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.
- 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.
COVID-19 deepens U.S. health disparities<p>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.</p><p>"There is one common divide in American communities, and that is poverty," said <a href="https://www.northwell.edu/about/leadership/debbie-salas-lopez" target="_blank">Debbie Salas-Lopez, MD, MPH</a>, 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."</p><p>Social determinants have far-reaching effects on health, and poor communities have unfavorable social determinants. To pick one of many examples, <a href="https://www.npr.org/2020/09/27/913612554/a-crisis-within-a-crisis-food-insecurity-and-covid-19" target="_blank" rel="noopener noreferrer">food insecurity</a> 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.</p><p>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 <em><a href="https://link.springer.com/article/10.1007/s11606-020-05971-3" target="_blank">Journal of General Internal Medicine</a></em> 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."</p><p>That's not to say better-off families in the U.S. weren't harmed. A <a href="https://voxeu.org/article/poverty-inequality-and-covid-19-us" target="_blank" rel="noopener noreferrer">paper from the Centre for Economic Policy Research</a> 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.</p><p>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.</p><p>"There are so many pandemics that this pandemic has exacerbated," Dr. Salas-Lopez noted.</p><p>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. <a href="https://www.scientificamerican.com/index.cfm/_api/render/file/?method=inline&fileID=123ECD96-EF81-46F6-983D2AE9A45FA354" target="_blank" rel="noopener noreferrer">Writing on this gap</a>, 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. </p><p>"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."</p>Research on the economic and mental health fallout of COVID-19 is showing two things: That unemployment is hitting <a href="https://www.pewsocialtrends.org/2020/09/24/economic-fallout-from-covid-19-continues-to-hit-lower-income-americans-the-hardest/" target="_blank" rel="noopener noreferrer">low-income and young Americans</a> 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 <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413844/" target="_blank" rel="noopener noreferrer">the authors of one review</a> wrote, the pandemic's effects on mental health is itself an international public health priority.
Working to close the health gap<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc5MDk1MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNTYyMzQzMn0.KSFpXH7yHYrfVPtfgcxZqAHHYzCnC2bFxwSrJqBbH4I/img.jpg?width=980" id="b40e2" class="rm-shortcode" data-rm-shortcode-id="1b9035370ab7b02a0dc00758e494412b" data-rm-shortcode-name="rebelmouse-image" />
Northwell Health coronavirus testing center at Greater Springfield Community Church.
Credit: Northwell Health<p>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.</p><p>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."</p><p>"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 <a href="https://www.northwell.edu/education-and-resources/community-engagement/center-for-equity-of-care" target="_blank" rel="noopener noreferrer">equity of care</a> that everyone deserves." </p><p>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 <a href="https://www.northwell.edu/news/insights/faith-based-leaders-are-the-key-to-improving-community-health" target="_blank" rel="noopener noreferrer">partnerships with leaders in those communities</a> and utilize those to ensure relationships last beyond the current crisis. </p><p>"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.</p><p>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.</p><p>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.</p><p>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.</p><p>"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.</p><p>"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."</p>
Textual analysis of social media posts finds users' anxiety and suicide-risk levels are rising, among other negative trends.
Aligning your goals with deeply held values produces better results—in your career and life.
- Self-concordant individuals set goals in alignment with their beliefs and values, according to new research.
- Internal motivations score higher than external influences, such as money or fear of shame.
- Mindful individuals achieve more satisfaction, as their goals align with their authentic selves.
