Most healthcare stakeholders and beyond recognize that major healthcare disparities exist between different racial and socioeconomic groups.  This has been documented extensively, particularly the link between low socioeconomic status (SES) and health problems.  Being born into poverty, or into a low-income neighborhood, significantly increases a person's risk of lifelong health issues and reduced access to healthcare.

What isn't examined as often is how to alleviate these healthcare gaps.  However, the ongoing COVID-19 pandemic, and the efforts medical providers have taken to mitigate it, has inadvertently highlighted and exacerbated this issue.  As this excellent Harvard article notes, healthcare providers have been proactively seeking solutions - and their successes can be seen as indicators towards larger plans and strategies to improve healthcare access across more SES groups.

So, what can we learn from the COVID-19 response, and attempts to reduce its impact among low-SES groups?  Let's take a look at some of the major insights.

How COVID-19 Responses Point Towards Reduced Healthcare Disparities Among Low-Income Groups

First, to lay a little groundwork:  One reason that COVID-19 tended to have a high impact on low-income groups is that their situation made them especially vulnerable to infection.  COVID-19 is primarily spread through air, as well as also being transmittable through shared contact with objects harboring the virus.

Those most at risk tended to be:

  • People in densely populated areas

  • People in multigenerational households with many occupants

  • People working in service-focused industries

  • People unable to work from home due to their jobs requiring physical presence

  • People who depend on public transportation

Unsurprisingly, these factors all correlate strongly to people in low-income neighborhoods, recent immigrants, and those with low SES.  The poor and disadvantaged minorities were at particular risk.   Worse, in many cases, these stem from much deeper systemic problems which are far outside the scope of healthcare to address.  Hospitals fighting COVID-19 have no ability to improve their city's low-income housing policies or provide better jobs to those at risk.

So, recognizing this, healthcare workers and strategists had to get creative in addressing these challenges.  These methods are worth analyzing because they can apply to many areas of healthcare, even without an ongoing pandemic.

I. Overcoming Language Barriers

Language barriers have been a major issue among healthcare providers, especially when it comes to outreach.  The vast majority of information about COVID-19 was in English.  Much was in Spanish as well, but even that was limited by comparison.  Other languages were almost entirely under-represented, with little or no official science-backed information being translated.

Worse, was that in some cases, it created opportunities for those pushing disinformation and conspiracy theories.  If they identified minority groups as being underserved by official sources in their own language, there was room for them to popularize false claims before official sources could fill the information vacuum.

Medical providers discovered a real need for translators, as well as the need to produce multimedia materials to increase outreach to those with a limited grasp of English.  Unfortunately, to do this is a difficult, time-consuming, and expensive process.

One potential light at the end of this tunnel is the ever-growing efficacy of computerized translation systems.  "Google Translate" and similar initiatives are far from perfect, but they're also much better than nothing.

II. Building Trust in Minority Communities

The issue of trust is a particularly thorny issue when attempting to build bridges into minority communities.  Many, such as black Americans, have long oral histories of mistreatment at the hands of white healthcare.  The fact that some of these stories are true, such as the notorious Tuskegee syphilis study, only makes the situation worse.

In short, many minority groups are so actively distrustful of the government or official healthcare sources that they have avoided taking recommended precautions or refuse to receive the COVID-19 vaccine.

Healthcare workers have found there is a true need to cultivate relationships with members of minority communities and are currently working with respected members of the community as part of their outreach to enact change.  Outsiders will have a hard time building in-roads on their own.  

Hopefully, the bridges built during COVID-19 outreach initiatives will continue to be used going forward.  

III. Addressing Privacy Concerns Among Immigrants

One of the most controversial issues, at least in the political sphere, has been the matter of how to treat undocumented immigrants.  Many hardliners in government at all levels would prefer these people be ignored or have even attempted to use outreach as a cover for identifying and deporting illegal residents.

However, from a medical perspective, this is entirely unhelpful.  During an outbreak, the undocumented need healthcare as much as anyone else.  Infectious diseases care not for residency status.  Unfortunately, the fear of being discovered and punished discouraged many undocumented aliens from coming forward and seeking treatment, even if they were actively spreading the disease among friends and family.

Those seeking to address this problem found they had to focus on privacy-related outreach, such as explaining how HIPAA laws prevent them from turning undocumented residents over to the authorities.  Other medical providers simply made it a point to not inquire into people's residency status and did not require any official documentation which an undocumented resident would lack.

This will undoubtedly continue to be a political hot topic, and providers will simply have to work with what they have. Many will likely have to continue deploying creative methods to avoid documenting or exposing illegal residents, in the name of the greater health good.

IV. Developing Better Data Tracking and Analysis

There's a larger problem underpinning all of this: how to properly identify at-risk minorities and low-income groups in the first place.  Given America's rocky history of racial problems, some providers are reluctant to look too deeply into the issue, out of fear that their efforts would be labeled as "racist" whether it’s true or not.

However, COVID-19 showed that sticking our heads in the sand simply isn't an option.  Again, infectious diseases do not care about race, SES, or other politically-charged issues.  Healthcare providers attempting to combat the disease have quickly discovered the need for better data tracking and statistical analysis to help them find and target high-risk groups.

That's where we come in.

Reducing Healthcare Disparities with Better Data Analysis

Socially Determined® is one of the few social risk analytics companies in the market focused on alleviating healthcare disparities among low-income and at-risk people.  We deliver Social Risk Intelligence™ to payers, providers, life sciences companies and more to help them understand how the Social Determinants of Health are affecting their communities and people. With these insights, they’re enabled to enact positive change and create strategic intervention programs to advance health equity and make an impact at scale.

Through smarter analysis and better application of resources, we believe it is absolutely possible to reduce these healthcare disparities - both now, during the COVID-19 crisis, and going forward into the future.

Contact us to learn more about how we can make this happen.

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