COVID-19 amplified America’s devastating health gap. Can we bridge it?
The COVID-19 pandemic is making health disparities in the United States crystal clear. It is a clarion call for health care systems to double their efforts in vulnerable communities.
Kevin Dickinson has been an independent writing consultant since 2011. During that time, he's worked as an educator, editor, journalist, and researcher, and written on subjects ranging from religion to Dr. Seuss, film history to Mars' surplus of iron oxide.
- The COVID-19 pandemic has exacerbated America's health disparities, widening the divide between the haves and have nots.
- Studies show disparities in wealth, race, and online access have disproportionately harmed underserved U.S. communities during the pandemic.
- To begin curing this social aliment, health systems like Northwell Health are establishing relationships of trust in these communities so that the post-COVID world looks different than the pre-COVID one.
In the last 100 years, we've made incredible advances in health care, advances that would be viewed as miraculous to any previous generation. To pick one example, the U.S. life expectancy in 1950 was 68.2 years. We've since added 10 years to that average. Social programs have helped the young and elderly, two of the most health-vulnerable populations, receive unprecedented levels of care and attention. And telemedicine has decoupled many Americans' health support and monitoring from brick-and-mortar hospitals, expanding access to care.
Yet, despite these advances and despite handily outspending other OECD nations on health care, the United States preserves vast health disparities. As James Madara, CEO and executive vice president of the American Medical Association, wrote on the organization's site: "The U.S. health system that exists today is a hodgepodge of ideas, programs, and regulations that is both extraordinarily expensive and highly inefficient. And despite its size and technological advancements, our health system is beset by tremendous gaps and inequities that favor some groups while unfairly disadvantaging others."
Our current predicament has its origins in tectonic sociohistorical forces that have shifted and fractured the health care landscape. For those at the peaks, access to superior care, education, resources, and social networks serve to protect their health. For those in the canyons, the ground continues to weather away with each past and ongoing crisis—consider, for example, the disproportionate fallout from the dissolution of the Mental Health Systems Act.
Then came COVID-19.
COVID-19 deepens U.S. health disparities
Communities on the pernicious side of America's health disparities have their unique histories, environments, and social structures. They are spread across the United States, but they all have one thing in common.
"There is one common divide in American communities, and that is poverty," said Debbie Salas-Lopez, MD, MPH, senior vice president of community and population health at Northwell Health. "That is the undercurrent that manifests poor health, poor health outcomes, or poor health prognoses for future wellbeing."
Social determinants have far-reaching effects on health, and poor communities have unfavorable social determinants. To pick one of many examples, food insecurity reduces access to quality food, leading to poor health and communal endemics of 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 case of coronavirus.
The pandemic didn't create poverty or food insecurity, but it exacerbated both, and the results have been catastrophic. A study published this summer in the Journal of General Internal Medicine suggested that "social factors such as income inequality may explain why some parts of the USA are hit harder by the COVID-19 pandemic than others."
That's not to say better-off families in the U.S. weren't harmed. A paper from the Centre for Economic Policy Research noted that families in counties with a higher median income experienced adjustment costs associated with the pandemic—for example, lowering income-earning interactions to align with social distancing policies. However, the paper found that the costs of social distancing were much greater for poorer families, who cannot easily alter their living circumstances, which often include more individuals living in one home and a reliance on mass transit to reach work and grocery stores. They are also disproportionately represented in essential jobs, such as retail, transportation, and health care, where maintaining physical distance can be all but impossible.
The paper also cited a positive correlation between higher income inequality and higher rates of coronavirus infection. "Our interpretation is that poorer people are less able to protect themselves, which leads them to different choices—they face a steeper trade-off between their health and their economic welfare in the context of the threats posed by COVID-19," the authors wrote.
"There are so many pandemics that this pandemic has exacerbated," Dr. Salas-Lopez noted.
