By Richard K. Thomas, PhD
The COVID-19 pandemic has revealed many things about America. It has cast a particularly harsh light on the failings of some U.S. systems, and the deficiencies of our healthcare system have been especially exposed. An unfortunate realization is that our healthcare system, despite its exorbitant cost, was not designed to deal with a crisis of this magnitude. A degraded public health infrastructure and unplanned system of private care have generated a pandemic response that mimics the overall system—fragmented, discontinuous and uncoordinated.
One attribute of this system that the pandemic has highlighted is the health disparities that exist among various groups within the population. The fact that health disparities exist is news to no one in healthcare; disparities in health status, health behavior, access to services and quality care, among other factors, have been well documented. Black people, Hispanic people and Native American people—already suffering from high rates of morbidity—have borne the brunt of the pandemic, with higher rates of infection, more serious cases and higher mortality rates.
Members of disadvantaged groups often suffer from relatively poor health status, characterized by pre-existing conditions that put them at extraordinary risk in the face of a pandemic. On top of all of this, members of these populations are less likely to have access to needed services, less likely to receive timely treatment and less likely to have insurance to cover it.
The COVID-19 pandemic has also underscored the role of social determinants in health and illness. Health professionals are certainly sensitive to the fact that unstable housing, food insecurity, environmental contamination and—above all—poverty contribute to many of the health-related problems disadvantaged populations face. These factors combine to create an illness-inducing environment. Considering the role of social determinants, there is a growing sense that healthcare alone cannot mitigate the pervasive, deep-rooted health conditions of large segments of our population.
Epidemiologists tell us that epidemics cannot be stopped by treating one patient at a time. This is particularly true when there is no vaccine or treatment available for a virus we know little about. The major deterrents to the spread of the disease have been population-level efforts—social distancing, quarantine and mass testing. This is a reminder that, unless the factors creating an unhealthy environment are addressed, there is little that the healthcare system can do when faced by a crisis of this type. Our healthcare system must come to grips with the role of the social determinants of health or continue to face an unacceptable level of avoidable death.
This brings us to the role of the healthcare industry going forward. Knowing what we know, what steps can be taken to address the identified issues and assure that the healthcare industry protects and enhances the population’s health?
- First, healthcare providers must develop a better understanding of the characteristics of their constituents, not just of their patients but of communities in general. It has been documented that the attributes of patients—what affects them before they receive care and after they receive it—are just as important for their prognosis as the treatment provided.
- Second, healthcare providers must collaborate with other sectors to address the social determinants of health. Today’s health problems require multisector collaboration for the collective impact necessary to improve community health. This type of collaboration is already underway, and health professionals must recognize the role they have to play in this process.
- Third, representatives of the healthcare industry must use their influence to help shape the policies that impact population health. This goes beyond policies affecting the delivery of care but, as with the social determinants, requires attention to areas that have not been historically linked to health issues.
Processes are already underway to address the fault lines exposed by the pandemic, and additional innovative approaches are being considered. Clearly, the healthcare industry must make a major contribution to these efforts even if only in a secondary role. The health of our population depends upon it.
Editor’s Note: For more on racial disparities in COVID-19 outcomes, listen to the Healthcare Executive podcast “COVID-19 Recovery: The Imperative to Resolve Disparities,” and read our CEO’s column, “Creating a Healthier, More Equitable Future,” in the July/August 2020 issue of Healthcare Executive magazine.
Richard K. Thomas, PhD, is vice president of Health and Performance Resources in Memphis and a research associate with the Social Science Research Center at Mississippi State University. He has been involved in healthcare market research and consultation with hospitals, clinics, health plans, and other healthcare organizations in the public and private sectors for more than 40 years.