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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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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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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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.

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Summer 2020 Newsletter

Sympathy and strength to all the parents juggling stay-at home schooling!

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 28th 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.

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June 2020 Newsletter During COVID19

One of many examples of the mixed emotions on this Independence Day

Introduction

Welcome to the June 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. I’m still dispensing with the newsletter subsections and concentrating on ways to address disparities and inequities.

Shannah’s Insights and Reflections

Month three of largely COVID19 lockdown. I’ve decided in honor of Independence Day, I’m going to provide an optimistic overview of all of the potential positives that can come out of our current state of oppression that has 3 strong drivers: the pandemic, the economy and systemic racial injustice. I use the term oppression in recognition that this weekend’s celebration commemorates the 13 colonies declaring independence from the oppression of the British Monarch. Many are not celebrating this year’s Independence Day because too many people in our nation do not have the freedom they should.

For those of you who know me, you know that a rosy outlook is a bit uncharacteristic, because I’m more a tell it like it is, don’t sugar coat it, kind of gal. Nevertheless, I am also passionate about transformation and believe we are at a critical juncture where we can choose a new and improved path for all people.

I live in a county and state that have embraced caution in reopening and erred on the side of keeping people safe. Our numbers continue to decline, but the US numbers are headed in the wrong direction. The upside perspective is more of our society needs convincing that the risks of the pandemic are greater than the benefits of reopening as quickly as possible.  We are seeing leaders recognize the need for caution and reversing their early opening decisions. Let’s hope this is the start of a reverse trend.

The growing cases continue to reflect inequities and disparities in our health system and in our country, underscoring the need for a reckoning with systemic, structural and cultural racism. There is a growing silver lining that I hope to portray in this month’s newsletter. The intersection of the pandemic, economic crisis and social injustice is sustaining pressure for much needed change and improvement. This is a growing perspective across the nation. As a country we can be much better than this and now is the time for change!

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May 2020 Newsletter during COVID19

Introduction

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.

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April 2020 Newsletter during COVID19

Introduction

Welcome to the April 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

We’ve experienced a sustained month of COVID19 and lock down/social distancing. It has also been a jarring exposé on health disparities and the implications of living conditions on individuals’ and families’ health status, health risks and access to care. I am again breaking away from my standard reporting this month and instead will highlight the ways the pandemic exposes the many drivers of health disparities and our need to address the fundamental inequities across all segments of our society.

Inequalities, prejudices and social and economic disparities lay the disastrous foundation for the disparate risks, impacts and treatment experienced by African Americans, Hispanics, immigrants, low income people and communities and elderly populations. This past month coverage focuses on the need for data. There is a growing voice that the disparities not only result from social determinants and comorbidities, but prejudice and discrimination. Unfortunately, how individuals and institutions treat individuals can be influenced or dictated by factors that should have no role in testing, treatment or services. Gaining true insight on this aspect will also be data dependent.

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