November Newsletter

My dog’s Halloween outfit!

Introduction

Welcome to my October 2021 Living Conditions and Health newsletter. You can find past newsletters with additional background materials, and different stories and initiatives on my website and in my LinkedIn articles or posts. Join me in identifying and coordinating initiatives that advance health, health equity and community and healthcare redesign.

Shannah’s Insights and Reflections

The prolonged pandemic and its disparate impacts on health and the economy continue to fuel needed changes in how many stakeholders think about health services and the living conditions that negatively impact individuals and communities. The politics and misinformation that influence our country’s ability to embrace needed and sustained changes make the progress feel fragile. This months’ entries seem to support this perspective, but that may just be my bias.

An article, and the recent Bipartisan Policy Center report it reviews, discuss the need to expand flexibility for investing in Social Determinants of Health (SDOH) focusing mostly on Medicaid, but also seeking to address silos across Medicaid, Medicare and CHIP.  The report also addresses funding, research, and workforce needs for implementing non-medical and preventive services that have evidence of success. The recommendations are a critical set of steps in the right direction. Equal attention should be given to the many other silos of social services and community infrastructure supports and the many other Federal programs that have overlapping and adjacent service capabilities.

The Transforming Public Health System Data Commission report on Charting a Course for an Equity Centered Data System was supported by the RWJF. It establishes the importance for change, the steps and processes taken to formulate the findings and recommendations and calls to action for a broad range of stakeholders. The Commission and the report represent a substantial undertaking among organizations and consultants to look across the problems laid bare by the pandemic and worsened by systemic racism and related inequities that resulted in the declaration of racism as a public health crisis. This quote from the conclusion emphasizes the significance of inadequate data:

“The Commission recommendations make it clear that in our current system, data on health inequities are divorced from the history and community conditions that shape poor health outcomes, resulting in an incomplete picture of who is most impacted and why.”

Kaiser Family Foundation published Medicaid Director survey results regarding spending in fiscal years 2021 and anticipated spending in 2022. Trends all show sustained increases due to COVID and growing investment in SDOH and initiatives to address health equity.  Increased funding will likely continue until the COVID public health emergency is no longer in effect. Certain changes due to COVID are likely here to stay including Telehealth and initiatives focused on greater equity in areas that include maternal and child health, behavioral health and COVID outcomes and vaccinations.

Manatt published key takeaways from the Gray v. Dignity case about hospital price transparency. Specifically, it challenged the hospital’s failure to disclose an added ER charge on top of the charge for the treatment received in the ER. The added charge was $1,552 that came down to $879.19 after insurer payments and adjustments. The case went against the class action suit on behalf of ER patients. The decision stated there was no explicit requirement in either CA state or Federal law. The court also accepted the notion that price disclosure should not dissuade individuals in need of ER care to avoid such care. I don’t usually cover court proceedings about payment, but this decision seems to run contrary to the problem of debt burden for low-income individuals. While it may meet the letter of the law it would arguably worsen the ability of individuals to avoid large add-on charges that they cannot afford.

I’ve discussed data challenges regarding race and ethnicity in prior newsletters including the census. An article in the New York Times highlights the Census problems with the current race categories and suggests alternatives for 2030. I am a bit on the fence about whether shifting towards country of origin and parents’ country of origin are appropriate measures. I also worry that such measures could have a chilling effect on response while also having the potential for being misused in support of further discrimination. I welcome other thoughts and reactions.

A NORC study showed only 1% of Medicare patients had their social determinants tracked in 2018 – this study seemed extremely early in the uptick of recognition and adoption of the importance of SDOH. In other words, if they wanted to know the baseline in 2018 it was very close to zero.

SIREN picks

My picks for SIREN’s October’s newsletter are: the literature and scoping review of primary care-based interventions to address the financial needs of patients experiencing poverty and the Social Emergency Medicine: Principles and Practice book.

The literature review provides important context on the variability and complexity of what is happening in the US and globally. The review provides a table of screening tools that can be tailored to primary care providers’ needs. It breaks down the findings by targeted interventions and service providers and service users (patients) needs.   The book tackles critical health equity subjects in the context of emergency medicine where the evidence of social injustice is perhaps most evident. It would be interesting to compare the findings in this book with the Public Health Data Commission findings discussed above. The book needs to be purchased, but you can get overviews of the chapters and buy chapters of interest if you aren’t ready for the entire book.

