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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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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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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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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February 2020 Newsletter

Early Signs of Spring!

Introduction

Welcome to the February 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.

This month you can read about: the politics of health inequality; varying roles of plans and hospitals in communities, services and investments; New Mexico and Rhode Island thinking more holistically; Colorado and California trying new levers to address social needs; Healthy Alliance IPA convener model for CBO collaboration; several community investments – Molina, OneCity, Inspira Health and the AMA; research and metrics continue to grow and be debated; and some past and future SDOH events.

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January 2020 Newsletter

Apparently Punxsutawney Phil says winter will be shorter this year!

Introduction

Welcome to my first 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.

This month you can read about: Community Care Corps; Lyft’s grocery access program; strengthening Human Services; Medicaid block grants, the public charge rule; the proposed Social Determinants Accelerator Act; DC Senior Housing Summit; ACP position on SDOH; Life experiences and income inequality; RISE SDOH benchmark survey; the impacts of closing Auto plants; Knowality; and recent eHI & WEDI and NASEM events.

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