Opinion: After COVID-19, we need more focus on health equality

Opinion: After COVID-19, we need more focus on health equality

The experience with COVID-19 over the past two and a half years has taught healthcare policymakers some important lessons. One of the most important is the clear evidence that despite efforts made in recent years to increase access to quality health care for all people, the gap between health equity remains.

And that gap was significant during COVID-19. The rates of test-confirmed diagnosis and exposure to COVID-19, hospitalization and death in New York City all show significant racial and ethnic differences. However, the gap was not limited to COVID-19. Those results reflect pre-existing differences in social determinants of health — things like education, jobs and neighborhood characteristics — which together result in poorer outcomes for affected populations.

Identifying a problem is one thing, of course, but coming up with a solution is quite another. And because of all the moving parts, the health equity puzzle is complex. For a long time, policymakers focused on coverage, thinking that the fundamental problem of health equity was that some populations couldn’t afford health care. And all that has had a positive effect. But it has not solved the problem of health inequality. Sure, the coverage issues linger. But there’s also some evidence that even with coverage, some people still don’t get the care they need.


And policymakers, payers and providers are starting to respond to this. When it comes to social determinants of health, such as education, housing, food, childcare, etc., policymakers encourage – and in some cases mandate – relationships between providers and community organizations that provide a variety of these social support and services. Providers, in turn, build those relationships, recognizing that not only is this a mechanism to improve the health of the population at large, it will also improve business outcomes in an environment where they are paid for patient outcomes rather than just service units.

These efforts are also closely related to cultural competence. Health service providers and social determinants of health should not only consider those social determinants – they should do so in a way that encourages diverse populations to use the available services. Perhaps the most obvious factor here is language – if people can’t find a provider that speaks the same language, they are less likely to search for services. But it goes much further: they also need providers who understand their cultural assumptions. On a more basic level, studies have shown that patients respond better to caregivers who just look like this.

And cultural competence is not limited to race and ethnicity. Several providers have had great success in providing services (sometimes in partnership with community organizations) that focus on serving the LGBTQ population. Increasingly, health care providers are also recognizing the value of focusing on providing care to individuals with disabilities, including physical, behavioral or intellectual disabilities. Often these are the most expensive populations, so improving their reach can often yield the most positive results, both substantively and financially.

But perhaps most importantly, a revived Department of Health is focusing on health equity in a much more coordinated way as part of a larger reorganization. The new Office of Health Equity & Human Rights that will connect previously unconnected resources in the department in a way that promises to focus on cultural competence and social determinants of health in a truly comprehensive way.

As policymakers focus more and more on these issues, providers should do the same, as reimbursement systems, government subsidies and supervision increasingly take health equity into account. A system that generates better outcomes for diverse populations will benefit not only patients, but also caregivers’ own outcomes.


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