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1.
Acad Med ; 96(11): 1546-1552, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1493981

ABSTRACT

Racially and ethnically diverse and socioeconomically disadvantaged communities have historically been disproportionately affected by disasters and public health emergencies in the United States. The U.S. Department of Health and Human Services' Office of Minority Health established the National Consensus Panel on Emergency Preparedness and Cultural Diversity to provide guidance to agencies and organizations on developing effective strategies to advance emergency preparedness and eliminate disparities among racially and ethnically diverse communities during these crises. Adopting the National Consensus Panel recommendations, the Johns Hopkins Medicine Office of Diversity, Inclusion, and Health Equity; Language Services; and academic-community partnerships used existing health equity resources and expertise to develop an operational framework to support the organization's COVID-19 response and to provide a framework of health equity initiatives for other academic medical centers. This operational framework addressed policies to support health equity patient care and clinical operations, accessible COVID-19 communication, and staff and community support and engagement, which also supported the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care. Johns Hopkins Medicine identified expanded recommendations for addressing institutional policy making and capacity building, including unconscious bias training for resource allocation teams and staff training in accurate race, ethnicity, and language data collection, that should be considered in future updates to the National Consensus Panel's recommendations.


Subject(s)
Academic Medical Centers/organization & administration , COVID-19/ethnology , Disasters/prevention & control , Health Equity/standards , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Civil Defense/organization & administration , Consensus , Cultural Diversity , Government Programs/organization & administration , Government Programs/standards , Healthcare Disparities/ethnology , Humans , Minority Groups/statistics & numerical data , Policy Making , Public Health/standards , SARS-CoV-2/genetics , Social Participation , Socioeconomic Factors , United States/epidemiology
2.
Healthc Policy ; 17(1): 17-24, 2021 08.
Article in English | MEDLINE | ID: covidwho-1431157

ABSTRACT

The unequal social and economic burden of the COVID-19 pandemic is evident in racialized and low-income communities across Canada. Importantly, social inequities have not been adequately addressed and current public policies are not reflective of the needs of diverse populations. Public participation in decision-making is crucial and there is, therefore, a pressing need to increase diversity of representation in patient partnerships in order to prevent the further exclusion of socially marginalized groups from research and policy making. Deliberate effort and affirmative action are needed to meaningfully engage and nurture diverse patient partnerships by broadening the scope of the patient community to include excluded or underrepresented individuals or groups. This will help us co-develop ways to enhance access and equity in healthcare and prevent the systematic reproduction of structural inequalities that have already been heightened by the COVID-19 pandemic.


Subject(s)
Biomedical Research/standards , COVID-19/therapy , Delivery of Health Care/standards , Health Equity/standards , Health Policy , Patient Selection , Research Design/standards , Adult , Aged , Aged, 80 and over , Canada , Female , Guidelines as Topic , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2
3.
Am J Public Health ; 111(8): 1481-1488, 2021 08.
Article in English | MEDLINE | ID: covidwho-1381323

ABSTRACT

California has focused on health equity in the state's COVID-19 reopening plan. The Blueprint for a Safer Economy assigns each of California's 58 counties into 1 of 4 tiers based on 2 metrics: test positivity rate and adjusted case rate. To advance to the next less-restrictive tier, counties must meet that tier's test positivity and adjusted case rate thresholds. In addition, counties must have a plan for targeted investments within disadvantaged communities, and counties with more than 106 000 residents must meet an equity metric. California's explicit incorporation of health equity into its reopening plan underscores the interrelated fate of its residents during the COVID-19 pandemic and creates incentives for action. This article evaluates the benefits and challenges of this novel health equity focus, and outlines recommendations for other US states to address disparities in their reopening plans.