One example is the health-wealth gap. The mental stressors of maintaining a low socioeconomic status, especially in the face of extreme affluence, can have a physically degrading impact on health. Writing on this gap, Robert Sapolsky, professor of biology and neurology at Stanford University, notes that socioeconomic stressors can increase blood pressure, reduce insulin response, increase chronic inflammation, and impair 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 produce wear and tear," Sapolsky writes. "It is outrageous that if children are born into the wrong family, they will be predisposed toward poor health by the time they start to learn the alphabet."Research on the economic and mental health fallout of COVID-19 is showing two things: That unemployment is hitting low-income and young Americans most during the pandemic, potentially widening the health-wealth gap further; and that the pandemic not only exacerbates mental health stressors, but is doing so at clinically relevant levels. As the authors of one review wrote, the pandemic's effects on mental health is itself an international public health priority.
We need to find ways to unify this country because we're all human beings. We're all created equal, and we believe that health is one of those important rights.
Working to close the health gap
Northwell Health coronavirus testing center at Greater Springfield Community Church.
Credit: Northwell Health
Novel coronavirus may spread and infect indiscriminately, but pre-existing conditions, environmental stressors, and a lack of access to care and resources increase the risk of infection. These social determinants make the pandemic more dangerous, and erode communities' and families' abilities to heal from health crises that pre-date the pandemic.
How do we eliminate these divides? Dr. Salas-Lopez says the first step is recognition. "We have to open our eyes to see the suffering around us," she said. "Northwell has not shied away from that."
"We are steadfast in improving health outcomes for our vulnerable and underrepresented communities that have suffered because of the prevalence of chronic disease, a problem that led to the disproportionately higher death rate among African-Americans and Latinos during the COVID-19 pandemic," said Michael Dowling, Northwell's president and CEO. "We are committed to using every tool at our disposal—as a provider of health care, employer, purchaser and investor—to combat disparities and ensure the equity of care that everyone deserves."
With the need recognized, Dr. Salas-Lopez calls for health care systems to travel upstream and be proactive in those hard-hit communities. This requires health care systems to play a strong role, but not a unilateral one. They must build partnerships with leaders in those communities and utilize those to ensure relationships last beyond the current crisis.
"We must meet with community leaders and talk to them to get their perspective on what they believe the community needs are and should be for the future. Together, we can co-create a plan to measurably improve [community] health and also to be ready for whatever comes next," she said.
Northwell has built relationships with local faith-based and community organizations in underserved communities of color. Those partnerships enabled Northwell to test more than 65,000 people across the metro New York region. The health system also offered education on coronavirus and precautions to curb its spread.
These initiatives began the process of building trust—trust that Northwell has counted on to return to these communities to administer flu vaccines to prepare for what experts fear may be a difficult flu season.
While Northwell has begun building bridges across the divides of the New York area, much will still need to be done to cure U.S. health care overall. There is hope that the COVID pandemic will awaken us to the deep disparities in the US.
"COVID has changed our world. We have to seize this opportunity, this pandemic, this crisis to do better," Dr. Salas-Lopez said. "Provide better care. Provide better health. Be better partners. Be better community citizens. And treat each other with respect and dignity.
"We need to find ways to unify this country because we're all human beings. We're all created equal, and we believe that health is one of those important rights."
Scientists use new methods to discover what's inside drug containers used by ancient Mayan people.
- Archaeologists used new methods to identify contents of Mayan drug containers.
- They were able to discover a non-tobacco plant that was mixed in by the smoking Mayans.
- The approach promises to open up new frontiers in the knowledge of substances ancient people consumed.
PARME staff archaeologists excavating a burial site at the Tamanache site, Mérida, Yucatan.
A new study looks at why mysterious voices are sometimes taken as spirits and other times as symptoms of mental health issues.
- Both spiritualist mediums and schizophrenics hear voices.
- For the former, this constitutes a gift; for the latter, mental illness.
- A study explores what the two phenomena have in common.