My interests often align with the starred entries of the monthly newsletter. I encourage everyone to sign up for the SIREN newsletter on the home page to see where your interests align.

RECENT & UPCOMING EVENTS AND RESOURCES

Two events flagged in the SIREN newsletter:

All In: Data for Community Health 2021 National Virtual Meeting – November 8-10, 2021 | Virtual  

AHA Community Health Improvement: Accelerating Health Equity Conference 2022
– May 10-12, 2022 | Cleveland, OH 

Modern Healthcare’s Social Determinants of Health Symposium, December 9,2021 Virtual price tag $99.00

NIH Rural Health Day Seminar, Structural-Level Determinants of Rural Health Disparities November 18, 2021

RISE Summit on Social Determinants, March 20-22, 2022, Nashville TN

Background and Definition

I have chosen the phrase “Living Conditions” rather than social determinants of health (SDOH) to make the concept more accessible.  This focus tracks with the Centers for Disease Control and Prevention’s SDOH definition “as conditions in the environments in which people live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”

Go here for more information from CDC on its organizing SDOH framework in Healthy People 2020

September Newsletter

The leaves are just starting to fall…

Introduction

Welcome to my September 2021 Living Conditions and Health newsletter. You can find past newsletters with additional background materials, and different stories and initiatives on my website and in my LinkedIn articles or posts. Join me in identifying and coordinating initiatives that advance health, health equity and community and healthcare redesign.

Shannah’s Insights and Reflections

The Biden Administration has gone all in on requiring vaccines.  The 6-part plan announced on September 9th is designed to facilitate vaccines in…” about 100 million Americans, or two thirds of the workforce.” This New York Times article gives an overview of the plan.  At the same time challenges with vaccine uptake have entrenched drivers including living conditions, health care access disparities and distrust, as discussed in a recent article from the Guardian.

I included coverage in the past newsletter on sustained structural racism in the form of poor housing and housing options for neighborhoods and purchase options that are predominantly targeting people of color. This recent article on locating a freeway in South Carolina that largely displaces black and brown people at the rate of 94% compared to whites is another too common occurrence that persists to this day. We need to be tracking all of these activities and reporting on them until policies and actions start to change. This practice should be illegal and is a vicious cycle that undermines sustainable black and brown communities.

Continue reading “September Newsletter”

Summer 2021 Newsletter

End of Summer Hydrangea

Introduction

Welcome to my Summer 2021 Living Conditions and Health newsletter. You can find past newsletters with additional background materials, and different stories and initiatives on my website and in my LinkedIn articles or posts. Join me in identifying and coordinating initiatives that advance health, health equity and community and healthcare redesign.

Shannah’s Insights and Reflections

This newsletter is a bit jam packed because I chose to combine July and August. Apologies for the longer than usual read.

COVID19 Continues to Govern Our Lives

Back to school debates and policies reveal how many different factors affect where individual, families, teachers, school districts and policy makers stand on: in-person and hybrid attendance, masks, and vaccinations. In some respects, it highlights the complexity of the sustained pandemic and how different risk considerations, and life circumstances, shape our individual and system approaches.

The two months of summer witnessed an enormous swing in the waning and resurgence of the pandemic. US vaccination rates grew with the approval of the vaccine for 12- to 18-year-olds. Unfortunately, politics, misinformation and distrust continued to fan the anti-vaccination fires.

Will full approval of the Pfizer vaccine remove a critical barrier to higher vaccination rates? It seems too soon to tell, but the consistent data showing 99% of COVID deaths are unvaccinated people should help more individuals and families to decide it is worth the down-side risks that to-date have been limited. Someone recently asked in a health literacy forum if there are better terms than ‘post-pandemic’; particularly since the end of this pandemic is nowhere in sight, and it is more likely it will evolve to something like the flu if we are lucky. It is a tough question with no great catchy terms. A recent National Geographic article shed light on how past pandemics evolved.

Mental Health, Health disparities, Medicaid and the US Safety Net

Many articles throughout the pandemic discuss disparities in mental health and mental health services. This recent article about mental health challenges faced by the underserved in Ohio highlights how difficult it is and has been for people in poverty and marginalized in society to manage through the added stress of the pandemic. These challenges were largely impossible to navigate when added to the inequities and uncertainties that children and young adults were already facing. Medicaid is again the place to turn for low-income families and children; however, state Medicaid programs often have very limited coverage and access for mental health. This Healthline article discusses the Medicaid mental health limitations and why we aren’t doing enough.

