Racial and ethnic disparities in COVID-19 outcomes lead experts to explore the root causes of health care inequities, and discuss solutions.
The health care industry has long recognized an awful truth: Race and ethnicity have a significant impact on a person’s health. The COVID-19 pandemic accentuated this unfortunate reality and has disproportionately impacted underrepresented and historically marginalized populations, Black and Latinx communities in particular.
To explain the factors that create disparities in health and the urgent need to address them, Kaiser Permanente and the Commonwealth Club of San Francisco jointly hosted a panel discussion featuring health equity experts. “Driving Equity in Health Care” was the fourth event in the Destination Health series.
Greg A. Adams, chairman and CEO of Kaiser Foundation Health Plan and Hospitals, acknowledged that the pandemic revealed fractures that exist in our society. He said the events of 2020 provided an opportunity to look internally at Kaiser Permanente, listen to people’s experiences related to systemic bias, and renew the organization’s commitment to fight racism and promote equity.
Kaiser Permanente’s total health approach includes providing culturally responsive care that attends to social needs, while advancing equity and addressing systemic racism. Kaiser Permanente is committed to leading the industry in developing and implementing innovative approaches to improve health equity and eliminate disparities in health care quality and access.
“Kaiser Permanente is an amazing organization that’s been around for 75 years. And for 75 years we've been on a path and a journey to really embrace diversity and inclusion and social justice,” Adams said. “We made a commitment that, as we develop a plan to own what we saw in our organization, that we would also stand up, look out, and be a voice for greater diversity and inclusion in our society.”
The panelists discussed the root causes of health care inequities, along with the efforts underway to address them, which have taken on new urgency during the pandemic.
Ronald Wyatt, MD, vice president and patient safety officer for MCIC Vermont, said, “We need to go back through the pain of history to understand where we are now. The social determinants of health are not new. This is the stuff that’s been killing us for hundreds of years: environmental racism, segregated housing, underappreciated jobs, and the list goes on.”
Vice president and chief equity and inclusion officer for Massachusetts General Hospital, Joseph Betancourt, MD, MPH, said he and his team anticipated that the pandemic would disproportionately impact communities of color, so they took steps to address the specific challenges they knew these groups would face.
Dr. Betancourt emphasized how important it was to have native Spanish-speaking representatives who understood both the language and the culture of the patients they were serving during the crisis. “We brought clinical, cultural, and linguistic competence to the encounter, and our colleagues really saw the importance of diversity in the health care workforce in ways they never understood it before.”
Ronald Wyatt, MD, vice president and patient safety officer for MCIC Vermont
“The social determinants of health are not new. This is the stuff that’s been killing us for hundreds of years.”
The panelists also talked about the complexities of public health efforts to put equity at the center of COVID-19 vaccination programs. It’s important that the communities hit hardest by the virus are among the first to be offered the vaccine, but many people in those communities are hesitant to get vaccinated. Physicians and other health care workers must act as trusted messengers, communicating that the data shows the COVID-19 vaccines are safe and effective.
Leana Wen, MD, emergency physician and visiting professor of health policy and management at George Washington University School of Public Health, said it is crucial to show understanding and empathy as we work to build trust with communities of color.
We need to acknowledge that fears and concerns about the COVID-19 vaccine are rational, based on people’s lived experience, said Aletha Maybank, MD, MPH, chief health equity officer and group vice president for the American Medical Association.
“We aren’t going to solve the realities around people not wanting to get vaccines without focusing on the systems and structures,” Dr. Maybank said. She pointed to a history of dangerous, racist health policies and clinical experiments as cause for concerns around the vaccine, and emphasized that we must address the real and perceived racism within our health care and public health systems to increase vaccination rates among underrepresented groups.