Goal Setting Is a Hamster Wheel. Learn to Set Systems Instead. | Adam Alter | Big Think<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="d8f8e080b9ad655a40d842f7c2be60d7"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/x44zEK39GOM?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>Self-concordance is a measure of how closely aligned your goals are with your personal values, as compared to goals that are set by internal or external pressures. In terms of goal-setting, self-concordance implies that your goals are made due to intrinsic motivation, whether because they're meaningful or because they represent your values. </p><p>Non-concordant goals are generally pursued for external factors, such as money, or due to societal pressure, like the fear of being shamed. Since mindfulness practitioners <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/jclp.20237" target="_blank" rel="noopener noreferrer">tend to exhibit</a> high levels of self-awareness, the researchers theorized such individuals would be better at setting—and achieving—their goals. </p><p>Nearly 800 undergraduates were recruited for a short survey. Each volunteer wrote down three personal goals for the coming week. They were then asked to rate each of the following questions on a seven-point scale: </p><ul><li>Because somebody else wants you to, or because you'll get something from someone if you do</li><li>Because you would feel ashamed if you didn't – you feel that you should try to accomplish this goal</li><li>Because you really believe it is an important goal to have</li><li>Because of the fun and enjoyment which the goal will provide you—the primary reason is simply your interest in the experience itself</li><li>Because it represents who you are and reflects what you value most in life</li></ul>
Credit: Wirestock / Adobe Stock<p>The first two reasons on that list are considered non-concordant, while the latter three are more likely to be ranked higher by mindful individuals. To judge that, each student filled out a 15-item Mindful Attention and Awareness Scale. The general thrust of the questionnaire is to discover how present an individual is when performing their daily tasks.</p><p>As hypothesized, students that scored higher ranked the latter motivations higher. The researchers believe self-awareness helps individuals decide "which goals are self-appropriate." Maintaining goals that are realistic with your values, beliefs, and life circumstances make them not only easier to achieve, but will also be aligned with what matters most to you. </p><p>As the researchers phrase it, </p><p style="margin-left: 20px;">"By habitually paying attention to their thoughts, feelings, sensations, and emotions, mindful individuals may develop a greater ability to recognize goals that are congruent with their authentic selves."</p><p>By setting attainable goals—also, perhaps unsurprisingly, an indicator of Flow States—mindful individuals score higher on self-esteem measures as well. Instead of dreaming of the impossible and being continually frustrated by disappointment, mindfulness teaches boundaries that you can work within. </p><p>Don't think of boundaries as a limitation. Mindful individuals treat them as a source of strength, as the practice of mindfulness helps you achieve goals in alignment with your authentic self. When looked at it from this perspective, the pursuit of other goals appears not only futile but emotionally and mentally damaging. </p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a> and <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank" rel="noopener noreferrer">Facebook</a>. His new book is</em> "<em><a href="https://www.amazon.com/gp/product/B08KRVMP2M?pf_rd_r=MDJW43337675SZ0X00FH&pf_rd_p=edaba0ee-c2fe-4124-9f5d-b31d6b1bfbee" target="_blank" rel="noopener noreferrer">Hero's Dose: The Case For Psychedelics in Ritual and Therapy</a>."</em></p>
Social media seems to stress some people out. Maybe its time for a break?
- Social media can make people anxious, depressed, lonely, and stressed out.
- There are several ways to cut back your use of it.
- Even using it slightly less has been shown to reduce depressive symptoms.
We used to smoke during five-minute breaks at work; now, we check the feeds.<p> A variety of studies show that too much time spent on social media can stress us out, leave us <a href="https://www.psychologytoday.com/us/blog/digital-world-real-world/202002/anxiety-and-social-media-use" target="_blank" rel="noopener noreferrer">anxious</a> and <a href="https://www.cnbc.com/2018/11/12/cutting-back-on-social-media-reduces-loneliness-depression-study-finds.html" target="_blank" rel="noopener noreferrer">depressed</a>, and ironically increase feelings of <a href="https://www.cnbc.com/2018/11/12/cutting-back-on-social-media-reduces-loneliness-depression-study-finds.html" target="_blank" rel="noopener noreferrer">loneliness</a>. These findings have been confirmed for both adults and <a href="https://journals.sagepub.com/doi/abs/10.1177/0706743719885486?journalCode=cpab" target="_blank" rel="noopener noreferrer">children</a>. <br> <br> These effects are caused by several factors. The curated images of other people's lives we see on the screen can leave us feeling like we're comparatively inadequate. The often