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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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.

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Fall 2020 Newsletter

Introduction

Welcome to the Fall 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 September, October and part of November 2020. It proves that if you wait long enough there is new hope and a new potential framework for addressing growing U.S. challenges. COVID19 and our needed racial reckoning have been magnifiers for health disparities and inequities that have always existed. They are driven by inadequate living conditions for a majority of our country that have gotten worse due to COVID19 and the economic downturn.

We currently have an administration that gave up on addressing the pandemic and the drivers of disparities. The Biden Harris administration (B-H) is already taking on the critical challenges we face for everyone in the US regardless of race, ethnicity or political affiliation.

My greatest fear is that a divided Congress and country will make it hard to move ahead quickly, but I anticipate that B-H will take a page from the current administration and use executive orders to leverage the full breadth of the executive branch’s administrative powers.

My overall takeaway from this extended period of time is Community, Community, Community, whatever we do it has to empower and invest at the community level in a way that acknowledges, eliminates and makes amends for discriminant and disparate services, treatment and opportunity. It should also strive for improvements and solutions that pool investments at the community level, rather than those driven by individual health systems or plans.

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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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March 2020 Newsletter During COVID-19



Photo by Anshu A on Unsplash

Introduction

Welcome to the March 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

Nothing in March is business as usual and this newsletter is no exception. I gather my intel on living conditions and health from google alerts. The first Coronavirus online story that surfaced (based on my search terms) was on March 8th about the first case in Kansas and that she was isolating at home. Just this statement underscores how living conditions or social determinants will be part of the fabric in which people manage through this pandemic. “Isolating” and “home” are two fundamental factors for how individuals who test positive will fair. Do they have a support network, albeit remote, that will help them through this challenge? Do they have a home in which they can isolate/self-quarantine, manage needed services and resources and avoid infecting others?

There was no further mention in my alerts until a COVID-19 Q&A on the 20th and an article identifying protection for rideshare drivers. This article discussed helping drivers know if they have been exposed to the virus, particularly medical rideshare drivers who are critical for patients needing rides. Drivers are at greater risk for exposure from patients and in turn are potentially exposing others.  The drivers may also want riders to wear protective gear that is increasingly difficult for even healthcare workers to get. Since that story the intersection of the pandemic and living conditions was regularly reported.

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November 2019 Newsletter

Introduction

Welcome to my November 2019 newsletter. You can find past newsletters in my LinkedIn articles and on my website with some additional background materials, different stories and initiatives that might be of interest. Join me in improving and coordinating initiatives that advance health, health equity and community and healthcare redesign.

This month you can read about: Bernard Tyson; Detroit medical students caring for the homeless; Oversight for the $1.5B ANC Healthcare trust in NC; alternatives to provider centric community initiatives such as land trusts, collaborative networks and public health initiatives; the role of CHCs in disasters and prevention; CMS changes in Medicaid flexibility and delay in consumer access regulations; hospital system investments in communities; Aetna/CVS’ loneliness program; US life expectancy downturn; Neighborhood Atlas and Healthify’s latest investment round.

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May 2019 Newsletter

Introduction

Welcome to the May 2019 monthly newsletter. You can find past newsletters in my LinkedIn articles and on my website with some additional background materials, different stories and initiatives that might be of interest. Join me in improving and coordinating initiatives that advance health, health equity and community and healthcare redesign.

This month you can read about: My recent blog on why asking for help shouldn’t be so hard; Fannie Mae’s innovation awards for improved housing; several stories about the substantial impacts of poor living conditions on healthcare in hospitals, FQHCs and primary care and the breadth of needed changes; More initiatives from Cerner and Kaiser and Blues plans investing in Solera Networks; a Health Affairs’ article on the need for further research; and many surveys from different vantage points.

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