The COVID-19 pandemic has shined a harsh light on the inequities that plague healthcare in the U.S. Many people were stunned to realize that the mortality rate from COVID-19 has been far higher for black and brown Americans than for their white counterparts—more than double, according to recent data. Researchers and policymakers understand that people of color and poor people of all races are dying in this country because medical care can't make up for things like substandard housing, food insecurity and jobs that cannot be done remotely.
But as we take steps to protect the country against a second surge of the virus, we can make real headway against these inequities. If we're smart about it, the changes we make now can put whole swaths of our country in a position to enjoy better health for the rest of their lives.
For instance, one reason for the novel coronavirus' disproportionate impact is that, early on, disadvantaged communities had less access to diagnostic testing. In the New York metropolitan area, people could go to a drive-thru site for testing … if they had a car. If not, they could forget about social distancing and stand in line for hours, in many cases uncomfortably close to others while they waited.
To ensure that the most vulnerable have the information they need to keep themselves safe, we have to provide disadvantaged areas with an ample supply of small testing centers. There are many ways to do this. Northwell Health has been working since mid-May with the New York State Department of Health and local pastors to offer COVID-19 testing at churches in primarily minority neighborhoods throughout New York City, Long Island and Westchester County. Health systems can also collaborate with community-based organizations, or simply post nurses at community centers or small storefronts. The key is to identify the communities that are most vulnerable and flood the zone with the care they need.
We also must make sure that everyone can take advantage of one of the few gifts bestowed by the pandemic: the explosive growth of telemedicine. This important new approach has taken off thanks to the (temporary) loosening of federal restrictions on the use of this approach, a new willingness on the part of Medicare and many commercial insurers to provide reasonable reimbursement, and numerous grants and awards from HHS and others. There's a good reason this innovation is being welcomed by regulators. For people who are elderly or chronically ill or who don't have a car or easy access to public transportation, being able to visit the doctor without leaving home can be life-saving. Telemedicine allows them to get care without risking exposure to infection.
The loosened regulations should be made permanent. Even so, reaping telehealth's benefits requires internet access; without it, this advance just creates a new kind of disadvantaged class. So when New York City schools moved to remote learning, the NYC Department of Education worked with Apple and T-Mobile to provide broadband-enabled iPads to 300,000 students who otherwise wouldn't be able to do their work. That's just one possible model—another might see Medicaid paying for members' internet access, just as some insurance companies already do for policyholders' gym memberships. Whatever the approach, universal internet access is essential if we're to reduce health disparities in today's world, not only because it allows everyone to take advantage of telemedicine but because it opens the door to online learning, job boards and the like. More education and better jobs are gateways to better health.
Finally, while we wait for better treatments and, hopefully, a vaccine, we need to be thoughtful about how we provide information—the best weapon we currently have against the new coronavirus. Healthcare institutions need to be sure that when they give out advice, they use their target audience's preferred language, avoiding scientific jargon and complicated terminology. That's especially important because the pandemic shut down many of the places where people with limited education or proficiency in English could get reliable information in a language they could easily understand, like community-based organizations and religious institutions. Technology can help here—Northwell uses an artificial intelligence-based chatbot to deliver infection test results and other important information in patients' preferred language and at the appropriate health literacy level. There are other similar tools, and the time to use them is now.
Like any virus, this coronavirus exploits its host's vulnerabilities. In the U.S., it attacked the most vulnerable through the cracks of our social infrastructure. If we embrace the opportunity now to mend those fractures, we can make our community better able to withstand the coronavirus and the future challenges that will surely come along.
