Summer 2020 Newsletter

Introduction

Welcome to the Summer 2020 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 covers months four and five of COVID19. We are experiencing opening and re-closing or sticking with social distancing depending on where we live. The monotony yet necessity of daily living during COVID19 is my rationale for a combined Summer newsletter spanning July and August. I’m not able to keep my rosy outlook from the June newsletter because much of the news, particularly around the surge and resurgence of the pandemic is not good and disproportionately continues to affect people of color and underserved communities. I have included a few promising care and services models that offer hope.

I will start off with a link to the late Representative John Lewis’ words for us to hear at his funeral.  As I posted when his opinion piece was published… in his final days, he gives us hope and is the example of leadership, even in death, that we desperately need.

I also want to take a brief moment to recognize all parents at the start of the 2020-2021 school year for meeting the challenge of back to home school! You are another segment of the unsung pandemic heroes facing a sustained living condition that affects you and your children’s mental and physical health. This Vox article should help everyone relate.

There is a growing trend of municipalities and states declaring racism a public health crisis. Unfortunately sustain incidences of police brutality have fueled this trend. More diverse organizations and institutions finding ways to embrace anti-racism may help turn the tide of brutality and could enable reform and sustained improvement in our communities and in the country. A Refinery29 article discusses how this declaration is only the beginning, but an important first step to allocating resources and taking strategic actions.

On August 28^th the 2020 Commitment March was held marking 57 years since the March on Washington and Martin Luther King Jr.’s I have a dream speech.  This march elevated demand for change to enact justice and healing. See some of the coverage here. It is an important example of the momentum of the movement since the murder of George Floyd and continued brutality including the most recent senseless shooting of Jacob Blake. The protest was designed to acknowledge the realities of and constraints to safely protesting during the pandemic and give voice and truth to the racist reality of our country.  Change is long overdue. Racism is a human and public health crisis.

A recent Health Affairs blog summarizes how rural Vermont’s successful actions should serve as a roadmap for improved COVID19 responses that systematically addresses living conditions:

“First, the presence of integrated networks bringing together health systems, social service providers, and communities facilitated rapid mobilization amid national and regional resource constraints. Second, health care organizations used existing systems, including electronic health records and community health workers, to identify vulnerable patients and address both health and social needs. Third, community hospitals leveraged their positions as trusted institutions to deliver public health messaging and collaborate with other actors to address barriers to compliance with public health measures. Many health systems provided financial backing of community-based responses. Finally, the research underscores that achieving health equity requires attention to more than the prevalence of disease or biomedical treatment. Prioritization of the social determinants of health, including poverty, discrimination, education, transportation, and housing, was central to the region’s success in the early phase of the epidemic.” 

Health disparities, inequities and potential solutions

Many Medicare Advantage programs are extending their non-medical services support including grocery delivery, telehealth and transportation to the end of the year due to COVID19. Let’s hope there is recognition that this is the right service and support with or without COVID19 because it keeps people healthy, safe and engaged.

More organization are focusing on how to address structural racism in health care and in the living conditions that drive health outcomes. This focus has been accelerated by Black Lives Matter and by the undeniable inequities and disparities revealed by COVID19. CDC has a COVID19 Equity Strategy that sets intermediate outcome goals for the next 3-12 months in four areas: the evidence base; expanded programs for testing, contact tracing, isolation, healthcare and recovery (to address disparities and inequities); expand programs and practices supporting essential and frontline workers (including food, grocery retail); and, expand an inclusive (reflect your community) workforce. Fortune discusses how health plans can address SDOH. Providers and the AMA are discussing how medical practice needs to change.  All of the approaches underscore collaboration and reflecting the community you are serving, i.e.,  having diverse staff that look like and understand the people in the communities you serve.

The final Healthy People 2030 objectives and measures were issued on August 18th and the Department of Health and Human Services stayed with the substantial reduction of objectives as proposed. While touting a focus on social determinants, health disparities and inequities, the final objectives and measures added few if any significant new objectives while dropping many important objectives.  There was no real response to the public comments requested and received.  There is a tool to look at how the objectives have changed from 2020 to 2030, but it is difficult to know what to look for. You can enter ‘SDOH’ to see what has been dropped. The announcement came with many strong statements of how this set of objectives will help address the stark disparities reveal by COVID19, but preparedness, pandemic and emergency objectives have largely been removed and related objectives are developmental. Hopefully this constrained set of objectives for the coming decade will not undermine the long-standing goals of Healthy People.

Emerging new models to watch and emulate:

C3 – Community Care Cooperative, is a unique nonprofit ACO (Accountable Care Organization) in Massachusetts (MA) that is comprised of 19 Federally Qualified Health Centers. FQHCs treat underserved communities and are historically are underfunded. As the name implies C3 is successfully engaging an integrated care and social support model. In a recent podcast, the CEO Christina Severin differentiates between SDOH and health-related social needs (circumstances that has profound impacts on health outcomes),  noting  “We consider social determinants of health to be largely driven by institutionalized racism and poverty.” She provides compelling arguments for addressing both drivers of poor health and disparate illness and death. C3 has a robust set of health IT tools that include a strong EHR network and a resource matching tool. Finally C3 taps into the MA flexible services program that enables ACOs to establish relationships with community organizations, connecting members to needed non-medical support and paying for the services.

Addressing all of the drivers of inequalities and social injustice require fundamental and sustained changes in communication, interaction and interventions. A great example from Richmond VA is local firefighters and volunteers knocking on doors with needed masks, sanitizers and information for COVID19 protection.

Please share the newsletter and connect via LinkedIn or email kossoncare@starpower.net with your reactions and input.

RECENT & UPCOMING EVENTS

Healthier Texas Summit Series – “upcoming session, Defining Coalitions and Their Role in Addressing Social Determinants of Health scheduled Thursday, September 3 from 10:30 a.m. – 11:30 a.m. will feature panelists sharing perspectives on how they define a coalition, how one is formed, and how coalitions address social determinants of health. To register for the free webinar, click HERE.”

I’ve left the link to the Aspen Ideas Festival from my last newsletter because it was a unique and compelling program.

The Aspen Ideas Festival discussed the problems and solutions of our time in an engaging and positive way. I encourage anyone looking for hope and inspiration to look at the schedule and watch what interests you and perhaps what feels most foreign to you that might give you some new perspectives.

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