December 2021 Newsletter

Introduction

Welcome to my December 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

It is the season of predictions and I marvel at how so many organizations and individuals still seem inclined to make predictions after living through the unprecedented and unpredictable past 2 years. I will take my prior stand of stating my hopes for the coming year that could be within our collective capabilities.

  1. The pandemic becomes the needed wake up call for our country and the world to approach life and humanity as the fragile gift that it is.
  2. All people living in the US have access to resources and services that enable living conditions that are secure and circumstances in which they can have a “fair and equitably opportunity to live” (borrowed from the Tulsa article below).
  3. Our country’s commitment to health equity and the elimination of structural racism will be codified in laws and programs so that there is no going back.
  4. Healthcare access is recognized as a right and all healthcare providers are supported to enable needed equitable access.
  5. Politics return to civil discussions that make the rights and needs of all Americans the driving priority.

Sadly, or perhaps by necessity the Omicron variant has put us all back in the realm of uncertainty and inequity as many struggle to get tested, to get results, to avoid unknowingly infecting friends and family.  The good news is it is proving to be milder for most people testing positive. The New York times reported US deaths have passed 800,000 and cases rose above 50 million. The impact of the pandemic continues to disproportionately affect people of color and underserved populations. The response to the pandemic is our daily reminder of how politics in many states are ignoring the stark realities of the pandemic. Let’s hope we see an improvement in 2022.

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November Newsletter

On Thanksgiving we should pay tribute to all of the unsung Native Americans

Introduction

Welcome to my November 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

Do you know someone with Long COVID? It is bad enough to have these challenges and symptoms, but to then be stigmatized and isolated will only make it worse. This BMJ opinion piece highlights the challenges and offers ways to support people with Long COVID.

Lancet Public Health article on the tremendous impact of Adverse Childhood Events (ACEs) is disheartening, yet vital for increased awareness. The article leads off by stating “it is estimated (globally) that one out of two children ages 2-17 suffer some form of violence each year.” The article cross referenced a meta-analysis estimating 89.9% of adults who are homeless have at least 1 ACE and 53.9% had 4 or more. Preventing childhood violence should be a top priority in all countries and communities.

This is the first article I’ve seen highlighting workers comp as an area that could substantially benefit from addressing socio-economic factors. I’m sure there have been activities, but perhaps not covered in the press. This aligns with more employers recognizing the role of social determinants of health on workers generally and potentially underlying risks of workplace injuries.

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October 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.”

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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.

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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.

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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.”

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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.

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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.

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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.

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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.

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