To Close Health Equity Gaps, “Hit the Road Where the Rubber Meets It”

The Centers for Disease Control and Prevention’s U.S. population data shows significantly higher death rates among Black, Hispanic and Latinx people, as compared to white people, especially in middle age. The CDC acknowledges that “long-standing systemic health and social inequities have put many people from racial and ethnic minority groups at increased risk of getting sick and dying from COVID-19.” In fact, a non-white person is six times more likely to die from coronavirus.

Social determinants of health, including poverty and physical environment, unfavorably impact patient outcomes. In New York state, Northwell Health has been working to address disparities by expanding its network, opening new ambulatory care facilities, health clinics, and educational programs for underrepresented and poor populations.

“We should be moving the best care out into the community, where people live,” says Michael Dowling, CEO of Northwell Health, and a keynote speaker at the 2020 virtual Healthcare Analytics Summit. “It has to be a priority to reduce those disparities in delivery and access to care.”

Now healthcare leaders like Dowling are paying attention to another large social factor that impacts health outcomes: trust in the healthcare system at large.

Growing up in Newark, New Jersey in the 1980s and 1990s, Sampson Davis never imagined himself becoming a doctor. His inner-city community was defined by poverty, crime, and survivability. He wasn’t much of a student, forced to focus on accessing necessities like food, clothing, and electricity, instead of academic excellence.

“I saw postal workers, I saw teachers, I saw police officers, but I never saw a doctor walking my blocks in my neighborhood,” Dr. Davis recalls in preparation for his HAS 20 keynote.

Having a visible presence in the community, outside the four walls of a hospital, helps build a health system’s relationship within diverse communities. Trusted community members, including faith leaders, are often the best messengers to confront serious health issues and “hit the road where the rubber meets it.”

“For years and years, we talked about healthcare access,” Dr. Davis emphasizes. “Healthcare access is great, that’s healthcare equality. But healthcare equity is giving people what they need.”

Dowling refers to a similar adage that appropriately drives his organization’s approach to community-based care: It’s not what’s the matter with you, it’s what matters to you. That’s why Northwell Health worked with the New York State Department of Health to offer COVID-19 testing at more than 60 churches to disadvantaged areas throughout New York City, Long Island, and Westchester County. They tested 1,400 individuals with COVID-19 symptoms, of whom 11.8% tested positive, and performed more than 41,500 antibody tests, which showed a 30.6 percent positive rate – a two- to three-times higher prevalence compared to wealthier and whiter areas. With facilities across southern New York, and this real-world data in hand, Northwell Health shifted its workforce and supply chain to better meet the needs of the most impacted communities.

Initiatives like this, and partnerships with local nonprofit service organizations, are steps toward reducing disparities created by social determinants of health. These efforts also increase trust among non-white communities who maintain skepticism about healthcare. While this may be a hard data point to measure, it is one that truly matters.