By Lisa Mitchell-Bennett, Special to the Herald
Some of the first high profile cases of COVID-19 positives included the rich and famous. Senators, professional athletes and governors have been affected by this horrible virus. It’s surprising and even scary that even folks with the best access to healthcare and resources have not escaped the pandemic, and have even, some would argue, been
more significantly affected by it in its first wave.
This is mostly due to their access to testing (which is still not widely available to most Americans) and perhaps initially their likelihood of travel. However, let us not underestimate the potential second wave, which is likely to ravage less privileged folks.
Despite having the most expensive health care system in the world, the United States ranks last overall among 11 industrialized countries on measures of health system equity, quality, efficiency, access to care, and healthy lives, according to a new Commonwealth Fund report. “Health Equity” is defined by the American Public Health Association as “….the opportunity everyone has in a society to attain their highest level of health”.
While individual health care providers, especially in times of crisis, are heroes and we are all grateful for their sacrifice, as a system, our healthcare has a long way to go.
We know that COVID-19 will ultimately affect the poor more than the wealthy in both the short and long term. It always does and already has. It may be that the virus does not discriminate against the higher income folks right now in terms of transmission, but the impact of an economy at a near standstill, unemployment and the burden on our already inequitable healthcare system, is harder on those who already struggled prior to the pandemic.
It is well proven that our health is determined, in part, by access to social and economic opportunities, especially in this country. These disparities have fueled a new thinking that cuts across the disciplines of health, education, housing and economics called “Social Determinants of Health (SDOH)”.
Although the healthcare system in the United States is not currently designed to address SDOH, this pandemic may push us to rethink our disjointed, privatized relic of health care design which still relies on a system of expensive, employer-based insurance (even though the majority of working people in many regions are still uninsured) and its focus on intervention versus the more affordable practice of prevention.
Prevention can mean opportunities for healthy living, and it can also mean the ability for a healthcare system to be nimble and equitable in terms of response to crisis. How does all of this affect our ability to control and prevent the spread of a virus like COVID-19? It makes it very difficult indeed.
A recent report by the Community Reinvestment Corporation called ‘Wealth and Health’ explains SODH best: “Health starts in our homes, schools, workplaces, neighborhoods, and communities. We know that taking care of ourselves by eating well and staying active, not smoking, getting the recommended immunizations and screening tests, and seeing a doctor when we are sick all influence our health.
Our health is also determined in part by access to social and economic opportunities; the resources and supports available in our homes, neighborhoods, and communities; the quality of our schooling; the safety of our workplaces; the cleanliness of our water, food, and air; and the nature of our social interactions and relationships. The conditions in which we live explain in part why some Americans are healthier than others and why Americans more generally are not as healthy as they could be.”
Locally, our county and some city governments have taken bold and necessary steps to contain the spread of COVID-19, and should be lauded for their relatively early and proactive response. This is especially crucial in an area like the Rio Grande Valley, where the poor outnumber the wealthy, and well over half of the population has no health insurance or income safety net.
While handwashing, sheltering in place, face coverings and even strict policies enacted by authorities to contain the spread of the virus are key conversations, what’s missing is the discussion about the conditions in many of our communities related to SDOH and health equity, which put us all at higher risk and contribute to the spread of viral infections as well as chronic disease.
The impact of Zika, Influenza, and now COVID-19 are exacerbated by poverty, access to paid leave, health insurance, housing conditions and food insecurity. In fact they directly contribute to the spread of infectious disease. Outcomes are also worsened by our higher rates of chronic disease like diabetes, heart disease and asthma. Lower income communities of Latino and Black majorities across the countryhave higher rates of these conditions due to the SDOH factors explained above. These also happen to be conditions that increase complications and decrease the odds of recovery from COVID-19.
This pandemic is an opportunity for us to rethink and review our society through a health equity lens. There are many businesses, small and large, needing a societal safety net to get through this crisis. Individuals as well will need assistance and a coordinated system of care. Much as many of us are using this time to reconnect with our families and reflect on our priorities, I am hopeful we can address the Social Determinants of Health in order to improve public health now and curb the spread of diseases in the future.
But for now, kudos to our local leaders for taking swift and certain measures to protect our community from a virus that has the potential to ravage our families, even more so than in wealthier communities.
We are more vulnerable here due to social determinants of health causing high rates of chronic disease. We must all do our best now to shelter in place and comply with sound public health regulations, and support the many folks who have been made more food insecure and vulnerable by losing their income, so we can survive to a future where we focus on designing a more equitable system in which everyone has a shot at being healthy! Because TuSalud ¡Si Cuenta! (Your Health Matters!)
