Visible Hands: Liberty and Healthcare for All 😷
There are huge gaps in health equity. Racial and ethnic health disparities appear deeply rooted in the US. What can we do?
We’ll start with some grim statistics on health disparities. According to the CDC, Black and Hispanic Americans are 3x as likely to be hospitalized and 2x as likely to die from COVID-19 versus a white, non-Hispanic American. Native Americans are 4x as likely to be hospitalized and have the highest likelihood of death. Depressingly, though perhaps unsurprisingly, racial disparities have persisted in the vaccine rollout with communities of color receiving a smaller share of vaccinations. What does this mean?
The myth around patient mistrust: When talking about gaps in healthcare for Black, Indigenous, and people of color (BIPOC) communities, we often hear a story around “mistrust”. However, this Health Affairs article (a must read for anyone passionate about health / racial equity) repudiates this notion. The authors highlight that health inequities are “less about what patients have failed to feel and more about what systems have failed to do.”
So if this is a systems problem, what are some of the underlying issues?
In looking at COVID-19 vaccination, public health experts emphasized disparities in access “Black and Hispanic Americans are less likely than their white counterparts to have internet access reliable enough to make online appointments; to have work schedules flexible enough to take any available opening; and to have access to dependable transportation to vaccine sites, among other factors.”
Social determinants of health matter: There has been a growing focus on addressing the Social Determinants of Health (SDoH). SDoH reflects conditions, from socioeconomic status to transportation access, that affect health, functioning, and quality-of-life outcomes and risks. And yes, social norms and attitudes (e.g., discrimination, racism, etc.) and language have all been deemed health determinants by the US government. The injustices in our society have very tangible negative impacts on the health of our nation.
As health disparities have become more apparent, there has been more incentive to develop and invest in solutions that address the factors that affect a patient’s health. Several tech startups, such as Unite Us and Eccovia, have emerged to connect the dots between social service organizations and the healthcare system. However, let’s remember that software alone is not going to solve racist societal structures.
Let’s take one SDoH, language: Turning to language access specifically, there are huge gaps in healthcare despite the existing legal protections. According to the Pew Research Center, almost half of all immigrants above the age of 5 are not proficient in English 67 million Americans speak a language other than English at home!
And let’s remember, English is not the official language of the United States. Language barriers are considered discrimination based on national origin and thus violations of Title VI of the 1964 Civil Rights Act in industries like healthcare where basically every player receives federal financing.
Most of today’s digital health solutions are geared towards the dominant culture in the US -- white, English-fluent patients. Hot digital health companies like Carbon Health only have language services in “beta” mode, even after raising hundreds of million in VC funding and operating in some of the most linguistically diverse markets in the US. How much of this capital is going towards services that actively increase health equity?
Though machine translation tools like Google Translate may be potentially useful in healthcare, the accuracy is not currently good enough. Yet, that’s often all we have. Take COVID vaccination websites -- Los Angeles County, which has one of the most diverse populations in the US, has a website entirely powered by Google Translate. In contrast, San Francisco County has dedicated pages in a handful of popular languages that appear professionally translated. How can we make sure there are resources to support access for all Americans?
Language is just one of a myriad of problems: We don’t have time to go into the implications of healthcare affordability or the uninsured rates within communities of color or the long list of other SDoH.
It is clear that governments, businesses, and our entire country can and should do more for health equity.
As a consumer (assuming we’re all consumers of the COVID-19 vaccine!):
For COVID-19 vaccination specifically, check out The Conversation by Greater than COVID for information for the Black community, by the Black community. Check out their full op-ed about fighting misinformation here.
For multilingual content regarding the COVID-19 vaccination in five different languages, check out VaxMyFam.org. More details about the site and its services can be found here. [Note: one of our writers worked on this initiative.]
As an investor:
Develop and invest in solutions that truly increase access. Just a couple in the context of healthcare: Cityblock Health, a company focused on serving low-income communities, became a unicorn last year. ConsejoSano, a startup focused on multicultural patient engagement, just raised their Series B.
As a citizen:
The Kaiser Family Foundation (KFF) is at the forefront of research on health disparities, so support their work with a donation! We have referenced their research at multiple points in the above article. (Note: KFF is not associated with Kaiser Permanente or Kaiser Industries in any way.)
We each have a role to play in anti-racism. To quote the aforementioned Health Affairs article, “Closing the gap in racial health outcomes in the United States will only be accomplished by identifying, confronting, and abolishing racism as an American tradition and root of inequity.”
As an employee:
If you work for a healthcare company (or frankly, any company that provides products or services to a diverse population), ask if there is language inclusivity. As a starting point, Centers for Medicare and Medicaid Services has put out this guide for language access planning.
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