January 2021 Newsletter

winter in Sedona


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.

Every new administration does a regulatory look back to make sure any last-minute regulatory action is consistent with the new administration’s vision and platform, even during same party transitions. Expect to continue to see rescinding, reversals or clarification from the new administration in the first 100 days and beyond. In past newsletters I’ve flagged some of the cuts and shift in programs like USDA’s supplemental Nutrition Assistance Program, at the very time health systems and insurers are trying to address food insecurity.  The hope is new leadership will be coordinating across these types of interrelated programs.

The look back will also be challenging in the midst of regulatory variance and forgiveness due to COVID. COVID19, vaccine distribution and the exposed inadequacies of our health system will need sustained focus. This makes pursuit of fundamental changes harder. As discussed in the last newsletter the vaccine is not without its challenges and many factors play into distrust. Our Ontario neighbors have come up with an ethical framework for COVID-19 vaccination distribution that the US could and should embrace.

CMS issued guidance on SDOH for CHIP and Medicaid programs. This was developed by the prior administration and will likely be revisited and hopefully expanded under the new HHS leadership. Nevertheless, it still underscores the growing flexibility states have to address living conditions if they have the will and finances to embrace expanded services. The expectation and early analysis shows it can help reduce healthcare costs, but there is need front end investment.

Two remaining items caught my attention in January. First, a National Academies of Sciences Engineering and Medicine workshop about the role of Critical health Literacy in addressing SDOH took place on at the end of January. The concept of “Critical Health Literacy” (CHL) is how to empower or operationalize change in SDOH at the individual and community level. CHL focuses is on providing needed information that can be understood, helping people know the root causes of the community problems and ways to make change. All three speakers bring great perspectives and examples of what works!

Second, a recent NY Times Article about the “Age of Surveillance Capitalism” helps to explain the factors behind the insurrection at the Capitol. It also emphasizes the conflict between a surveillance society and a democracy. The article walks through how the access, ownership and control of personal information resulted in another sort of coup that enabled the insurrection. The language is somewhat complex, but the statement “Surveillance capitalists now hold the answers to each question, though we never elected them to govern” explains how commercial interests have gained control over information and what constitutes the “truth”. As we pursue needed change, we should be transparent about what is being done to help rebuild needed trust.

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


Health Disparities Research Institute (HDRI) virtually August 9-13, 202, Applications will be accepted from February 1 – March 8, 2021! Designed to help aspiring early-career minority health and health disparities research scientists. Go to the website for more information.

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