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Pandemic Puzzle: Health disparities and equitable recovery

In Stanford's Pandemic Puzzle virtual symposium, experts discuss medical and economic issues of the Covid-19 pandemic.

Last week, the second event of the Pandemic Puzzle, a virtual symposium series that examines how the United States -- and the world -- responded to the COVID-19 pandemic, hosted experts who identified ways to better prepare for the next global disease crisis.

The recent event focused on the disproportionate impact of COVID-19 on Black and Latino communities. Leaders from government, business and health care discussed the disparities and how to promote an equitable recovery.

After the session, I had the opportunity to talk with panelist Alyce Adams, PhD, a professor of epidemiology and population health at Stanford Medicine who studies the impact of chronic disease in underserved populations. She discussed the effects of the pandemic on people with underlying health conditions and the medical, social and economic challenges to improving health care outcomes in these groups. 

How did you become interested in studying the impact of chronic diseases on underserved populations? How are they disproportionately affected?

Photo by Rod Searcey

I witnessed the impact of chronic conditions, like diabetes, cancer and heart disease, on my own family as a child. What was most unsettling was the level of acceptance of these diseases in underserved populations and that their impact in these communities is inevitable. Members of marginalized groups are more likely than others to be diagnosed at younger ages with multiple chronic conditions. 

These conditions have an enormous impact on employment, income and quality of life and they have a cumulative effect over time, both as individuals age and across generations. That experience sparked my interest in learning how to improve quality of life among older adults in these groups, as well as the role of health policy in addressing disparities in outcomes.

What lessons or opportunities have come out of the pandemic that could help eliminate pre-existing health disparities and health inequities? 

The pandemic highlighted the important role that non-clinical factors play in health outcomes. For example, in a study of disparities in COVID-19 infection rates and outcomes at Kaiser Permanente, we found that where you live was one of the most important drivers of risk of COVID-19 infection and that disparities in hospitalization were largely driven by whether you had chronic illness prior to infection. These findings drive home the importance of addressing the structural and systemic factors that contribute to these inequities.

In the panel, you talked about 'equal opportunity for positive health outcomes.' What are some of the hurdles that must be overcome to achieve these goals? 

At a minimum, we need to ensure equal access to high-quality care. For example, there are considerable differences in Medicaid coverage across states, which contributes to geographic disparities in the ability to access care. 

We must also address modifiable factors within our health systems that contribute to disparate care even when people have more or less equal access. One example is ensuring that health messages are presented in a way that is understandable and engaging for all patients. 

Perhaps most importantly, we need to address the factors that prevent people from pursuing healthy lifestyles, which stop or delay the onset of chronic disease. One clear example is making sure people have access to drinkable water and healthy food options. This is not a given for many communities in the United States. 

A theme of the panel was the need to partner with communities to improve chronic disease care in underserved populations. Why is that important?

Engaging communities and other stakeholders in the development of interventions is critical to maximize the effectiveness and sustainability of these interventions in the long term. Community health workers can be effective partners in the development and implementation of education and screening programs for the prevention and early detection of cancer because they understand where their community members live and the factors that influence behavior and outcomes. 

Engaging leaders outside of the health care field is also important because of the myriad non-health care factors that influence people's ability to take care of their health. For instance, social service agencies, schools and employers are vital in identifying aids and barriers to prevention and control of chronic conditions. 

Is there a chance for meaningful, positive change, even amid so many challenges?

Yes. I am hopeful that this crisis will become an opportunity for fundamental shifts in how we think about health and public health policy. Stanford's interdisciplinary environment makes it uniquely suited to identify multi-level interventions that are likely to have the biggest impact on population health and health equity. 

The third installment of the Pandemic Puzzle on Oct. 28 will bring together leading epidemiologists, public health experts and government leaders to discuss how to track and mitigate the effects of the next emerging infectious disease, while the fourth, on Nov. 19, will address innovation and discovery during a global crisis. You can register for free here.

Photo by Moab Republic

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