May 2020
Health Equity: Before, During and After COVID-19
By: Dr. Derek J. Robinson, M.D., MBA, FACEP, CHCQM, Vice President and Chief Medical Officer, Blue Cross and Blue Shield of Illinois (BCBSIL)
In the wake of shelter in place with shuttered beauty salons and office practices alike, our communities have looked for signs of progress during the COVID-19 pandemic and wondered when we will get back to our normal way of living. Daily reports on how many people have tested positive, how many are hospitalized, how many ventilators are available, and how many people have died – all have become the new norm. Yet, as inpatient volumes have decreased to create surge capacity, the suffering and fight for survival in emergency departments and critical care units has illuminated an alarming picture.
In the spotlight of the COVID-19 pandemic, we’ve seen startling racial disparities in COVID-19 infection and death rates in Chicago, across Illinois, and in other locations across the country. In Chicago, as of the date of publishing, the African American community has the highest infection rate and 65.9% of deaths from COVID-19, nearly five times the death rate of any other racial/ethnic group reported by the Chicago Department of Public Health.1 Across Illinois, this community has experienced 34.2% of all COVID-19 deaths according to the Illinois Department of Public Health.2
When we think back to what we considered to be normal life before COVID-19, we realize that many of the same communities across Illinois that are experiencing higher COVID-19 transmission rates have also experienced shorter life expectancies, disproportionately high rates of infant mortality and concentrated poverty. In Chicago, we may recall contemporary studies of the far reaching impact of community disinvestment, and life expectancy gaps by neighborhood that stretch wider than those of any city across America.3 This is a “normal” that needs to change.
As health care professionals, we understand that social determinants of health are major drivers of health outcomes, largely falling outside of health care delivery. The Centers for Disease Control and Prevention (CDC) website identifies people at higher risk, with an emphasis on racial and ethnic minority groups. “Addressing the needs of vulnerable populations in emergencies includes improving day-to-day life and harnessing the strengths of these groups.”4 Access to quality health care is an important factor in improving health outcomes and we all have important roles to play.
The CDC lists recommendations for what health care systems and health care providers can do, such as implementing “standardized protocols in accordance with CDC guidance and quality improvement initiatives, especially in facilities that serve large minority populations.” The CDC also notes the importance of being aware of social and economic conditions, reducing potential cultural barriers, addressing implicit bias, connecting patients with community resources and encouraging patients to ask questions.5
Health care providers play a critical role in preventing and improving the health of all individuals living with chronic medical conditions. This is one of the reasons BCBSIL is progressively and steadily starting to include the reduction of health care disparities in its value based care programs. We’ve also added a Health Equity and Social Determinants of Health section on our Provider website, where you’ll find resources such as a list of ICD-10 Z codes for social determinants of health that may be included on claims.
Health equity is an important element of quality that has too often been overlooked, at the risk of health for vulnerable populations. The perils of the status quo, and our nation’s seeming acceptance of social inequity and health disparities in a variety of contexts, reminds us of what Dr. Martin Luther King, Jr. described as the ‘inescapable network of mutuality,’ noting that we are ‘tied in a single garment of destiny. Whatever affects one directly, affects all indirectly.’
Our efforts to help change the status quo must accelerate across areas of action. As we try to see beyond the pandemic and current economic turmoil, we also must address injustices in the social determinants of health, so that all individuals can be resilient and achieve their best possible health.
Learn more about Dr. Derek J. Robinson
1 CDPH, Data and Reports, Latest Data. Accessed May 4, 2020, at https://www.chicago.gov/city/en/sites/covid-19/home/latest-data.html.
2IDPH, Coronavirus Disease 2019 (COVID-19), COVID-19 Statistics. Accessed May 4, 2020, at https://www.dph.illinois.gov/covid19/covid19-statistics.
3Chicago Tribune. Chicago's lifespan gap: Streeterville residents live to 90. Englewood residents die at 60. Study finds it's the largest divide in the U.S. (June 6, 2019). Accessed April 23, 2020, at http://www.chicagotribune.com/business/ct-biz-chicago-has-largest-life-expectancy-gap-between-neighborhoods-20190605-story.html.
4,5 CDC, Coronavirus Disease 2019 (COVID-19), People Who Need Extra Precautions, Others At Risk, COVID-19 in Racial and Ethnic Minority Groups. Accessed April 24, 2020, at https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medic judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.