spoken of "<a href="https://psychcentral.com/blog/fear-of-missing-out/" target="_blank" rel="noopener noreferrer">fear-of-missing-out</a>" is a real thing. When you have dozens of people doing something once, with continual updating it can appear like everybody is doing something all the time. The political aspects of social media can make things worse. Even when people agree with you, the slew of information can be too much, says Dr. Erin Elfant, a clinical psychologist working out of California. <br> <br> She goes on to mention that social media provides a perverse incentive for being <a href="https://www.ksby.com/news/social-medias-impact-on-stress-during-contentious-election-season" target="_blank" rel="noopener noreferrer">stressed</a>:<br> <br> "When we tend to say something that is a strongly worded opinion, we tend to get more response for that which also means that it positively reinforces us getting really stressed."</p><p>It seems like a vicious cycle. Posting things that make people react is the point, even if that reaction is to make them stressed. Whatever works at getting a reaction will be posted again. <br></p>
How to spend less time on social media<iframe width="730" height="430" src="https://www.youtube.com/embed/fE_QoebLUFQ" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe><p> There are a variety of ways to make avoiding checking your feeds every six seconds a little easier. </p><p> <strong>Delete your apps</strong></p><p> Making it a little harder to get to social media can help you use it less. Beyond making a kind of initiative sense, this method is supported by empirical evidence. <a href="https://en.wikipedia.org/wiki/Nudge_theory" target="_blank" rel="noopener noreferrer">Nudge Theory </a>in behavioral economics is based around this. People often do what's easiest, and that can be manipulated for good. Having to spend that much more effort getting to your social media page might be the thing that keeps you off it. <br> <strong><br> Set time limits on your usage.</strong></p><p>If you don't want to delete the apps outright, that's fine; there are other options. Most smartphones can show you a breakdown of how much time you're spending on an app, either through included features or through third-party apps that are readily <a href="https://www.pcmag.com/how-to/5-ways-to-cut-back-on-social-media" target="_blank" rel="noopener noreferrer">available</a>. You can easily track your screen time and change your behavior accordingly. </p><p>If you use a web browser to access these sites, you can use a variety of <a href="https://launchparty.org/google-chrome-extensions-that-help-block-time-wasting-websites/" target="_blank">extensions</a> to control how long you're allowed to browse before blocks kick in. Others allow you to set times when you can't access the sites, like working hours, or to set other conditions. <br> </p><p> <strong>Consider what you're following</strong></p><p> If you're like me, you've been invited to endless pages by other people, which you accepted to be polite. After a few years, you start to wonder why you still get updates from these random pages that mean nothing to you. If you aren't going to cut back, you can reduce your stress and your feed's clutter with a review of what pages you're following. Is there a page (or person) whose posts only make you mad? You should consider not following them anymore. </p><p> Plus, if there is less to look at, you may find yourself spending less time on social media as a result. A feed with only 1 pages will have fewer updates to review than one with 20. </p><p> <strong>Set a day of rest</strong></p><p> There's a reason most cultures had a designated day of rest; we need it. <br> <br> The idea of a <a href="https://www.verywellmind.com/why-and-how-to-do-a-digital-detox-4771321" target="_blank" rel="noopener noreferrer">digital detox</a> is increasingly popular, and an offshoot of that is setting a "<a href="https://www.huffpost.com/entry/digital-sabbath-20_b_5288740" target="_blank" rel="noopener noreferrer">digital sabbath</a>." Much like the religious one, the idea here is that you take a set amount of time (either the weekend or a part of it) as a day of rest during which you cannot use or check social media. <br> <br> This solution has the added benefits that you're not giving up on social media, just limiting your use to specific days, and that you can make the rules for it as strict or lax as you require. You could ban all internet use outside of email on the sabbath, or you could just keep yourself from looking at Twitter. </p><p> <strong>Turn off notifications</strong></p><p> If all else seems like too much, try just turning off your notifications. You should be deciding when you want to look at social media, not the social media pages. Who knows, if you aren't told every time your aunt posts a new image of her cat, you might not find the need to look at each one of the pictures. </p><p> Social media has an extremely mixed track record of doing what it was supposed to do in terms of bringing people together in a new and fun way. Given how much stress it's caused us lately, maybe cutting back can do us all some good. </p>
The negative associations of introversion help to explain why loneliness now carries such social stigma.