Subject(s)
COVID-19/prevention & control , Health Equity/standards , Health Promotion/standards , Minority Groups/statistics & numerical data , COVID-19/epidemiology , California , Health Services Accessibility/standards , Humans
5.
J Prev Med Public Health ; 54(1): 1-7, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1314808

ABSTRACT

The Korean government's strategy to combat coronavirus disease 2019 (COVID-19) has focused on non-pharmaceutical interventions, such as social distancing and wearing masks, along with testing, tracing, and treatment; overall, its performance has been relatively good compared to that of many other countries heavily affected by COVID-19. However, little attention has been paid to health equity in measures to control the COVID-19 pandemic. The study aimed to examine the unequal impacts of COVID-19 across socioeconomic groups and to suggest potential solutions to tackle these inequalities. The pathways linking social determinants and health could be entry points to tackle the unequal consequences of this public health emergency. It is crucial for infectious disease policy to consider social determinants of health including poor housing, precarious working conditions, disrupted healthcare services, and suspension of social services. Moreover, the high levels of uncertainty and complexity inherent in this public health emergency, as well as the health and socioeconomic inequalities caused by the pandemic, underscore the need for good governance other than top-down measures by the government. We emphasize that a people-centered perspective is a key approach during the pandemic era. Mutual trust between the state and civil society, strong accountability of the government, and civic participation are essential components of cooperative disaster governance.


Subject(s)
COVID-19/prevention & control , Health Equity/standards , Health Policy , Infectious Disease Medicine/legislation & jurisprudence , COVID-19/physiopathology , Government Programs/legislation & jurisprudence , Government Programs/methods , Health Equity/statistics & numerical data , Humans , Infectious Disease Medicine/methods , Infectious Disease Medicine/trends , Pandemics/prevention & control , Pandemics/statistics & numerical data , Public Health/legislation & jurisprudence , Public Health/methods , Public Health/trends , Republic of Korea
12.
Milbank Q ; 99(2): 340-368, 2021 06.
Article in English | MEDLINE | ID: covidwho-1249380

ABSTRACT

Policy Points Telehealth has many potential advantages during an infectious disease outbreak such as the COVID-19 pandemic, and the COVID-19 pandemic has accelerated the shift to telehealth as a prominent care delivery mode. Not all health care providers and patients are equally ready to take part in the telehealth revolution, which raises concerns for health equity during and after the COVID-19 pandemic. Without proactive efforts to address both patient- and provider-related digital barriers associated with socioeconomic status, the wide-scale implementation of telehealth amid COVID-19 may reinforce disparities in health access in already marginalized and underserved communities. To ensure greater telehealth equity, policy changes should address barriers faced overwhelmingly by marginalized patient populations and those who serve them. CONTEXT: The COVID-19 pandemic has catalyzed fundamental shifts across the US health care delivery system, including a rapid transition to telehealth. Telehealth has many potential advantages, including maintaining critical access to care while keeping both patients and providers safe from unnecessary exposure to the coronavirus. However, not all health care providers and patients are equally ready to take part in this digital revolution, which raises concerns for health equity during and after the COVID-19 pandemic. METHODS: The study analyzed data about small primary care practices' telehealth use and barriers to telehealth use collected from rapid-response surveys administered by the New York City Department of Health and Mental Hygiene's Bureau of Equitable Health Systems and New York University from mid-April through mid-June 2020 as part of the city's efforts to understand how primary care practices were responding to the COVID-19 pandemic following New York State's stay-at-home order on March 22. We focused on small primary care practices because they represent 40% of primary care providers and are disproportionately located in low-income, minority or immigrant areas that were more severely impacted by COVID-19. To examine whether telehealth use and barriers differed based on the socioeconomic characteristics of the communities served by these practices, we used the Centers for Disease Control and Prevention Social Vulnerability Index (SVI) to stratify respondents as being in high-SVI or low-SVI areas. We then characterized respondents' telehealth use and barriers to adoption by using means and proportions with 95% confidence intervals. In addition to a primary analysis using pooled data across the five waves of the survey, we performed sensitivity analyses using data from respondents who only took one survey, first wave only, and the last two waves only. FINDINGS: While all providers rapidly shifted to telehealth, there were differences based on community characteristics in both the primary mode of telehealth used and the types of barriers experienced by providers. Providers in high-SVI areas were almost twice as likely as providers in low-SVI areas to use telephones as their primary telehealth modality (41.7% vs 23.8%; P <.001). The opposite was true for video, which was used as the primary telehealth modality by 18.7% of providers in high-SVI areas and 33.7% of providers in low-SVI areas (P <0.001). Providers in high-SVI areas also faced more patient-related barriers and fewer provider-related barriers than those in low-SVI areas. CONCLUSIONS: Between April and June 2020, telehealth became a prominent mode of primary care delivery in New York City. However, the transition to telehealth did not unfold in the same manner across communities. To ensure greater telehealth equity, policy changes should address barriers faced overwhelmingly by marginalized patient populations and those who serve them.


