Welcome to the May 2020 newsletter. You can find past newsletters with additional background materials, and different stories and initiatives in my LinkedIn articles and on my website. Join me in improving and coordinating initiatives that advance health, health equity and community and healthcare redesign.
Shannah’s Insights and Reflections
Two months of COVID19 and lock down/social distancing in Montgomery County Maryland while states and counties create a patchwork of openings, sustained lock down or social distancing and many things in between. Meanwhile individuals and leaders vary in their willingness to continue safe practices.
Added to the pandemic is the long overdue collective outrage over police brutality and the sustained injustices against individuals and communities of color in our society. Is the political landscape we each live in another important social determinant? Having a true voice in how policies and programs are shaped that fosters hope and the belief that each of us can influence change. More fundamentally, whether individuals can trust law enforcement and safety institutions to protect their rights and safety is a sustained uncertainty for Blacks and communities of color.
Sadly, as the pandemic exposes the systemic disparities and inequalities of our communities and health system for communities of color; we experience a harsh reminder of how racism is still a fundamental driver of life and health disparities through the brutal police murder of George Floyd.
I am struggling in the midst of the pandemic and warranted civil disobedience to stick with a daily routine and a timely newsletter. I try to hold on to the hope that the undeniable facts will finally convince all of us to take the needed steps to create an equitable society where we all have the resources and opportunities to live a healthy and fulfilling life.
I’m still dispensing with the newsletter subsections and concentrating on the topic of disparities and inequities. I’m highlighting a range of presentations and news items that speak to the problems and potential solutions.
Some solutions are promising, but everything will be challenged by inadequate funding during a deep recession with risks of future spikes in the pandemic.
Share your personal or community stories by connecting via LinkedIn or email email@example.com I welcome suggestions in all topic areas, particularly community driven models.
A personal or individual story
Has COVID19 fundamentally changed how we help people in need?
I was coming back from a walk in the woods and saw an older neighbor on the ground in the street and ran to see if he needed help. He said he couldn’t get up. By the end of the incident we had about 6 neighbors trying to help, none of us had the strength to lift him and did not want to cause any added injuries. Although the individual and his spouse did not want to place a call to 911, One neighbor who has been caring for her home bound husband for several years with a lot of 911 experience called and asked for a ‘lift assist”. What followed next was a number of questions about who was involved did anyone have COVID19, a fever, recently traveled out of the country … etc. I was surprised by the number of questions and the length of time it took. I would think that our new normal would involve universal precautions to treat every emergency call as if there might be COVID19 exposure risk, because we can never be sure even in answering the questions accurately.
Health disparities and inequities
Avalere Health’s insights on COVID19 exacerbating Social Determinants of Health Impacts provides a good high-level overview of the landscape and the weaknesses the pandemic reveals in our health system. The statement that the virus “may not discriminate” then leads to the clear indication that many other societal factors do discriminate and one, or both, result in the disproportionate health and mortality impacts on the poor and underserved populations in our society.
Humana splits COVID19 relief investments between short-term relief and longer recovery. The $50M investment is split ~70/30 short-term/long-term. Recognizing the urgency of immediate needs, but sustained and exacerbated challenges of recovery for families that we’re struggling pre-pandemic. Post-pandemic challenges will be greater due to the anticipated slow economic recovery that means more people without jobs and the related inability to pay for basic needs notably food and housing. Find more details about the post-pandemic challenges in this article from Open Minds.
The Bipartisan Policy Center report and web conference on TeleHealth and COVID19 in rural areas discusses the added challenges of rural communities during the pandemic. Disparities and inequities for vulnerable populations is often worse in rural areas due to limited built infrastructure and limited healthcare resources. The report outlines 5 ways to change the erosion of health and care delivery in rural America.
Two early June webinars show some important mechanisms for improved support of living conditions, while also highlighting the obstacles.
The Changing Healthcare Landscape webinar hosted by the Aging and Disability Institute, discussed emerging Community Integrated Health Networks (CIHNs) as a model for improved delivery of community-based services addressing social determinants of health. The recording and slides should be available soon. CIHNs are envisioned as the way to scale integration of aging services networks with health systems by supporting more efficient administrative services and interactions with plans and delivery systems. Unfortunately, this design is still driven by the healthcare delivery model and runs the risk of diluting the very focus of the broader and more socially- and community-driven services needed to address daily living and quality of life needs. In response to my question about using different metrics to measure success, there is some activity. Specifically, NQF is working with CMS on a measurement framework to assess food insecurity and housing instability.
The Alliance for Health Policy’s COVID-19 webinar series featured the important Role of Medicaid. The discussion reminds us of the fundamental safety net design of Medicaid that uniquely can and does address social determinants of health, yet at the same time is caught in the cross hairs of the pandemic and economic downturn. Most states used the program to address unmet healthcare needs with the help of stimulus dollars, but as the funding wanes and regulatory flexibilities are removed all states will be hard pressed to sustain support. Even with the added funding states were challenged to meet the disproportionate needs of the underserved populations that are harder hit by the pandemic.
Late breaking decision from the Trump Administration that all COVID19 testing will be required to have accompanying demographics data. A similar Bill was introduced by Senator Warren in April. Perhaps a bipartisan recognition that we cannot understand the depth and breadth of the problem without sufficient data.
Courtney Lang’s article “Together at a distance: the Mental Health Crisis of COVID19 and the Peril of Racial Injustice”, emphasizes the importance of mental health disparities during the pandemic and escalating social injustice. “Today’s pandemic environment has revealed a new population of mental health patients and consumers. The numbers augmented by incidents of racism and police brutality are triggering for people of color who have succumbed to COVID19 at a disproportionate rate. At the same time mental health access and funding continues to be a problem.
Please share the newsletter and connect via LinkedIn or email firstname.lastname@example.org with your reactions and input.
CURRENT & UPCOMING EVENTS
American Racism through the Lens of COVID-19 Wednesday June 10th 10AM Eastern
NEW DATES: RISE National Summit on Social Determinants, June 9-11, 2020 is now a virtual event.
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