The study<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTQ5Nzc1OS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxOTU1ODQwOX0.wlQLO9cjh2hFAz9BXwf2DpaqwepAlybru_OH6J4ZwzI/img.jpg?width=980" id="d04f9" class="rm-shortcode" data-rm-shortcode-id="f0534bcc03c74a09cc45445de779df40" data-rm-shortcode-name="rebelmouse-image" data-width="1440" data-height="1373" />
Credit: Camila Quintero Franco/Unsplash<p>The researchers, led by <a href="https://www.dur.ac.uk/research/directory/staff/?mode=staff&id=15156" target="_blank">Adam Powell</a> of Durham University's Hearing the Voice project and Department of Theology and Religion interviewed conducted online surveys of 65 clairaudient mediums they found through contact with spiritualist communities. The survey also included 143 people from the general population who responded in the affirmative to the question "Have you ever had an experience you would describe as 'clairaudient?'" posed through an online study recruitment tool.</p><p>All participants spoke English and were aged 18-75. 84.4% were from the U.K.with the rest mostly from the North Americas, Europe, or Australasia.</p><p>Of the spiritualists surveyed, 79% said hearing voices was a normal part of their lives at church and at home, while 44.6% said that they heard voices every day. Most respondents reported the voices as being inside their heads, though 31.7% said they came from outside their bodies.</p><p>Not surprisingly, more spiritualists reported believing in the paranormal than did the general population participants. They also cared less about what others thought of them.</p><p>Both groups were prone to visual hallucinations as well.</p>
Youth and absorption<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTQ5Nzc2NS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzNzE3MTUyNn0.BsqsYO4KFNF9RX9O6TXYE14RysJgiwXua7FegMBf8Ss/img.jpg?width=980" id="5fe11" class="rm-shortcode" data-rm-shortcode-id="6fb24471c94f7e69617c763927c1dc0e" data-rm-shortcode-name="rebelmouse-image" data-width="1440" data-height="1080" />
Credit: Tanner Boriack/Unsplash<p>Spiritualist clairaudients reported their first experiences with other voices early in life. Of these participants, 18% said they had heard voices for as long as they remembered. The average age, however, for first hearing voices was 21.7 years. Schizophrenia typically presents when a person is somewhat older than this, in the <a href="https://www.mayoclinic.org/diseases-conditions/childhood-schizophrenia/symptoms-causes/syc-20354483" target="_blank">late 20s</a>.</p><p>Significantly, 71% said their experience with voices pre-dated their awareness of spiritualism. Rather than religion prompting the hearing of voices, it seems that it's more like the other way around — voices led them to religion.</p><p>Says Powell, "Our findings say a lot about 'learning and yearning.' For our participants, the tenets of spiritualism seem to make sense of both extraordinary childhood experiences as well as the frequent auditory phenomena they experience as practicing mediums."</p><p>Still, the voices came first he says, so "all of those experiences may result more from having certain tendencies or early abilities than from simply believing in the possibility of contacting the dead if one tries hard enough."</p><p>The more likely factor is spiritualist clairaudients' relationship with absorption. Responses to questions based on the 34-point <a href="https://www.ocf.berkeley.edu/~jfkihlstrom/TAS.htm" target="_blank">Tellegen Absorption Scale</a> revealed that these people tended toward absorptive personality characteristics. These are described by the study's authors as "being readily captured by entrancing stimuli, reporting vivid mental imagery, becoming immersed in one's own thoughts."</p><p>Some, though not all, voice-hearing individuals from the general population were found to exhibit high levels of absorption — those that did were more likely to believe in the paranormal than others.</p>
Implications<p>The study's finding regarding the relative young ages at which spiritualist clairaudients begin hearing voices suggests that these individuals' more welcoming attitude toward the phenomenon may have to do with malleability of youth — a belief in the fantastical is part of being young.</p><p>Says co-author <a href="https://www.northumbria.ac.uk/about-us/our-staff/m/peter-moseley/" target="_blank">Peter Moseley</a> of Northumbria University, "Spiritualists tend to report unusual auditory experiences which are positive, start early in life and which they are often then able to control. Understanding how these develop is important because it could help us understand more about distressing or non-controllable experiences of hearing voices too."</p><p>The authors of the study do note, however, that their findings leave two big unanswered questions: Does a tendency toward absorption reveal "a predisposition to having RSEs or a belief in the plausibility of having RSEs?"</p><p>The other obvious big question? It's beyond the scope of this survey, but are those really the voices of the dead?</p>
Dr. Eric Lander is a pioneer in genomics. What role will he play in the new administration?
