that are historically and systematically rooted in racism prevent some populations from benefiting from the policies, programs, and structures within the healthcare landscape. To improve health equity, we must collaboratively and systematically address social determinants of health that prevent individuals from accessing quality healthcare services.
A community health approach to reaching unvaccinated Arizona residents in underserved regions.
In partnership with the Maricopa County Department of Public Health and FQHCs across Maricopa County, Providertech is collaborating to identify nearby communities that meet certain criteria using the CDC’s Social Vulnerability Index (SVI). The SVI stems from census data across 15 social factors spanning household composition and transportation access to socioeconomic status and racial and ethnic groupings. The rankings offer insight into areas that are likely to experience significant obstacles to health care, such as a lack of transportation or speaking a primary language other than English.
Leading with the needs that are top of mind for each individual.
The ultimate goal is to increase COVID-19 vaccine rates for the area, but outreach communications aren’t leading with this. Instead, those who identified as unvaccinated within each at-risk census tract receive text messages with health content that is relevant to their existing needs and conditions. Parents of kids between the ages of 12 to 17, for example, are sent text reminders about well-child visits for their children. Other content is related to re-engaging those with chronic conditions, as chronic disease populations are also identified as individuals who may have put their health conditions on the back burner during the pandemic.
After the recipient engages via text, the Community Health Worker (CHW) is able to correspond via text (or phone, if preferred by the patient). They also send a secondary text to offer information about the COVID-19 vaccine, including a link to a landing page where the patient can learn more and/or register for the event. The text messages are not intended to replace personal conversations within the healthcare setting, but rather provide a way to scale opportunities for the discussion among those most likely to experience disparities in health care.
Leveraging the personal connection with their primary care provider.
Since primary care providers are often identified as trusted sources of information, when messaging content is delivered via secure text messaging it also specifies the primary care provider associated with the patient as the sender. Once a recipient responds to the text, the CHW is able to engage back with the next steps for scheduling the care they need as well as sharing information about an upcoming nearby COVID-19 vaccine event for which they can attend. If a patient shows interest, the CHW helps to register the patient for the event and assists with transportation or any other needs to ensure they attend. If the patient declines the invitation, they are encouraged to reach out for additional information if they change their mind.
Connecting through community workers who look and talk like the patients.
The power of the CHW model is that these people are members of the community who speak their language, attend the same churches, and shop at the same grocery stores—people just like them. This helps build trust and confidence within a population that may otherwise feel intimidated by a traditional hospital setting. At the vaccine events, patients will be greeted by CHWs and the events also accept walk-ins for individuals who may have initially turned down the invite but changed their minds. While there, patients participate in a social determinants of health screening so the CHW can help with any other needs, from personal protective equipment like masks to food insecurity. They also discuss any other health needs, including dental services, chronic care support, or overdue well-child visits. The vaccine events are planned through the fall, and we’re excited about the opportunity to work towards a more equitable healthcare landscape. Despite heightened disparities as a result of the pandemic, community and national stakeholders at large are engaging in the hard work of reversing the disparate healthcare structures rooted in racism. To learn more about how your organization can leverage technology to reach and support those in need, contact us today.