The experience of COVID-19 over the past two and a half years has taught health policymakers a number of important lessons. One of the most important is the clear evidence that, despite efforts in recent years to increase access to quality health care for all, the health equity gap remains.
And that gap was significant during COVID-19. The rates of test-confirmed COVID-19 diagnosis and exposure, hospitalization and death in New York City all show significant racial and ethnic disparities. However, the gap was not limited to COVID-19. These results reflect pre-existing differences in the social determinants of health — things like education, jobs, and neighborhood characteristics — which together generally lead to poorer outcomes for affected populations.
Of course, it’s one thing to identify a problem, but it’s another thing to find a solution. And because of all these moving parts, the health equity puzzle is complex. For a long time, policy makers focused on coverage, the idea being that the fundamental problem of health equity was that some populations had no means of paying for care. And it all had a positive impact. But that hasn’t solved the problem of health care disparity. Admittedly, hedging issues persist. But evidence also suggests that even where coverage is available, some people are still not getting the care they need.
And policymakers, payers and providers are starting to respond. When it comes to social determinants of health like education, housing, food, childcare, etc., policymakers encourage – and in some cases mandate – relationships between providers and community organizations that provide a variety of these social supports and services. Providers, in turn, build these relationships, recognizing that this is not only a mechanism for improving the health of the general population, but also for improving provider bottom lines in an environment where they are paid for patient outcomes rather than units of service.
These efforts are also closely linked to cultural competence. Not only do health care service providers and social determinants of health need to consider these social determinants, but they need to do so in a way that encourages diverse populations to use available services. Perhaps the most obvious factor here is language – if people can’t find a provider that speaks the same language, they’re less likely to search for services. But it goes far beyond that – they also need providers who understand their cultural assumptions. On a more fundamental level, studies have shown that patients respond better to providers who simply look like them.
And cultural competence is not limited to race and ethnicity. Several providers have had great success in delivering services (sometimes in partnership with community organizations) focused on serving the LGBTQ population. Increasingly, providers are also recognizing the value of focusing on providing care for people with disabilities – including physical disabilities, behavioral disorders, or developmental disabilities. Very often, these are the most expensive populations, so improving their reach can often yield the most positive results both substantively and financially.
But perhaps more importantly, a newly reinvigorated state health department is aiming for health equity in a much more coordinated way as part of a broader reorganization. The new Office of Health Equity and Human Rights which will connect previously unconnected resources to the department in a way that promises to focus on cultural competence and the social determinants of health in a truly comprehensive way .
As policy makers increasingly focus on these issues, it would behoove providers to do the same, as reimbursement systems, state subsidies and monitoring increasingly take into account health issues. health equity. A system that generates better outcomes for diverse populations will benefit not only patients, but also providers’ bottom lines.