Continue reading “Summer 2021 Newsletter”

June 2021 Newsletter

Introduction

Welcome to my June 2021 Living Conditions and Health newsletter. You can find past newsletters with additional background materials, and different stories and initiatives on my website and in my LinkedIn articles or posts. Join me in identifying and coordinating initiatives that advance health, health equity and community and healthcare redesign.

Shannah’s Insights and Reflections

I’m leading off with this thought provoking quote from the Toronto Star that applies equally to the US and should be a priority for all state and Federal legislatures.

“The worst thing we risk facing would be to reflect at the end of the next decade — or perhaps after the next pandemic — and realize we failed to seize this pivotal moment. That we failed to deliver a new vision for a fairer, greener and more innovative Canada, after our pandemic war. That after winning, we had no equivalent to housing for veterans, the NHS, the G.I. Bill, or great new universities — those enduring legacies of post-WWII rethinking and rebuilding. That we simply threw money at the same agencies and programs, expecting a different outcome.”

Continue reading “June 2021 Newsletter”

May 2021 Newsletter

May marks Mothers’ Day and during the pandemic women who are mothers, or stood in for mothers, deserved our recognition every day. We repeatedly hear how the pandemic has forced many women to leave the workforce to care for children and aging parents. We need better services and supports for women to have the same options as men.

Introduction

Welcome to my May 2021 Living Conditions and Health newsletter. You can find past newsletters with additional background materials, and different stories and initiatives on my website and in my LinkedIn articles or posts. Join me in identifying and coordinating initiatives that advance health, health equity and community and healthcare redesign.

Shannah’s Insights and Reflections

May brought many major changes in the health status of our country that feel like a new and perhaps sustainable direction. It also marked the one-year anniversary of George Floyd’s murder that has yielded some steps in the right direction, but we also witnessed many more people of color being murdered by police.

The New York Times has a timeline of good and bad events and changes that have occurred across the country since George Floyd’s death. The overall trends give me some hope. The same day in the New York times there was a discussion of how the economy during the pandemic yielded increased tax revenues for many states and perhaps the funding in the latest economic assistance packaged should be repurposed for some of the infrastructure investments. I would love to see incentives that redirect the investments to underserved communities hardest hit by the pandemic. States will not necessarily invest in these communities without encouragement.

Viola Fletcher the oldest survivor of the Tulsa Massacre, age 107, testified before Congress  and seeks justice! To ignore the past is to risk repeating past atrocities. There are too many indicators, including the many ways our most vulnerable populations have been hardest hit during the pandemic, that should convince all companies, organizations, communities and individuals that the time for systematic and structural change is now.

Dr. Anthony Fauci, in his commencement address at Emory College of the arts and sciences emphasized our societal failings that have caused the COVID19 disparities and the disparities that have existed for decades. He emphasized that racism and the many social determinants of health (SDOH) that have caused these deadly disparities will continue long after the pandemic. He noted that “Righting this wrong will take a decades-long commitment,” he said. “I strongly urge you to be part of that commitment.” I am extending his recommendation to all of us that recognize the need for change.

Continue reading “May 2021 Newsletter”

April 2021 Newsletter

Spring is a time of renewal and new beginnings, a baby owl in Rock Creek Park

Introduction

Welcome to my April 2021 Living Conditions and Health newsletter. You can find past newsletters with additional background materials, and different stories and initiatives on my website and in my LinkedIn articles or posts. Join me in identifying and coordinating initiatives that advance health, health equity and community and healthcare redesign.

Shannah’s Insights and Reflections

April was Minority Health Month and there were many programs and announcements highlighting what public and private organizations are doing to address health equity. Many discussions were grounded in the health inequities of COVID19. These are important and valuable initiatives, but the inequities are not unique to health and healthcare. One article describes the many ways, the health system collects the disparities of structural racism. Structural racism is rooted in: lacking access to critical resources and supports that provide needed basic living conditions; and, historic social injustices and inequities in all aspects of life. An article in the Hill on the need for an increased minimum wage that offers a living wage is another example of ongoing policies that disproportionately impact minorities. These negative social determinants have been present for decades, if not centuries and will require sustained and increased efforts to fix.

The current minimum wage is inadequate for individuals and families to live on. MIT’s Living Wage Calculator shows that “A single-mother with two children earning the federal minimum wage of $7.25 per hour needs to work 138 hours per week, nearly the equivalent of working 24 hours per day for six days, to earn a living wage.” This was based on 2019 data and is likely worse due to increase prices resulting from the pandemic.

