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Disparities and covid19 dfh
The document discusses health disparities in the United States exacerbated by the COVID-19 pandemic, particularly focusing on how these disparities disproportionately affect African American populations. It emphasizes the importance of understanding upstream and downstream social determinants of health, and advocates for the implementation of equity-driven solutions to address these disparities. Additionally, it highlights various secondary impacts of COVID-19 on public health, including mental health crises and reduced access to care.
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Disparities and covid19 dfh
- 1. What Can theCOVID-19 Pandemic Tell Us About Health Disparities in the United States? Debra Furr-Holden, PhD Associate Dean for Public Health Integration C.S. Mott Endowed Professor of Public Health Director, NIMHD-funded Flint Center for Health Equity Solutions Michigan State University, College of Human Medicine, Division of Public Health
- 2. Student Learning Objectives Studentswill be able to distinguish between health disparities and health inequities 01 Students will be able to distinguish between upstream, midstream, and downstream determinants of health 02 Students will understand current disparities in COVID-19 cases, deaths, and testing 03 Students will learn about innovative strategies to reduce COVID-19 disparities, as well as health disparities and inequities beyond COVID- 19 04
- 3. Background Definitions: Health Disparity •Healthy People 2020 defines a health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. • Camara Jones said health disparities are the differences in outcomes; when health disparities are eliminated, health equity will be achieved.
- 4. Background Definitions: Health Equity •Health equity, as defined by Healthy People 2020 definition, is the attainment of the highest level of health for all people. • Health equity, as defined by Camara Jones, Morehouse School of Medicine, is the assurance of the condition of optimal health for all people. • By the end of this conversation, you can create your own definition of health disparities and health equity.
- 5. Background Definitions: Social Determinantsof Health • As defined by Healthy People 2020, the social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. • Conditions (e.g., social, economic, and physical) in these various environments and settings (e.g., school, church, workplace, and neighborhood) have been referred to as “place.” • In addition to the more material attributes of “place,” the patterns of social engagement and sense of security and well-being are also affected by where people live.
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- 8. Upstream versus DownstreamDefined • The term upriver (or upstream) refers to the direction towards the source of the river, i.e. against the direction of flow. • The term downriver (or downstream) describes the direction towards the mouth of the river, in which the current flows. Source: thechartroom.com
- 9. A Few Examplesfrom the Field Upstream vs. Downstream in a Health Equity Framework
- 10. Source: https://hqc.sk.ca Obtained from:https://twitter.com/hqcsask/status/1106604911091990528/photo/1
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- 12. Upstream versus Downstreamin Health Equity Upstream The source of the river/disparities • What are these factors? Downstream The mouth of the river/the disparities • What are these factors? Source: thechartroom.com
- 13. Gaps in theField of Health Equity Health equity literature, leaders, and initiatives typically focus on what health equity is….. • …and (mostly) intervenes on (downstream) disparities. • …but not how we got here, i.e., how did we get to be such an inequitable society (in general and relative to health). • …but not how how we can achieve health equity (attainment versus assurance). • …but not the causes of the causes of health inequity (and in our society at large). Dare I start naming the ‘…isms’.
- 14. Disparities Facing Usduring COVID-19
- 15. COVID-19 is disproportionately affecting African Americans15% 33% 14% 42% 70% 41% 0% 10% 20% 30% 40% 50% 60% 70% 80% Illinois Louisana Michigan % Population % COVID-19 Deaths
- 18. Tremendous Racial Disparitiesin COVID-19 • Confirmed racial disparities in cases and deaths in multiple states and cities across the country…. …and a lack of data continues to fuel the debate • Confirmed racial disparities in cases and deaths in Michigan… …and at least we have shared the data/facts • Emerging racial disparities in Texas and many other places …and likely in many other cities and many for many other population subgroups
- 19. Why? Pre-existing health conditions Increasedexposure Medical mistrust Misinformation and/or misunderstanding Social determinants of health The Usual Suspects…
- 20. Explanations versus Algorithms • We haveaccepted these usual suspects/explanations • The explanations so far are not actionable • These explanations have influenced algorithms for who gets what • Screening • Mobile testing • Hospital admissions • DNRs • The algorithms are (I believe) attributable to excess morbidity and mortality literally killing people!
- 21. Solutions……??? 1. Pre-existing health conditions 2.Increased exposure 3. Medical mistrust 4. Misinformation and/or misunderstanding 5. Social determinants of health …Reorder the Algorithm!!!