Subject(s)
Health Equity/standards , Primary Health Care/organization & administration , Telemedicine/methods , Attitude of Health Personnel , COVID-19/epidemiology , Female , Humans , Male , Pandemics , Patient Acceptance of Health Care , Primary Health Care/economics , SARS-CoV-2 , Surveys and Questionnaires , Telemedicine/economics , Telemedicine/statistics & numerical data
13.
Acad Med ; 96(11): 1586-1591, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1246779

ABSTRACT

PURPOSE: Recent national events, including the COVID-19 pandemic and protests of racial inequities, have drawn attention to the role of physicians in advocating for improvements in the social, economic, and political factors that affect health. Characterizing the current state of advocacy training in U.S. medical schools may help set expectations for physician advocacy and predict future curricular needs. METHOD: Using the member school directory provided by the Association of American Medical Colleges, the authors compiled a list of 154 MD-granting medical schools in the United States in 2019-2020. They used multiple search strategies to identify online course catalogues and advocacy-related curricula using variations of the terms "advocacy," "policy," "equity," and "social determinants of health." They used an iterative process to generate a preliminary coding schema and to code all course descriptions, conducting content analysis to describe the structure of courses and topics covered. RESULTS: Of 134 medical schools with any online course catalogue available, 103 (76.9%) offered at least 1 advocacy course. Required courses were typically survey courses focused on general content in health policy, population health, or public health/epidemiology, whereas elective courses were more likely to focus specifically on advocacy skills building and to feature field experiences. Of 352 advocacy-specific courses, 93 (26.4%) concentrated on a specific population (e.g., children or persons with low socioeconomic status). Few courses (n = 8) focused on racial/ethnic minorities and racial inequities. CONCLUSIONS: Findings suggest that while most U.S. medical schools offer at least 1 advocacy course, the majority are elective rather than required, and the structure and content of advocacy-related courses vary substantially. Given the urgency to address social, economic, and political factors affecting health and health equity, this study provides an important and timely overview of the prevalence and content of advocacy curricula at U.S. medical schools.


Subject(s)
Health Equity/standards , Patient Advocacy/education , Racism/ethnology , Schools, Medical/statistics & numerical data , American Medical Association/organization & administration , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Child , Curriculum/statistics & numerical data , Education, Distance/organization & administration , Female , Humans , Male , Physician's Role , Politics , Prevalence , Racism/statistics & numerical data , SARS-CoV-2/genetics , Schools, Medical/organization & administration , Sexual and Gender Minorities/psychology , Social Determinants of Health/standards , Surveys and Questionnaires , United States/epidemiology
15.
Am Soc Clin Oncol Educ Book ; 41: 108-117, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1234574

ABSTRACT

Colorectal cancer mortality has decreased considerably following the adoption of national screening programs, yet, within at-risk subgroups, there continue to be measurable differences in clinical outcomes from variations in screening, receipt of chemotherapy, radiation or surgery, access to clinical trials, research participation, and survivorship. These disparities are well-described and some have worsened over time. Disparities identified have included race and ethnicity, age (specifically young adults), socioeconomic status, insurance access, geography, and environmental exposures. In the context of the COVID-19 pandemic, colorectal cancer care has necessarily shifted dramatically, with broad, immediate uptake of telemedicine, transition to oral medications when feasible, and considerations for sequence of treatment. However, it has additionally marginalized patients with colorectal cancer with historically disparate cancer-specific outcomes; among them, uninsured, low-income, immigrant, and ethnic-minority patients-all of whom are more likely to become infected, be hospitalized, and die of either COVID-19 or colorectal cancer. Herein, we outline measurable disparities, review implemented solutions, and define strategies toward ensuring that all have a fair and just opportunity to be as healthy as possible.


