Over the last 100 years, we have made incredible progress in healthcare, a progress that would be seen as miraculous for any previous generation. To select an example, Life expectancy in the United States in 1950 it was 68.2 years. We have since added 10 years to this average. Social programs have helped young and old people, two of the most vulnerable populations, receive unprecedented levels of care and attention. And telemedicine has separated the health support and monitoring of many Americans from brick hospitals, expanding access to care.
And yet, despite this progress and despite the dexterity spending other OECD countries on healthThe United States retains huge health gaps. As James Madara, CEO and executive vice president of the American Medical Association, wrote on the organization’s website: “The American health care system that exists today is a mixture of ideas, programs and regulations that is both extremely expensive and highly inefficient. And despite its size and technological advances, our health care system is hit by huge gaps and inequalities that favor some groups while unfairly disadvantaging others. “
Our current difficulty stems from tectonic socio-historical forces that have displaced and shattered the healthcare landscape. For those at the top, access to superior care, education, resources and social media serves to protect their health. For those in the canyons, the land continues to weaken with each passing and ongoing crisis – consider, for example, the disproportionate effects of the dissolution of the Mental Health Systems Act.
Then came COVID-19.
COVID-19 deepens health gaps in the United States
Communities on the disastrous side of America’s health disparities have their own unique history, environment, and social structures. They are common in the United States, but they all have one thing in common.
“There is a general division in American communities and that is poverty,” he said Debbie Salas-Lopez, MD, MPH, Senior Vice President of Community and Population Health at Northwell Health. “It’s an underwater move that shows poor health, poor health outcomes or poor health prospects for future well-being.”
Social determinants have far-reaching consequences for health, and poor communities have unfavorable social determinants. To select one of the many examples, food insecurity reduces access to quality food, leading to poor health and general endemics from chronic medical conditions. The U.S. Centers for Disease Control and Prevention has identified some of these conditions, such as obesity and type 2 diabetes, as increasing the risk of developing a severe coronavirus case.
The pandemic does not create food poverty or insecurity, but exacerbates both, and the results are catastrophic. A study published this summer in Journal of General Internal Medicine suggests that “social factors such as income inequality may explain why some parts of the United States are more affected by the COVID-19 pandemic than others.”
This does not mean that wealthier families in the United States have not been harmed. A document from the Center for Economic Policy Research noted that families in higher middle-income counties are experiencing pandemic-related adjustment costs – for example, reducing income interactions to align with social distancing policies. However, the newspaper finds that the costs of social distancing are much higher for poorer families, who cannot easily change their living conditions, who often include more people living in one home and relying on mass transit to get there. to workplaces and grocery stores. They are also disproportionately represented in key jobs, such as retail, transport and healthcare, where maintaining physical distance may be almost impossible.
The article also cites a positive link between higher income inequality and higher levels of coronavirus infection. “Our interpretation is that poorer people are less able to defend themselves, which leads them to make different choices – they face a steeper compromise between their health and economic well-being in the context of the threats posed by COVID-19. “, the authors wrote.
“There are so many pandemics that this pandemic has escalated,” said Dr. Salas-Lopez.
One example is the difference between health and wealth. Mental stressors to maintain a low socio-economic status, especially in conditions of extreme wealth, can have a physically detrimental effect on health. Writing this gap, Robert Sapolski, a professor of biology and neurology at Stanford University, notes that socioeconomic stressors can raise blood pressure, reduce insulin response, increase chronic inflammation and disrupt the prefrontal cortex and other brain functions through anxiety, depression and cognitive load.
“Thus, from the macro level of entire body systems to the micro level of individual chromosomes, poverty finds a way to lead to wear and tear,” Sapolski wrote. “It’s outrageous that if children are born into the wrong family, they will be prone to ill health as they begin to learn the alphabet.”
Research on the economic and psychological consequences of COVID-19 shows two things: That unemployment is staggering low-income young Americans most during a pandemic, potentially increasing the gap between health and wealth; and that the pandemic not only exacerbates mental health stressors, but does so at clinically relevant levels. Like the authors of a review wrote, the impact of the pandemic on mental health is in itself an international priority for public health.
We need to find ways to unite this country, because we are all human. We are all created equal and we believe that health is one of these important rights.
Work to overcome the health gap
Northwell Health Coronavirus Testing Center at Greater Springfield Community Church.
Credit: Northwell Health
The new coronavirus can spread and infect indiscriminately, but existing conditions, environmental stressors and lack of access to care and resources increase the risk of infection. These social determinants make the pandemic more dangerous and undermine the ability of communities and families to recover from the health crises that preceded the pandemic. How to eliminate these divisions? Dr Salas-Lopez says the first step is recognition. “We need to open our eyes to see the suffering around us,” she said. Northwell is steadily improving health outcomes for our vulnerable and under-represented communities, which have suffered from the spread of chronic diseases, a problem that led to disproportionately higher mortality among African Americans and Latinos during of the COVID-19 pandemic, “said Michael Dowling, President and CEO of Northwell.” We are committed to using every tool we have – as a healthcare provider, employer, buyer and investor – to combat disparities and provide Recognizing the need, Dr. Salas-Lopez calls on health systems to travel upstream and be proactive in these affected communities, which requires health systems to play a strong role, but not They need to build partnerships with leaders in these communities and use them to ensure to continue after the current crisis. “We need to meet with community leaders and talk to them to understand what their needs are for the community and what they need to be in the future. Together, we can work together to create a plan for significant improvement. [community] health, and to be prepared for anything that follows, “she said. Northwell has built relationships with local religious and community organizations in underserved color communities. These partnerships have allowed Northwell to test more than 65,000 people in the subway area. New York: The health system also offers training on the coronavirus and precautions to limit its spread, and these initiatives have begun the process of building trust, a trust Northwell relies on to return to these communities to administer flu vaccines to prepare for what experts fear could be a tough flu season.As Northwell begins building bridges across sections of the New York area, much remains to be done to cure health care in the United States as a whole. that the COVID pandemic will awaken us to profound differences in the United States. “COVID changed our world. We need to take advantage of this opportunity, this pandemic, this crisis, to do better, “said Dr. Salas-Lopez. Provide better care. Ensure better health. Be better partners. Be better citizens of the community. And treat each other with respect and dignity. “We need to find ways to unite this country because we are all human. We are all created equal and we believe that health is one of those important rights.”