- 22. Turn risk intopriority for continuum of care 3. Pre-existing health conditions 2. Increased exposure 4. Medical mistrust/race 5. Access to Primary Care 1. Social determinants of health
- 23. Take Aways STOP DESCRIBINGTHE PROBLEM AND START IMPLEMENTING SOLUTIONS MAP SOLUTIONS ONTO PRIORITIES (VS VARIATION IN CARE BASED ON RISK) FOCUS ON FACTORS WE CAN CONTROL/IMPACT. STOP BLAMING THE DISPARATE BRING A HEALTH EQUITY LENS USE DATA TO INFORM ACTIONS/INTERVENTIONS STRENGTHEN PUBLIC- PRIVATE PARTNERSHIPS
- 24. Other likely disparatepopulations OTHER RACIAL/ETHNIC MINORITIES PRISONERS OTHER INSTITUTIONALIZED POPULATIONS POOR SEXUAL MINORITIES UNINSURED ELDERLY UNDOCUMENTED RESIDENTS & NON-NATIVE ENGLISH SPEAKERS
- 25. Policy Initiatives Needed 1. Equity-Driven Access •Testing • Hospital admissions • Critical care (e.g., DNRs) 2. Equity-Driven Protections • E.g., Off label medications testing in prisoners and other institutionalized populations 3. Equity in Resource Allocation • Even if inequity is not built in, it’s the natural drift • Funding must require equity 4. Proactive (versus Reactive or Post-Hoc) Intervention
- 26. Student Learning ObjectivesMet? Students will be able to distinguish between health disparities and health inequities 01 Students will be able to distinguish between upstream, midstream, and downstream determinants of health 02 Students will understand current disparities in COVID-19 cases, deaths, and testing 03 Students will learn about innovative strategies to reduce COVID-19 disparities, as well as health disparities and inequities beyond COVID- 19 04
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- 28. Secondary Impacts ofCOVID-19 that We Are NOT Talking About A bonus session if we have time
- 29. COVID-19 Secondary Impacts that We AreNOT Talking About Management of pre-existing and new health conditions the impact of fear 1. People waiting longer than normal/suffering at home from non- COVID related illness == excess morbidity/worse outcomes 2. People dying at home from non- COVID related illness == excess mortality
- 30. COVID-19 Secondary Impacts that We AreNOT Talking About Lapses in primary care and preventive care 1. Primary Care visits are at an all time low 2. Vaccination rates are at an all time low 3. Potential for unusual disease outbreaks following COVID-19 (e.g., measles) 4. A less health nation possibly emerging following COVID-19
- 31. COVID-19 Secondary Impacts that We AreNOT Talking About Mental Health 1. Mental Health Care was already lacking 2. People are under tremendous COVID- related stress 3. How we manage death and dying has changed
- 32. COVID-19 Secondary Impacts that We AreNOT Talking About Behavioral Health 1. Care was already lacking 2. People are under tremendous COVID- related stress 3. Many Inpatient and Intensive Outpatient Programs had to ‘kick people out’ • Many were sent home with ‘bottles’ and no other care • Opioid overdose death is spiking in many places
- 33. How Are WeDoing in Michigan with COVID-19? A bonus session if we have time
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- 40. What’s happening at the locallevel COUNTIES ARE STANDING UP LOCAL TASK FORCES ADDRESSING GAPS IN TESTING AND DOING CONTACT TRACING ADDRESSING DISPARITIES/INEQUITIES
- 41. Bottom Line THINGS AREMOVING IN THE RIGHT DIRECTION STILL TOO EARLY TO TELL, CAUTIOUSLY OPTIMISTIC BEST STRATEGY IS TO CONTINUE TO PRACTICE GOOD PUBLIC HEALTH (I.E., PROTOCOLS, TESTING, CONTACT TRACING)
- 42. The Cliff ofGood Health By Camara Jones https://www.youtube.com/watch?v=to7Yrl50iHI
Editor's Notes
- #4 SOURCES: https://www.ncbi.nlm.nih.gov/books/NBK540766/ (Camara Jones); https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities (Healthy People 2020)
- #5 SOURCES: https://www.ncbi.nlm.nih.gov/books/NBK540766/ (Camara Jones); https://www.healthypeople.gov/ (Healthy People 2020)
- #6 SOURCES: https://www.ncbi.nlm.nih.gov/books/NBK540766/ (Camara Jones); https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health (Healthy People 2020)
- #9 Obtained from: https://thechartroom.co/2019/05/20/are-we-travelling-upstream-or-downstream/
- #11 https://twitter.com/hqcsask/status/1106604911091990528/photo/1
- #12 https://www.slideshare.net/NCCMT/methods-and-tools-for-integrating-health-equity-into-public-health-program-planning-and-implementation
- #13 Obtained from: https://thechartroom.co/2019/05/20/are-we-travelling-upstream-or-downstream/
- #20 Pre-existing health conditions Increased exposure (e.g., essential workers) Medical mistrust Misinformation and/or misunderstanding Individual determinants of heath Social determinants of health (e.g., poverty, access to care, transportation)
- #35 from bridgemi.com