Subject(s)
Colorectal Neoplasms/epidemiology , Health Equity/standards , Humans
16.
Am J Public Health ; 111(4): 610-611, 2021 04.
Article in English | MEDLINE | ID: covidwho-1194521
17.
Nurs Inq ; 27(4): e12386, 2020 10.
Article in English | MEDLINE | ID: covidwho-897264
19.
Milbank Q ; 99(2): 426-449, 2021 06.
Article in English | MEDLINE | ID: covidwho-1112172

ABSTRACT

Policy Points Equitable access to a COVID-19 vaccine in all countries remains a key policy objective, but experience of previous pandemics suggests access will be limited in developing countries, despite the rapid development of three successful vaccine candidates. The COVAX Facility seeks to address this important issue, but the prevalence of vaccine nationalism threatens to limit the ability of the facility to meet both its funding targets and its ambitious goals for vaccine procurement. A failure to adequately address the underlying lack of infrastructure in developing countries threatens to further limit the success of the COVAX Facility. CONTEXT: Significant effort has been directed toward developing a COVID-19 vaccine, which is viewed as the route out of the pandemic. Much of this effort has coalesced around COVAX, the multilateral initiative aimed at accelerating the development of COVID-19 vaccines, and ensuring they are equitably available in low- and middle-income countries (LMICs). This paper represents the first significant analysis of COVAX, and the extent to which it can be said to have successfully met these aims. METHODS: This paper draws on the publicly available policy documents made available by the COVAX initiatives, as well as position papers and public statements from governments around the world with respect to COVID-19 vaccines and equitable access. We analyze the academic literature regarding access to vaccines during the H1N1 pandemic. Finally, we consider the WHO Global Allocation System, and its principles, which are intended to guide COVAX vaccine deployment. FINDINGS: We argue that the funding mechanism deployed by the COVAX Pillar appears to be effective at fostering at-risk investments in research and development and the production of doses in advance of confirmation of clinical efficacy, but caution that this represents a win-win situation for vaccine manufacturers, providing them with opportunity to benefit regardless of whether their vaccine candidate ever goes on to gain regulatory approval. We also argue that the success of the COVAX Facility with respect to equitable access to vaccine is likely to be limited, primarily as a result of the prevalence of vaccine nationalism, whereby countries adopt policies which heavily prioritize their own public health needs at the expense of others. CONCLUSIONS: Current efforts through COVAX have greatly accelerated the development of vaccines against COVID-19, but these benefits are unlikely to flow to LMICs, largely due to the threat of vaccine nationalism.


Subject(s)
COVID-19 Vaccines/supply & distribution , Health Equity/standards , International Cooperation , COVID-19/prevention & control , COVID-19 Vaccines/economics , Global Health , Humans , Pandemics/prevention & control , SARS-CoV-2 , World Health Organization
20.
J Am Board Fam Med ; 34(Suppl): S247-S249, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1100018

ABSTRACT

BACKGROUND: Short- and long-term effects of COVID-19 will likely be designated pre-existing conditions. We describe the prevalence of pre-existing conditions among community health center patients overall and those with COVID-19 by race/ethnicity. MATERIALS AND METHODS: This cross-sectional study used electronic health record data from OCHIN, a network of 396 community health centers across 14 states. RESULTS: Among all patients with COVID-19, 33% did not have a pre-existing condition before the pandemic. Up to half of COVID-19-positive non-Hispanic Asians (51%), Hispanic (36%), and non-Hispanic black (28%) patients did not have a pre-existing condition before the pandemic. CONCLUSIONS: The future of the Patient Protection and Affordable Care Act is uncertain, and the long-term health effects of COVID-19 are largely unknown; therefore, ensuring people with pre-existing conditions can acquire health insurance is essential to achieving health equity.


Subject(s)
COVID-19/epidemiology , Community Health Centers/statistics & numerical data , Adult , Aged , Comorbidity , Cross-Sectional Studies , Female , Health Equity/standards , Humans , Male , Middle Aged , Patient Protection and Affordable Care Act/trends , Preexisting Condition Coverage/trends , Prevalence , SARS-CoV-2 , United States , Young Adult
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