- Dr. Lander is a mathematician and geneticist who's best known for his leading role in the Human Genome Project.
- Biden nominated Dr. Lander to head the Office of Science and Technology Policy and also serve as a cabinet-level science adviser, marking the first time the position has been part of the presidential cabinet.
- In an open letter, Biden said it's essential for the U.S. to "refresh and reinvigorate our national science and technology strategy to set us on a strong course for the next 75 years."
Who is Dr. Eric Lander?<p>Born in Brooklyn, New York, Dr. Lander started his academic career as a mathematician, often arriving at high school an hour early to do math. He won multiple awards in mathematics in his teens, including the Mathematical Olympiad in 1974.<br></p><p>Finding mathematics "too monastic" to pursue as a career, he began teaching managerial economics at Harvard Business School. Then, at the <a href="https://www.worldsciencefestival.com/videos/eric-lander-the-genesis-of-genius/" target="_blank">encouragement of his brother</a>, a neurobiologist, Dr. Lander became interested in studying neurobiology and microbiology. This pushed him to his main lifelong pursuit: unraveling the mysteries of the human genome.</p><p>Dr. Lander spent more than a decade as a leader within the Human Genome Project, which provided the world a complete map of all human genes in 2003. In 2004, he founded the Broad Institute, a biomedical and genomic nonprofit research center that partners with M.I.T. and Harvard University.</p>
Pixabay<p>Broad's <a href="https://www.broadinstitute.org/news-multimedia/basic-q-about-broad-institute" target="_blank">mission</a> is to "fulfill the promise of genomics by creating comprehensive tools for biology and medicine, making them broadly available to the world and applying them to the understanding of human biology and the diagnosis, treatment, and cure of human diseases." The institute aims to diminish diseases by better understanding cellular mechanisms, rather than simply treating symptoms.</p><p>Despite some <a href="https://www.statnews.com/2016/01/25/why-eric-lander-morphed/" target="_blank">minor controversies and patent disputes</a>, Dr. Lander remains a monumental figure in American science, and also previously served as co-chairman of former President Barack Obama's science advisory council.</p>
What will Dr. Lander do in the Biden administration?<p>If confirmed by the Senate, it's not exactly clear what Dr. Lander will do in his role as cabinet science adviser and head of the OSTP. But his primary focus likely won't be COVID-19, considering Biden has already established a task force dedicated to shaping policy and recommendations related to the pandemic.<br></p><p>But Biden revealed some of his expectation in an <a href="https://buildbackbetter.gov/wp-content/uploads/2021/01/OSTP-Appointment.pdf" target="_blank">open letter</a> that posed five questions for the Office of Science and Technology Policy to explore:</p><ol><li>What can we learn from the pandemic about what is possible—or what ought to be possible— to address the widest range of needs related to our public health?</li><li>How can breakthroughs in science and technology create powerful new solutions to address climate change—propelling market-driven change, jump-starting economic growth, improving health, and growing jobs, especially in communities that have been left behind?</li><li>How can the United States ensure that it is the world leader in the technologies and industries of the future that will be critical to our economic prosperity and national security, especially in competition with China?</li><li>How can we guarantee that the fruits of science and technology are fully shared across America and among all Americans?</li><li>How can we ensure the long-term health of science and technology in our nation?</li></ol><p>The president-elect wrote that it's essential to "refresh and reinvigorate our national science and technology strategy to set us on a strong course for the next 75 years," concluding:</p><p style="margin-left: 20px;">"I believe that the answers to these questions will be instrumental in helping our nation embark on a new path in the years ahead—a path of dignity and respect, of prosperity and security, of progress and common purpose. They are big questions, to be sure, but not as big as America's capacity to address them. I look forward to receiving your recommendations—and to working with you, your team, and the broader scientific community to turn them into solutions that ease everyday burdens for the American people, spark new jobs and opportunities, and restore American leadership on the world stage."</p>
SMARTER FASTER trademarks owned by Freethink Media, Inc. All rights reserved.