Continue reading “April 2021 Newsletter”

March 2021 Newsletter

My weeping cherry tree was a gift in March

Introduction

Welcome to my March 2021 Living Conditions and Health newsletter. You can find past newsletters with additional background materials, and different stories and initiatives on my website and in my LinkedIn articles or posts. Join me in identifying and coordinating initiatives that advance health, health equity and community and healthcare redesign.

Shannah’s Insights and Reflections

March felt different one-year into the pandemic. The increase in vaccinations is starting to bring hope and allowing people to reconnect in-person. This is a critical first step for individuals and families who have been isolated. Unfortunately, the vaccination rollout challenges and distrust, continue to create uncertainty about reaching national vaccination goals.

There continues to be misinformation about the vaccines and efforts to dissuade people from getting the vaccine. The Public Health Collaborative has a misinformation alert tool that keeps people up to date on the misinformation and provides resources to help combat such information. They have also developed a vaccine misinformation management field guide. I think of myself as someone who is keeping up with the field and the misinformation, but there is much more happening than I had realized.  In the age of social media, there are so many more information channels for anyone around the globe seeking to manipulate information.

Drew Altman CEO of the Kaiser Family Foundation (KFF) posted about “Where to Start to Build Vaccine Confidence.” If you want vaccination information coverage from KFF go to their COVID19 vaccine monitoring dashboard.

Continue reading “March 2021 Newsletter”

February 2021 Newsletter

My characterization of the lopsided investments in improved health outcomes. The stick figure is by an unknown author and is licensed under CC BY-SA

Introduction

Welcome to my February 2021 newsletter. You can find past newsletters with additional background materials, and different stories and initiatives on my website and in my LinkedIn articles or posts. Join me in identifying and coordinating initiatives that advance health, health equity and community and healthcare redesign.

Shannah’s Insights and Reflections

February is the shortest and coldest month (in much of the U.S.) and did not bring enough relief to the scourge of the pandemic. A recent article about the approaching “milestone” of 500,000 deaths in the US emphasizes the scope as many people continue to marginalize the true impacts. It is almost the equivalent of the total Wyoming population or major city populations like Atlanta, Raleigh, Minneapolis, Kansas City, or most major cities west of the Mississippi river and east of the Rockies.

We continue to see poor and inequitable distribution of the vaccine. People with means and technology access are navigating the complexities of finding a vaccine better than underserved populations. A Forbes article highlights how extreme weather shows the importance of living conditions in Texas and disrupts vaccine distribution throughout the country.

There is growing momentum for adoption of a digital vaccine passport to allow all businesses and services to validate vaccine status and be able to safely open and operate.  This may make disparities worse regarding COVID and healthcare because of mixed vaccine access and the risk of discrimination based on the haves and have nots of passports. If we are determined to go down this route as a country, then we should enable this digital passport to also serve as identity authentication for patient access to their own health information.

A new rule on consumer access to our electronic health information goes into effect on April 5, 2021. Somewhat like state IDs for people who do not have a license, people should be able to get the passport for purposes of unique digital credentials without having received the vaccine. It would not be proof of the vaccine in that instance, but it could ensure the passport investment has sustained and more equitable value.

A quote from a recent Journal of Public Health Management and Practice article shows how contact tracing discriminates or forces impossible choices:

“Tough choices presented a sort of “catch-22”: Do good and honestly name all known close contacts and risk a “snitch” label; or avoid the label, yet leave friends, neighbors, or coworkers in the dark, … and let the avoidable spread of disease continue. When identified as a close contact or COVID-19 positive, many low-income families had to make the tough choice between conforming to COVID-19 restrictions or losing income, and worse yet, risking job loss or antagonizing their employers by reporting that they got infected at work. Some had to choose between strictly quarantining and meeting basic needs–food on the table, the roof over their heads, utilities intact, and so forth.”

Life expectancy analysis of the first 6 months of 2020 shows an average 1-year drop due to COVID19 combined with worsening living conditions. Sadly, and predictably, the reduction is much worse for people of color. Black male life expectancy dropped 3 years, for Hispanic males 2.4 years, black females 2.3 years and in truth, non-Hispanic white female and males only dropped 0.7 and 0.8 respectively. The RAC monitor article discusses drug overdoses as one of the added SDOH causes, likely all of the poorer conditions in which underserved populations live and work contributed.

