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Pandemics affect vulnerable communities that are already facing disproportionate health care challenges. We take a look at how these communities are most impacted and how preventative action could pave the path for better health care outcomes.

For every health condition that can be either prevented altogether or prevented from getting worse, the thinking goes that “an ounce of prevention is worth a pound of cure”. In the United States, however, we have historically taken the opposite approach. In fact, the U.S. spends more on health care than any other highly developed country: 17 percent of the GDP compared to an average of 8.7 percent for other developed countries.

Despite this formidable investment, health metrics such as chronic disease, life expectancy and infant mortality are worse in the U.S., especially among people of color. In Delaware alone, black babies are 2.7 times more likely to die in their first year of life than white babies. Black individuals living in highly segregated Wilmington neighborhoods have life expectancies up to 16 years shorter than those living in less segregated neighborhoods.
The national focus on curative care also makes it challenging for health care systems to stay afloat, with over half of all U.S. hospitals losing money on patient care and those serving uninsured or publicly insured populations especially hard hit. And while some argue that a prevention-first approach will drive better financial results, others use the often-cited example that if we help people stop smoking, they’ll live longer. If they live longer, taxpayers will have to spend more on Social Security and Medicare – a higher cost proposition.
With such conflicting perspectives, where does one start to make a change? How do we drill deeper into the data and identify opportunities to switch gears? And what is the value – the return on investment – for doing things differently?
Preventative Action to Address Social Determinants of Health
Instead of focusing wholly on the perspective of reducing high-risk health behaviors or disease progression, some health care systems are specifically addressing the role that social drivers play. These drivers, or Social Determinants of Health (SDoH), are defined by Healthy People 2020 as, “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”
The goal when working with social determinants is to create solutions that balance sustainable health care savings with high quality, community level care. For example, a Pennsylvania study embedded a six-member community worker team in low-income neighborhoods to help patients with their identified social needs. Over a one-year period, these patients experienced 30% fewer inpatient admissions than the control group and the program returned $2.47 for every dollar invested.
In another study, Shore Quality Physicians Group offered free rides to diabetic patients who regularly missed their appointments. While some patients declined the ride, the offer itself prompted some patients to come in on their own. For those who accepted the ride, the practice reduced hospital admission rates among diabetics from 68 per 1,000 patients to 42 per 1,000.
The Impact of a Pandemic of Vulnerable Communities
Like these and other health professionals, Delaware’s Department of Health and Social Services recognizes the value of addressing social determinants. DHSS acknowledges that there are many Delaware communities lacking in employment, education, housing, and healthy food options and in turn, “have poorer health than communities with more resources.”
People of color typically have at least one social determinant, which can create mental, emotional, and physical stress that can lead to acute and chronic diseases. Most recently, stress caused by isolation and anxiety during a pandemic has made matters worse for vulnerable populations. While the coronavirus has affected millions worldwide of all races, research at the MIT Sloan School of Management found that, “COVID-19 death rates in the U.S. are significantly correlated with patients’ age, race, socioeconomic status, and other social determinants of health data.”
More specifically, black populations have been disproportionately affected by this outbreak, with early data indicating they have had higher rates of hospitalizations and are more likely to die from COVID-19 than white populations. In Delaware, these social determinants include:
  • Housing disparities: Higher rates of black people live in low-income, multiple unit residences than white people, increasing the risk of transmission due to crowded living spaces. 
  • Employment disparities: Black workers are more likely to work in hourly-wage service occupations that cannot be performed from home. This prevents social distancing and increases risk of transmission.
  • Transportation disparities: Black Delawareans represent just 21% of the commuting population yet are 55% of the people who use public transportation to get to work.
  • Health care disparities: Black Delawareans experience inequities in access to and quality of health care, putting them at higher risk for developing comorbid conditions.
  • Poverty: COVID comorbidities are significantly correlated with poverty. 9.1% of white Delawareans live in poverty, while 20.2% of Black Delawareans do.
  • Food desert: Individuals living in low-income neighborhoods have limited access to supermarkets and grocery stores, lowering their ability to consume the healthy foods that could help build immunity to the coronavirus.
  • Safe public spaces: Many low-income neighborhoods are also high-crime areas where it is unsafe to be physically active outdoors. This increases the risk of obesity and other comorbid medical conditions, which then increases the risk of complications from COVID-19.
To learn more about the state’s activation plan to address the social determinants of health exposed by COVID-19, particularly for the homeless population in Delaware, be sure to read this recent article co-authored by DCHI's Board Member, Rita Landgraf, Director, University of Delaware Partnership for Healthy Communities, and fellow State leaders. 
Socially Informed, Racially Equitable
COVID-19 has shown us that health pandemics disproportionately affect people of color, who are more likely to have one or more social determinant of health. Until such time that there is a national push to invest in solutions that alleviate social barriers while delivering financial gains, we can look to results that extend beyond the bottom line. Results like better community health in struggling neighborhoods. Fewer hospital admissions for marginalized individuals. Opportunities to lower mortality rates both during and in absence of a pandemic. And perhaps most importantly, the chance to develop health care practices and policies informed by social determinants of health, especially around promoting racial equity.
Note: This article represents a compilation of information published by others and does not constitute medical, legal, financial, or consulting advice. All information is believed to be current and accurate at the time of posting. References and links to third parties do not constitute an endorsement, sponsorship, or warranty, expressed or implied.

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