In the last 100 years, we have made incredible advances in health care, advances that will be considered miraculous for any previous generation. To select an example is Life expectancy of the United States in 1950 was 68.2 years. We have since added ten years to this average. Social programs have helped young and old, two of the most vulnerable populations, gain unprecedented levels of care and attention. And telemedicine has decoupled the health support and surveillance of many Americans from brick hospitals and expanded access to care.
Yet in spite of these advances and in spite of easy expenditure on other OECD nations in health care, The United States maintains large health disparities. As James Madara, Executive Director and Executive Vice President of the American Medical Association, wrote on the organization’s website: “The American health care system that exists today is a ton of ideas, programs, and rules that are both extraordinarily expensive and very ineffective. And despite its size and technological advances, our health care system is plagued by huge gaps. and inequalities that favor some groups while unfairly favoring others. “
Our current situation has its origins in tectonic sociohistorical forces that have shifted and broken the health landscape. For those at the top, access to superior care, education, resources and social networks serve to protect their health. For those in the gorges, the earth continues to weather with each passing and ongoing crisis – consider, for example, the disproportionate fallout from the dissolution of the Mental Health Systems Act.
Then came COVID-19.
COVID-19 elaborates on US health inequalities
Societies on the harmful side of America’s health inequalities have their unique stories, environments, and social structures. They are spread all over the United States, but they all have one thing in common.
“There’s a common divide in American society, and that’s poverty,” he said Debbie Salas-Lopez, MD, MPH, senior vice president of community and public health at Northwell Health. “It is the undercurrent that manifests poor health, poor health outcomes or poor health forecasts for future well-being.”
Social determinants have far-reaching effects on health, and poor societies have unfavorable social determinants. To choose one of many examples, food insecurity reduces access to quality foods, leading to ill health and common endemics of chronic medical conditions. The U.S. Centers for Disease Control and Prevention has identified some of these conditions, such as obesity and type 2 diabetes, that increase the risk of developing a serious case of coronavirus.
The pandemic did not create poverty or food insecurity, but it exacerbated both, and the results have been catastrophic. A study published this summer in Journal of General Internal Medicine suggested that “social factors such as income inequality may explain why some parts of the United States are hit harder by the COVID-19 pandemic than others.”
That is not to say that better-off families in the United States were not harmed. ONE paper from the Center for Economic Policy Research noted that families in counties with higher median incomes experienced adjustment costs associated with the pandemic – for example, lowering income-earning interactions to adapt to social distance policies However, the paper found that the cost of social distance was much higher for poor families who could not easily change their living conditions, which often include more people living in a home and a reliance on mass transit to reach work and grocery stores. They are also disproportionately represented in important jobs, such as retail, transportation, and healthcare, where maintaining physical distance can be anything but impossible.
The paper also cited a positive correlation between higher income inequality and higher rates of coronavirus infection. “Our interpretation is that poor people are less able to protect themselves, leading them to different choices – they face a steeper compromise between their health and their economic well-being in the context of the COVID-19 threats,” the authors wrote.
“There are so many pandemics that this pandemic has worsened,” noted Dr. Salas-Lopez.
An example is the gap between health and prosperity. The mental stressors of maintaining a low socioeconomic status, especially in the face of extreme prosperity, can have a physically degrading effect on health. Writing on this hole, Robert Sapolsky, professor of biology and neurology at Stanford University, notes that socioeconomic stressors can increase blood pressure, reduce insulin response, increase chronic inflammation, and impair prefrontal cortex and other brain functions through anxiety, depression, and cognitive strain.
“Thus, from the macro level in whole body systems to the micro level in individual chromosomes, poverty finds a way to produce wear and tear,” writes Sapolsky. “It’s outrageous that if children are born into the wrong family, they will be prone to ill health when they start learning the alphabet.”
Research into the economic and mental health of COVID-19 shows two things: That unemployment is hitting low-income and young Americans most during the pandemic, potentially widening the gap between health and prosperity further; and that the pandemic not only exacerbates mental health stressors, but does so at clinically relevant levels. As the authors of a review wrote, the effects of the pandemic on mental health are in themselves an international public health priority.
We need to find ways to unite this country, because we are all human. We are all created equal and we believe that health is one of these important rights.
Working to close the health gap
Northwell Health coronavirus test center at Greater Springfield Community Church.
Credit: Northwell Health
Roman coronavirus can spread and infect indiscriminately, but pre-existing conditions, environmental pressures and lack of access to care and resources increase the risk of infection. These social determinants make the pandemic more dangerous and destroy the ability of communities and families to heal from health crises that precede the pandemic. How do we eliminate these differences? Dr. Salas-Lopez says the first step is recognition. “We have to open our eyes to see the suffering around us,” she said. “Northwell has not been disappointed by that.” “We are determined to improve the health outcomes of our vulnerable and underrepresented society, which has suffered from the prevalence of chronic disease, a problem that led to the disproportionately high death rate among African Americans and Latinos during the COVID-19 pandemic,” he said. Michael Dowling, Northwell’s President and CEO, “We are committed to using every tool at our disposal – as a healthcare provider, employer, buyer and investor – to fight differences and ensure the equal care that everyone deserves.” Recognized, Dr. Salas-Lopez urges health systems to travel upstream and be proactive in hard-hit communities, requiring health systems to play a strong role, but not a one-sided one. They need to partner with leaders in those communities and use them to ensure that conditions last beyond the current crisis. “We need to meet with community leaders and talk to them to get their perspective on what they believes that the needs of society are and must be for the future. Together we can create a plan for measurable improvement [community] Northwell has built relationships with local faith-based organizations and community organizations in underserved color communities. These partnerships enabled Northwell to test more than 65,000 people across the New York metro area. The health system also offered training on coronavirus and precautions to slow the spread. These initiatives began the process of building trust – confidence that Northwell has expected to return to these communities to administer flu vaccines to prepare for what experts fear could be a difficult flu season. While Northwell has begun building bridges over the divisions of the New York area, much remains to be done to heal American health care in general. There is hope that the COVID pandemic will awaken us to the profound differences in the United States. “COVID has changed our world. We have to seize this opportunity, this pandemic, this crisis to make it better,” said Dr. Salas-Lopez. “Give better care. Give better health. Be better partners. Be better citizens. And treat each other with respect and dignity.” We need to find ways to unite this country because we are all human. We are all created equal and we believe that health is one of the most important rights. “