Continue reading “February 2021 Newsletter”

January 2021 Newsletter

winter in Sedona

Introduction

Welcome to my January 2021 newsletter. You can find past newsletters with additional background materials, and different stories and initiatives on my website and in my LinkedIn articles or posts. Join me in identifying and coordinating initiatives that advance health, health equity and community and healthcare redesign.

Shannah’s Insights and Reflections

The year did not start off well from a pandemic, economic or social unrest/racists standpoint. We will be dealing with the aftermath of a US insurrection facilitated by our past president for years to come. This could be a positive if, as a country, we step back and recognize sadly this also represents the US and structural racism that needs to be acknowledged and addressed.

This newsletter will focus on needed and promising new directions to address the exposed frailty of our health and social infrastructure to highlight the potential for the Biden-Harris Administration and a new Congress. There are enormous challenges that need to shape how we pursue substantive and sustainable change, but it feels like there is also an appetite and expectation.

The Biden Administration swiftly reversed many executive orders that affected or sustained health disparities and inequities. The Executive Order on Advancing Racial Equity and Support for Underserved Communities Through the Federal Government is an ambitious and needed undertaking that should have everyone’s attention. I have to admit it has kept me up some nights thinking about how the government can take this comprehensive approach and still have some real near-term impacts.

To say this is a complex project is an understatement. To recognize it needs a multi-prong approach that looks at both the problems and solutions from different angles will likely be the basis for its success or failure.

This quote from the Executive Order introduction speaks to the breadth of the task:

“Affirmatively advancing equity, civil rights, racial justice, and equal opportunity is the responsibility of the whole of our Government.  Because advancing equity requires a systematic approach to embedding fairness in decision-making processes, executive departments and agencies (agencies) must recognize and work to redress inequities in their policies and programs that serve as barriers to equal opportunity.”

One of the fundamental barriers to support for underserved communities is the fragmented nature of our federal and state government programs. This fragmentation is reflected in the local program implementation and the inability of communities to leverage resources across programs to address their unique priorities. We see this every day when trying to help individuals and families access services, even as local counties and cities try to have a no wrong door policy that connects people to the resources and services they need regardless of where they show up in the system.

In the short term our country needs to make immediate changes in the systemic discrimination evident in our: justice system – policing, courts and jails; schools; housing, and employment. We also need to address basic human needs. Can we set priority goals that would lift all boats; perhaps eliminating or dramatically reducing: homelessness, poverty, hunger, and violence? The challenges emerge when we consider how we make changes and facilitate the needed increased investment in so many critical endeavors.

An RWJF issue brief on Improving affordability and sustainability of housing is a great example of the breadth of needed change in just one target area. The report highlights a broad range of program changes and improvements needed to foster affordable sustainable housing for low income populations, but it does not speak to funding, specifically how do we finance these efforts.

The Ways and Means Committee published A Bold Vision for a Legislative Path toward Health and Economic Equity. It is a great framework for many pieces of needed change in a broad set of policies through legislation. It also makes clear the extraordinary amount of change that is needed. Yet it is arguably only the first of many steps. It embraces many existing approaches that perhaps should be revisited, and the suggested changes are often very incremental in nature.

Continue reading “January 2021 Newsletter”

2020 Yearend Newsletter

Introduction

Welcome to my 2020 year-end newsletter. You can find past newsletters with additional background materials, and different stories and initiatives on my website and in my LinkedIn articles or posts. Join me in identifying and coordinating initiatives that advance health, health equity and community and healthcare redesign.

Shannah’s Insights and Reflections

Yearend of a year we could not have predicted and that will have impacts for many years to come feels unsettling. There are many opportunities to make fundamental changes that will promote health equity and upstream investments in living conditions. These could strengthen our country and communities if embraced and sustained. There is enormous work to be done if we choose to take a bold path, but the benefits would be worth it.

Two year-end inspirational highlights. The first is the story of Jack Geiger MD who sadly recently passed away. It shows that with determination, enabling improved living conditions as a part of the healthcare mission can and has been done in more difficult times than ours. In the early 60s he established and transformed community health centers in South Boston and the Mississippi Delta with a social medicine model that addressed social and economic needs.

The second highlight is community fridges to help feed hungry neighbors. The number of community-led stocked refrigerators has increased at least 500% in the past 8 months and the movement shows a combination of contributions and partnerships that include volunteers, restaurants, stadiums and financial donations coming together to make everyone better off.

Continue reading “2020 Yearend Newsletter”