We Can’t Fix Healthcare Inequity if We Can’t See It

By Amy Fellows, MPH, Senior Advisor at Pivot Point Consulting, a Jvion Partner

The Biden Administration has made racial equity a priority in its campaign to vaccinate America against COVID-19. Despite the best intentions and significant effort, disparities still exist. 

According to the latest data from the Kaiser Family Foundation, White vaccination rates are still 1.4 times higher than Black rates and 1.2 times higher than Hispanic rates. To be fair, progress has been made since the early days of vaccinations, but there’s still work to do. 

Why do these disparities persist, even after a year of national attention on the racial disparities in COVID-19 vaccinations, treatment, and outcomes? Because attention alone can’t solve these problems. To correct disparities in vaccinations or any other health outcome, we need to address the underlying cause: the unequal impact of social determinants of health (SDOH) stemming from racism.

Racism as a Public Health Threat

Racial disparities are not unique to health outcomes; they exist in access to housing, education, public transportation, nutritious food options, medical resources, and intergenerational wealth. Racial minorities also have more exposure to environmental toxins such as pesticides, lead, and air pollution. On top of that, centuries of toxic stress from racism affects the genes of those impacted, resulting in epigenetic impacts that span generations and have been linked to disproportionate suffering of chronic pain. 

All of these inequities in social determinants ultimately manifest in health inequities. This is part of the reason why, after years of activism, the CDC officially declared racism a public health threat this year. 

There are many ways social determinants can get in the way of optimal health outcomes. Consider, for example, a single mother who works two retail jobs to support her children. If she is to pay for rent and food, she can’t afford to take time off to get vaccinated. On top of that, imagine she lives in a rural area and doesn’t have a car, relying on coworkers to give her rides to work. How is she supposed to get to her vaccine appointment? She may also have low health literacy due to a limited education, and may believe the vaccine will harm her. Even with high health literacy, she may still be hesitant to get the vaccine after generations of trauma from racial bias and mistreatment in healthcare.

When you consider how variations of this story are repeated across millions of individuals, it becomes clear how social determinants like these can perpetuate the racial inequities in healthcare.

Taking Action on Social Determinants of Health

Fortunately, the industry has come to acknowledge the role social determinants play in driving health disparities. Over the last 20 years, health systems have invested billions into population health programs to address SDOH, including partnerships with food banks, housing systems and transportation services. 

But healthcare still has a long way to go in addressing SDOH. I know firsthand: I spent over a decade installing Epic EHR systems in safety net clinics and community health centers across Oregon. These providers treat the most vulnerable patients — those most impacted by SDOH.

But historically, SDOH risk factors are rarely captured in a meaningful way in the patient’s electronic health record (EHR). This means providers lack visibility into how SDOH factors impact their patients. Even if the EHR system includes some SDOH data elements or risk scores, they typically don’t provide the context to understand how SDOH factors impact their patients’ risk for negative outcomes or what can be done about them.

As a result, investments in population health have seen limited returns, failing to efficiently target the right individuals and communities. 

Health systems can’t effectively address social determinants if they don’t know where and how they present themselves, or what interventions will be most effective for different individuals and communities. We need a better way to connect the data we have on SDOH to the patients affected, and to the interventions that will make a difference.

This blog is based on a recent webinar co-hosted by Amy and Jvion’s Chief Product Officer Dr. John Showalter. Watch the full webinar here, and stay tuned for a follow up Q&A with Dr. Showalter to learn how AI can give healthcare organizations more visibility into the ways social determinants impact the health of the patients and populations they serve.

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