How to address minority health inequities exposed during Covid-19

The demonstrations against racial inequalities currently sweeping the globe, along with the continual spread of the coronavirus across the world, is shining a spotlight on an already serious problem the public health community has been fighting for years: health inequity in minority communities.

These groups have long endured limited access to care and a greater likelihood of experiencing chronic conditions, such as diabetes, heart disease and obesity. Adding Covid-19 to the mix is now amplifying the effects, as we’re witnessing higher rates of infection and death from Covid-19 among African Americans, Hispanics and rural residents.

The Vulnerable Become Even More Vulnerable
Overall, large life expectancy gaps occur most frequently in cities that have higher levels of racial and ethnic segregation. Looking at differences by ethnicity, it’s clear that chronic conditions disproportionately impact minorities, too. The U.S. Centers for Disease Control and Prevention (CDC) reports that nearly 44% of African American men and 48% of women have some form of cardiovascular disease. And, they are 30% more likely than white patients to die prematurely from heart disease and two times as likely to die prematurely from stroke. Obesity, which has many associated chronic diseases, also impacts minorities more so than others. Hispanic children ages 2 to 19 had the highest prevalence of obesity in the U.S. (21.9%), while Mexican Americans, specifically, suffer more from diabetes than other Hispanics.

Adding to the problem is the likelihood of minority groups to delay or go without needed care. A recent study noted that African American and Hispanic adults are less likely than white adults to have a usual source of care or have had a health visit in the past year. And those living in rural areas face a range of barriers accessing care, from proximity and availability of providers to lower income and lack of insurance coverage.

These inequities take an economic toll, too. It estimated that disparities cause about $93 billion in excess medical care costs and $42 billion in lost productivity annually, not to mention economic losses due to premature death.

Covid-19 Has Worsened the Impact
A variety of studies released in the last few months have looked at the impact of Covid-19 on minority groups. The results are sobering.

Research published in mid-April in JAMA has highlighted that African-Americans are more at risk from contracting Covid-19, as well as dying from it. A survey of predominantly black U.S. counties showed an infection rate of 137.5 out of 100,000 people (3x higher) and a death rate of 6.3 out of 100,000 (6x higher) than predominantly white counties. Another study also noted that African Americans accounted for a higher share of confirmed cases and deaths compared to their share of the total population. Hispanics and Asians had similar results in some states as well.

Further, new Medicare Covid-19 data shows more than 325,000 Medicare beneficiaries had a diagnosis of Covid-19 between January 1 and May 16, 2020. This translates to 518 Covid-19 cases per 100,000 Medicare beneficiaries. In addition, the data indicates that nearly 110,000 Medicare beneficiaries were hospitalized for Covid-19-releated treatment, which equals 175 Covid-19 hospitalizations per 100,000 Medicare beneficiaries. And, blacks were hospitalized with Covid-19 at a rate nearly four times higher than whites.

The disparities presented here go beyond race/ethnicity and suggest the impact of social determinants of health, particularly socio-economic status.

Digital Health Bridges the Gaps in Vulnerable Communities
These statistics seem grim and possibly difficult to overcome. But in today’s healthcare environment, it shouldn’t be this way. Healthcare’s shift to value-based, patient-centered care can help address the shortcomings by holding providers’ accountable for quality of care. However, value-based care depends on continuous assessments of quality and outcomes – something that can be hard to achieve when these groups generally lack sufficient access to healthcare services.

Today, there is an urgent need to expand the use of digital health to help vulnerable populations who still require routine care in the face of a pandemic. Digital health could be a great equalizer, providing opportunities for all people to receive care.

Take remote patient monitoring (RPM), for example. RPM tools have been used successfully to assist clinicians and promote patient-centered care. According to the Centers for Medicare & Medicaid Services (CMS), “RPM services support the CDC’s goal of reducing human exposure to the novel coronavirus while also increasing access to care and improving patient outcomes.” Most importantly, such technologies support the goals of data-driven healthcare and improvement of overall population health.

In addition, widely available education is crucial. Poor management in underserved communities has become more normalized, but it is important to recognize that inequalities in outcomes are a symptom of inequalities in opportunity and access. Digital health education that is accessible to the patient at home or on their smartphone is one way we can bridge the divide. Whether digital health education is administered through your community center, your pharmacy, or your primary care doctor, we must change this narrative. And we can start by providing a framework with which providers can address the causes of disparities in various educational settings.

In all, while the coronavirus pandemic has exposed the challenges and threats that rural communities and minorities face with regard to accessing care and addressing chronic conditions, solutions exist to help overcome these hurdles. What we need now is for HHS, CMS, and Congress to permanently remove restrictions that prevent full utilization of currently available technology in rural areas. In order to create a better health system of tomorrow, we need every voice and mind involved.

Photo: Ada Yokota, Getty Images

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