The COVID-19 pandemic has called attention to deep-rooted racial and ethnic inequities and disparities that are causing communities of color to be impacted by the virus at a much higher rate than their White counterparts.
A recent live virtual course, COVID-19 as a Catalyst for Improvements in Health Care Delivery, took an in-depth look at the scope of the problem and explored an array of strategies to help level the playing field. Co-moderators of the event were Enrique Caballero, MD, faculty director of diabetes education for Postgraduate Medical Education (PGME) and Ellen Long-Middleton, PhD, RN, lead nurse planner for PGME.
The Role of Racial and Ethnic Differences in COVID
Presenter Cheryl Clark, MD, ScD, assistant professor of medicine at HMS and director of health equity research and intervention at the Center for Community Health and Health Equity through Brigham and Women’s Hospital, stressed the importance of finding new ways to address disparities in care and outcomes for those who are most vulnerable.
Dr. Clark referred to the National Academy of Medicine’s report, Unequal Treatment, which defines disparity as “a difference that’s not due to clinically appropriate care or patient preferences.” This could be the result of a number of factors, such as not having interpreters, time pressure, payment models, insurance coverage, racism and bias. Ways to counteract these issues could be using population health data to try to recognize these biases; using the same standards of care for everyone; expanding the diversity of the care team to check bias and discrimination and incentivizing change through payment models, she said.
Addressing Social Determinants of Health
These steps alone, though, would not be enough to level the playing field without also addressing the social determinants of health—or circumstances into which a person is born, grows, lives, works and ages—as well as the systems put into place to deal with illness, Dr. Clark stressed.
“These circumstances and systems are all social choices that are shaped by economics, social policies, politics and laws, and we make choices that create the context for health,” she said.
She also pointed out that according to the World Health Organization (WHO), health inequities are differences between groups and individuals that are avoidable and unfair.
There are several ways we can think about striving for equity, through steps such as providing fair employment, good living conditions and social safety nets to protect standards of living, as well as incorporating health into all policies, ensuring financing is fair and collecting and monitoring data to understand the full story.
Addressing Inequities in the Workplace and in the Community
Dr. Clark pointed out that at the height of the pandemic, Blacks made up 22 percent of the population in Boston, but they represented 41 percent of the cases and 34 percent of the deaths.
This ultimately led Brigham and Women’s to set up work streams focused on key points to address the problem, including employee equity, community health and access to care, data, communication, policy and advocacy. “Our trainees, faculty and students were able to work in partnership with the state of Massachusetts to make sure that patients of color were not discriminated against. We also thought about how to elevate inequities in clinical care so they could be addressed. In addition, we explored the power of multi-disciplinary teams to engage people in communities in their own care,” Dr Clark said.
“For example, early on in the pandemic it became clear that we needed to set up communication. The staff at the Brookside Community Health Center called all high-risk patients and asked about medical and social determinants of health, and made sure everyone had the medicines they needed and enough food and were able to shelter in place,” she said. In addition, the hospital improved language access for patients to make sure people with low English language capacity would not be left behind.
Meeting Community Needs during COVID-19
“We also collected data on social determinants of health at Brigham and Women’s through our Accountable Care Organization. We found food insecurity was greatly increased during COVID-19,” Dr. Clark said. “Community partnerships allowed us to deliver food boxes to people’s homes. We also set up testing sites in several neighborhoods throughout Boston. All of this has provided an important opportunity for us to improve social determinants of health,” she stressed.
In addition to caring for the community, the hospital also recognized the importance of taking care of its employees.
“We worked with other local hospitals to advocate for affordable childcare and personal protective equipment. We also connected employees to resources needed during COVID. We wanted to make sure employees knew this is a safe place,” she said.
She pointed out that as her hospital—and others—thinks about future directions, it’s essential to continue to address structural racism, both inside the institution’s own doors and beyond in order to make care fully accessible for all. “We also need to make sure to hold ourselves accountable, and we need to invest in our communities to make sure we are taking care of everyone,” she said.
Written by Lisa D. Ellis