Living Conditions and Health – A Forum for Tracking Ground Breaking Activities on Improved Living Conditions

February 8, 2022February 11, 2022

January 2022 Newsletter

A new beginning is being launched in this newsletter

Introduction

Welcome to my January 2022 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.

A New Direction

This is my last Living Conditions and Health newsletter. It has been four years and time flies even during COVID! I have decided to concentrate my future posting and blogging on advancing multistakeholder investment and engagement in upstream efforts to improve living conditions AKA Social Determinants of Health (SDoH). I still dislike this term. It is one more mouthful acronym that doesn’t resonate with the people outside of the healthcare bubble, including the people we are trying to help.

I see the need for broader stakeholder engagement as the greatest gap in advancing sustained health equity, supporting underserved individuals and communities, and dismantling racism. These efforts need to be pursued in tandem with improvement in living conditions for health and sustainable living. Broad stakeholder engagement is needed to focus on the full landscape of barriers and benefits to greater equity and opportunity. These efforts must also be led by the individuals and communities we seek to support and non-health stakeholders in the communities including employers, investors, infrastructure businesses and community-based organizations. Often health care providers and payers are anchor institutions in communities and will still play a key role in the multi-stakeholder support. As I start to shift my focus, I wonder if the public health perspective would bring a more balanced view to this worthy task. The pandemic has taught us that public health brings a broader perspective that enables change when given the resources.

If you have been following my newsletters you know I strongly support changes that are not unduly tied to discrete healthcare outcomes and instead focus on basic human needs of individuals, families, and communities. The best part of having tracked SDOH over the past 4 years is the broad acknowledgement that circumstances in which people live, work and play is the greatest driver of health outcomes (40-60%) while clinical care effects only 20% of health outcomes. However, most of the healthcare industry investments are heavily focused on target members or patients of each organization rather than looking at the collective needs of the people in the communities with inadequate resources for basic daily living needs. I’m getting ahead of my first official post for this new direction but rest assured, or with trepidation, that I will still be engaged. I will be seeking out like minded colleagues and friends to help advance this approach locally and nationally, and my focus will still be directly related to living conditions and health.

The inequities laid bare by the pandemic and discussed at the JP Morgan Health Equity conference mentioned below are what excite me about taking a new direction in my efforts to help advance change. I also admit freely that this new direction my have unduly influenced this final newsletter. Apologies if you were expecting something different.

January 5, 2022January 5, 2022

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.

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.
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).
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.
Healthcare access is recognized as a right and all healthcare providers are supported to enable needed equitable access.
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.

November 5, 2021December 6, 2021

October Newsletter

Introduction

Welcome to my October 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 prolonged pandemic and its disparate impacts on health and the economy continue to fuel needed changes in how many stakeholders think about health services and the living conditions that negatively impact individuals and communities. The politics and misinformation that influence our country’s ability to embrace needed and sustained changes make the progress feel fragile. This months’ entries seem to support this perspective, but that may just be my bias.

An article, and the recent Bipartisan Policy Center report it reviews, discuss the need to expand flexibility for investing in Social Determinants of Health (SDOH) focusing mostly on Medicaid, but also seeking to address silos across Medicaid, Medicare and CHIP. The report also addresses funding, research, and workforce needs for implementing non-medical and preventive services that have evidence of success. The recommendations are a critical set of steps in the right direction. Equal attention should be given to the many other silos of social services and community infrastructure supports and the many other Federal programs that have overlapping and adjacent service capabilities.

The Transforming Public Health System Data Commission report on Charting a Course for an Equity Centered Data System was supported by the RWJF. It establishes the importance for change, the steps and processes taken to formulate the findings and recommendations and calls to action for a broad range of stakeholders. The Commission and the report represent a substantial undertaking among organizations and consultants to look across the problems laid bare by the pandemic and worsened by systemic racism and related inequities that resulted in the declaration of racism as a public health crisis. This quote from the conclusion emphasizes the significance of inadequate data:

“The Commission recommendations make it clear that in our current system, data on health inequities are divorced from the history and community conditions that shape poor health outcomes, resulting in an incomplete picture of who is most impacted and why.”

September 9, 2021September 9, 2021

Summer 2021 Newsletter

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.

June 10, 2021

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.

May 4, 2021May 5, 2021

April 2021 Newsletter

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.