Health disparities and how to address them have been part of the national dialogue for decades, dating back to President Ronald Reagan’s administration in the 1980s, according to reporting by the Association of American Medical Colleges. That’s when the federal government enacted laws and developed policies to help people who are underserved by healthcare services. Now, nearly 40 years later, against the backdrop of the COVID-19 pandemic and with substantial amounts of data supporting the widening of those disparities, the conversation about health inequity has been reignited. Payers and providers must pay attention to and address the inequality that exists and is driven by ethnic, social, economic and lifestyle influences if they want to offer effective healthcare services and achieve better outcomes for underserved individuals and populations, while also reducing healthcare costs.
Understanding Health Equity
In its Healthy People 2020 initiative, the U.S. Department of Health and Human Services (HHS) asserted that health equity allows all people to attain the highest level of health. The Institute of Medicine (now the National Academy of Medicine) noted in its 2001 report, “Crossing the Quality Chasm: A New Health System for the 21st Century,” that truly equitable care doesn’t vary because of personal characteristics, such as ethnicity, gender or age, or because of socially determined circumstances, such as gender identity, geographic location or socioeconomic status.”
Yet, despite the acknowledgment of what health equity is and the desire to achieve it, factors outside of the healthcare system continue to drive health inequality, according to an article published in May by the Kaiser Family Foundation. These factors, the subject of much research, are known as social determinants of health (SDoH), or the environmental conditions present in the geographic locations where people live, learn, work and play that influence their health, well-being, and quality of life. According to the Office of Disease Prevention and Health Promotion, social determinants of health include safe housing and neighborhoods, transportation, racism and discrimination, education and job opportunities, access to nutritious foods and physical activity, clean air and water, and language and literacy skills. Most often the populations that are most impacted by SDoH have lower socioeconomic positions, which correlate to poor health, the Kaiser Family Foundation found. In other words, the lower the household income, the unhealthier the individual is.
Population Health’s Response to Health Inequity
To mitigate SDoH’s effect on underserved populations, public health officials and healthcare organizations have implemented Population Health initiatives. Population Health has surfaced as a discipline that evaluates the health data of people living in a geographic location and strives to proactively improve their health outcomes by influencing their health behaviors. Research has found that changing health behaviors is most effective when combined with changing the broader environment that enables poor health choices, says a May 30, 2018, post on the Health Affairs Blog, produced by “Health Affairs,” the leading journal of health policy thought and research. Implementing these changes may involve developing practices or policies to remove barriers to health services and increasing opportunities to improve well-being.
In practice, a hospital that supports a local farmer’s market in an area with little access to wholesome and nutritious food choices is contributing to a Population Health initiative to influence behavior. The hospital’s actions encourage healthier eating, diminish the possible risks associated with poor nutrition and eventually lead to people in that community needing fewer medical interventions.
On the policy side, the Affordable Care Act (ACA), signed into law by President Barack Obama in 2010, drives Population Health successes by incentivizing providers who participate in programs that reduce health disparities. When these providers are rewarded financially by insurers on the federal marketplace, they are motivated to use their relationships with patients and their influence within their local communities to effect healthy changes in those areas. Additionally, the ACA includes 62 stipulations aimed at reducing or eliminating health disparities among racial and ethnic minorities and other vulnerable segments. The law also established six offices to ensure federal regulations incorporate health equity measures and established the National Center on Minority Health and Health Disparities as a part of the National Institutes of Health, according to the Association of American Medical Colleges.
But Population Health initiatives and the Affordable Care Act that rewards them aren’t the cure-all for health disparities. In fact, data continue to show that people of color and low-income individuals have higher rates of chronic and costly conditions and are still uninsured. Therefore, when individuals within these populations get sick, they tend to seek care in a hospital emergency room, leading to higher treatment costs. Moreover, their illness — often more serious due to lack of preventive care or delayed care — causes them to miss work, lose wages and disrupt the care of their families. So, their medical costs combined with these indirect costs strain their personal finances, drive up healthcare expenses and negatively impact the broader community. In fact, analysis reported by the Kaiser Family Foundation reveals that health disparities cause approximately $93 billion in excess medical care costs and $42 billion in lost productivity.
Health Inequity Highlighted by the Pandemic
Reduced access to care and unhealthy local influences for certain populations have been dramatically showcased during the COVID-19 pandemic. People of color, including Blacks, Hispanics, American Indian and Alaska Natives (AIAN), as well as Native Hawaiian and other Pacific Islanders (NHOPI), have higher risks of contracting COVID-19 and dying from the disease than their White and Asian counterparts. The Kaiser Family Foundation attributes this higher risk to these populations’ location, which often finds them living in multi-family households, working where close proximity is necessary, and relying on public transportation. The Foundation also notes that these populations often have underlying health conditions and seek testing and care for COVID-19 much later than other populations with better access to care and insurance coverage. Additionally, people of color, those with low incomes, and members of the LGBTQ+ populations have been disproportionately affected by job loss and mental health issues from the pandemic, setting up a vicious cycle that prevents them from improving their health.
With the development of the COVID-19 vaccine, another disparity has emerged, as Blacks and Hispanics have been less likely to receive the vaccine, the Kaiser Family Foundation report revealed. This could be from their inability to access vaccination sites during working hours or hesitancy due to their documented general distrust of healthcare providers or fear of government authority.
Whatever the reasons driving the disparities showing up in the wake of the COVID-19 pandemic, it’s clear that solutions are needed to attain the health equity that saves lives and reduces overall healthcare costs.
A Tool for Reducing Disparities
Healthcare is local. Factoring in local influences using data helps address the first mile of the healthcare journey so that we’re not getting to the last mile with fewer tools, worse outcomes, and deeper costs.
Location intelligence and niche data that is now available, allows us to get a better understanding of external influences that affect individual’s day-to-day behavior and how that behavior impacts their health.
This data-driven approach can be used to develop benefit and care plans that are more tailored to an individual’s needs in closing the existing gap between underserved populations and those with better access to healthcare services.
