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In the last several days, the CDC revised its guidance to say most Americans are safe without masks, the White House updated its National COVID-19 Preparedness Plan with a focus on moving forward safely, and more and more Governors are easing or lifting masking requirements.   

Across the U.S., 14-day averages of COVID-19 cases and deaths both decreased, 55 percent and 26 percent, respectively and spanning all age groups 76 percent of Americans have at least one shot and 65 percent are fully vaccinated.  

What’s more, new research from Morning Consult suggests that “there are signs of hope that at least some Americans can return to some semblance of normal.”  

Yet, such statistics are primarily focused on the national level. Among the potential side-effects of initiatives to return to the new or next normal: Poorer communities are at risk of being left behind wealthier counterparts with higher vaccination rates, more effective safety protocols and modern ventilation systems amid this still-ongoing pandemic. 

Advancing equity will be among the topics at the Health Evolution Summit, Apr. 6-8, 2022. Apply to participate.

Making matters more complex in underserved communities is the reality that despite federal, state and local government efforts to proactively address vaccine hesitancy it has persisted in communities of color — the very same communities that have historically faced many challenges with access to both information and health care, particularly during the last two years. 

Executives leading organizations on the frontlines have thus far found the following tactics to be effective in under-resourced communities:  

    • Increasing health literacy 
    • Addressing social determinants of health  
    • Focusing on whole-person care that includes mental health  

Increasing health literacy 
Lacking health literacy is among the roots of vaccine inequities as 58 percent of Blacks have below basic or basic health literacy proficiency, compared to 28 percent of Whites, according to research published on NCBI. A Center for Health Care Strategies report found that such conditions tie into more hospital visits, longer stays and higher health care costs.  

“Distrust in health care systems is well earned due to economic neglect and the tarnished history of unethical medical experimentation that continues to reverberate in our times,” said Sanjiv Shah, MD, Chief Medical Officer at MetroPlusHealth Plan in New York City, which provides low-to-no cost health insurance to 600,000 members spanning a variety of vulnerable populations across New York City. 

“We all need to do more to educate and earn the trust of communities of color on COVID-19 vaccination and appropriate testing,” Shah said.    

Addressing the social determinants of health 
Nashville General Hospital CEO Joseph Webb urges leaders to focus on variables that have the greatest potential to reduce “persistent disparities” and advance health equity, in a Health Evolution guest opinion piece 

“Community stakeholders such as physicians, politicians, community leaders and of course public hospitals, should work together to address the obstacles and gaps in education,” Webb wrote. “Such action would positively impact equal access to quality health that is customized to the needs of the individual and promote better health outcomes and lower costs.” 

CEOs and executives working to advance equity can access these Health Evolution resources:  
Health equity roadmap: A methodical approach for CEOs 

CEO guide to increasing vaccine uptake in diverse communities 
Industry Pledge to accelerate greater health equity

Nashville General Hospital serves as a hub for community care with a focus on social determinants of health, Webb explained, including employment, food insecurity, transportation, and housing. 

As part of broader efforts to advance equity, MetroHealth focuses on hiring within the community because those are the people best suited to understand the most relevant and local social determinants of health and safety needs.

“We believe in enhancing the body, mind, and spirit by addressing homelessness, lack of access to care, education, food insecurity and isolation,” Shah said, adding that its offerings include housing for some people who need it.  

Beyond the pandemic, Shah explained that the organization, like many others in this critical time, is working to be able to better understand its populations more comprehensively.  

“We are taking active steps to improve the data collection of race and ethnicity of our members and focusing quality improvement efforts where disparities exist,” Shah said. 

Focusing on whole-person care that includes mental health 
Prior to the pandemic, MetroPlusHealth began transitioning its behavioral health program in-house and completed the move in October 2020.  

“Traditionally, these concerns were handled separately,” Shah said.  

As part of the transition, the organization enlisted and collaborated with primary care physicians to identify behavioral health issues at the front lines to be more aware of patients’ behavioral health challenges and start the necessary treatment as soon as possible.

Q&A: Tom Insel on why mental health needs ‘a social movement’

The work proved critical throughout the pandemic as MetroPlusHealth conducted a mental health survey that showed 55 percent of New Yorkers indicated the pandemic has, not surprisingly, negatively impacted their mental health—and that was in the fall of 2021 prior to the Omicron variant’s rise. 

“This transition allows us to address physical health and behavioral health equally,” Shah said.  

Working toward a more equitable future 
As the U.S. both moves forward and prepares for the potential that a new variant could emerge, uncertainty remains as to when the pandemic will be endemic and what that will mean for various populations, including underserved communities. 

“The goal is to get out of the pandemic, which means that we must work together to beat the virus,” Shah said.  

And there’s another potential twist on the horizon as the federal government looks to end the emergency and the temporary measure to increase the ACA marketplace subsidies that extended coverage to more than 12 million Americans during the pandemic. Should those provisions lapse with the Public Health Emergency, currently scheduled to end April 15, 2022, the result could be an increase in the number of uninsured people; some experts suggest that the changes could be extended but ultimately will expire.  

Webb noted that increasing health literacy, addressing social determinants, and focusing on more holistic care can help advance equity for more Americans.  

“Such action would positively impact equal access to quality health that is customized to the needs of the individual and promote better health outcomes and lower costs,” Webb wrote. “Our goal is to make sure the burden doesn’t fall on populations with lower socioeconomic status. Health equity is a social justice issue. It’s never going to go away.”