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The Systemic Flaw that is Health Inequity

April 15, 2020
5:51 pm

During times of crisis, a point of structural weakness becomes glaringly visible and vulnerable.  The COVID-19 pandemic has placed a spotlight on the inequities that exist in this country when it comes to health and well-being.  The importance of the social determinants of health is more apparent than ever.

As concerns grew about the virus spreading, the predominant proportion of white collar workers could storm the grocery stores and then settle in for the long haul in front of their laptops.  Meanwhile, blue collar workers began losing jobs and health protection, or were forced to work in hazardous conditions, constantly at risk of exposure to the virus.  Available data is making clear the socioeconomic divide that COVID-19 has laid bare.  In New York City, the bottom income quadrant accounts for 36 percent of all coronavirus cases in the city while the top quadrant accounts for just 10 percent.

Those who have no choice but to risk exposure in order to receive a paycheck, or conduct daily life activities like visit a laundromat or make frequent trips to the grocery store because they don’t have the money to stock up the pantry, are the ones who have the least access to quality healthcare to protect their lives.  People in low-income jobs, or who have lost their job during the pandemic, face hospitalizations with high out-of-pocket costs if they become sick.  They also frequently don’t have the support systems to help them in the event of serious illness.

As this virus has a greater impact on those who are less able to achieve social distancing, it’s creating a greater awareness of the work that needs to be done on social determinants.  The World Health Organization has provided examples of the factors that, besides clinical care, play a role in population health.  Safe and affordable housing, access to education, public safety, availability of healthy foods, local health services, toxic-free environments – all have a tremendous effect on our health and longevity and too many Americans are lacking some or all of these determinants.

The good news is that the healthcare industry is devoting considerable resources and attention to addressing health disparities and the social determinants of health.  The Healthcare Leadership Council has held a national summit on the issue and issued a report with specific recommendations.  And, on the ground, we’re seeing multiple initiatives that are demonstrating how community health programs, telehealth services, and expanding the definition of health benefits to include commodities like housing and transportation are making a difference in the lives of vulnerable populations.

The COVID-19 crisis is making it clear that we need to accelerate these efforts.

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