By KIM BELLARD
In a week where we’ve seen the bungled Afghan withdrawal, had Texas show us its contempt for all sorts of rights, watched wildfires ravage the west and Ida wreak havoc on a third of the country, and, of course, witnessed COVID-19 continue its resurgence, I managed to find an article that depressed me further. Thank you, Aaron Carroll.
Dr. Carroll – pediatrician, long-time contributor to The New York Times, and now Chief Health Officer of I.U. Health — wrote a startling piece in The Atlantic: We’ve Never Protected the Vulnerable. He looks at the resistance to public health measures like masking and wonders: why is anyone surprised?
Some of his pithier observations:
- “Much of the public is refusing. That’s not new, though. In America, it’s always been like this.”
- “COVID-19 has exposed these gaps in our public solidarity, not caused them.”
- “America has never cared enough. People just didn’t notice before.”
Wow. What was that about Texas again?
Some of Dr. Carroll’s examples include our normally lackadaisical approach to influenza, our failure to recognize the dangers we often pose to immunocompromised people, our paltry family and sick leave policies, and our vast unpaid care economy. He could have just as well pointed to our (purposefully) broken unemployment system or the stubborn resistance to Medicaid expansion in 12 states (Texas again!), but you probably get the point.
Everyone likes to complain about our healthcare system – and with good reason – but it is not an abyss we somehow stumbled into. It’s a hole we’ve dug for ourselves, over time. We may not like our healthcare system but it is the system we’ve created, or, perhaps, allowed.
Health insurance was once largely community-rated, spreading the risk equally across everyone to protect the burden on the sickest, until some insurers (and some groups) figured out that premiums could be cheaper without it. Use of preexisting conditions and medical underwriting also served to protect the less vulnerable, until ACA outlawed those practices.
How structural racism and implicit bias impact America’s babies, even prior to birth
By ELLIE STANG
Becoming a new mother in America is more dangerous for some mothers than it should be. Each year, 700 women die in childbirth or from pregnancy-related causes in the United States, the highest number of any developed nation.
Health inequities in America mean that overwhelmingly, Black women and their infants are the ones impacted: Black mothers are 243% more likely to die from pregnancy than white ones. These discrepancies are wide ranging: American Indian and Alaska Native women are also 2x more likely to experience an adverse outcome as compared to their white counterparts. Too many of our mothers are dying of preventable causes. The CDC estimates that 70% of maternal deaths are avoidable – which helps underscore the urgent need to create tangible change.
Recent forces have helped shine a long overdue spotlight on the Black maternal mortality crisis in America. In April, the Biden Administration released a proclamation during Black Maternal Health Week, and planned legislative changes to address implicit bias in healthcare and apply funding where it is truly needed. Congress is fielding the “Momnibus” bill, which would fund grassroots organizations at the community level, actively establish bias training programs, and fill gaps created by social determinants of health (SDOH). Late last year, the HHS released an action plan to reduce maternal mortality and adverse outcomes by 50% in five years.
It is heartening to see action finally being taken: our mothers deserve more. At the same time, while we champion standardized and equal access to care for all of our mothers, we cannot overlook the newest cry in the room: the infant’s. Even before drawing her first breath, a baby girl’s future will be irrevocably shaped by structural racism and socioeconomic factors way beyond her control.
That’s why, to address health inequities, we must begin with our babies. Despite great advances in NICU technology and managed healthcare, infant mortality is on the rise – and it disproportionately affects Black babies. Today, black infants are twice as likely to die as their white counterparts.
By ALYA AHMAD, MD
Call it what you want, white privilege and health disparity appear to be two sides of the same coin. We used to consider ethnic or genetic variants as risk factors, prognostic to health conditions. However, the social determinants of health (SDOH) have increasingly become more relevant as causes of disease prevalence and complexity in health care.
As a pediatric hospitalist in the San Joaquin Valley region, I encounter these social determinants daily. They were particularly evident as I treated a 12-year old Hispanic boy who was admitted with a ruptured appendix and developed a complicated abscess, requiring an extensive hospitalization due to his complication. Why? Did he have the genetic propensity for this adverse outcome? Was it because he was non-compliant with his antibiotic regimen? No.
Rather, circumstances due to his social context presented major hurdles to his care. He had trouble getting to a hospital or clinic. He did not want to burden his parents—migrant workers with erratic long hours—further delaying his evaluation. And his Spanish-speaking mother never wondered why, despite surgery and drainage, he was not healing per the usual expectation.
When he was first hospitalized, his mother bounced around in silent desperation from their rural clinic to the emergency room more than 20 miles from their home and back to the clinic, only to be referred again to that same emergency room. By the time he was admitted 2 days later, he was profoundly ill. The surgeon had to be called in the middle of the night for an emergency open surgical appendectomy and drainage. Even after post-operative care, while he was on broad-spectrum intravenous antibiotics, his fevers, chills and pain persisted. To avoid worrying his mother, he continued to deny his symptoms. Five days after his operation, he required another procedure for complex abscess drainage.
By PHUOC LE MD
I was born in a rural village outside of Hue, Vietnam in 1976, a year after Saigon fell and the war ended. My family of four struggled to survive in the post-war shambles, and in 1981, my mother had no choice but to flee Vietnam by boat with my older sister and myself. Through the support of the refugee resettlement program, we began our lives in the United States in 1982, wearing all of our belongings on our backs and not knowing a word of English.
Though we struggled for years to make ends meet, we sustained ourselves through public benefit programs: food stamps, Medicaid, Section 8 Housing, and cash aid. These programs were lifelines that enabled me to focus on my education, and they allowed me to be the physician and public health expert that I am today. Looking back, I firmly believe that the more we invest in the lives and livelihoods of immigrants, the more we invest in the United States, its ideals, and its future.
So, when I first learned of the current administration’s plan to make it harder for immigrants with lower socioeconomic statuses to gain permanent U.S. residence, the so-called changes to the “Public Charge” rule, I felt outraged and baffled by its short-sightedness.
By FRED TROTTER
On Oct 19, I will begin to MC the health equity hackathon in Austin TX, which will focus on addressing healthcare disparity issues. Specifically, we will be using healthcare data to try and make an impact on those problems. Our planning team has spent months thinking about how to run a hackathon fairly, especially after the release of a report that harshly criticized how hackathons are typically run.
A Wired article written earlier this year trumpets a study called “Hackathons As Co-optation Ritual: Socializing Workers and Institutionalizing Innovation in the ‘New’ Economy,” which criticizes the corporate takeover of hackathons. Hackathons are inherently unfair to participants according to these two sociologists.
They argue that hackathons have become a way for corporations to trick legions of technologists into working for free. To a sociologist, that looks like exploitation, and it is hard to see how they are wrong.
After reading the article, I was struck by how many things about typical hackathons are backward:
- Hackathons romanticize workaholism and celebrate insomnia – With hackathons typically running 24-72 hours straight, sleep is for the weak. Those who don’t sleep are seen as heroes.
- Junk food is the only option – Most hackathons provide unhealthy snacks, high in fructose and low in protein. Participants are expected to fuel their unpaid work sprints with sugar and caffeine. These are frequently the only eating options available.
- Healthy work patterns ensure that there are breaks. Opportunities to chat, or walk and take a break from work. And the idea of encouraging people to get up and move, let alone stretch, is unheard of at these hackathons. Hundreds of geeks, unable to shower, or leave the room, can create a pretty bad smell.
- Judging is at best arbitrary, and in some cases completely rigged, with winners sometimes chosen in advance.
On occasion, I have seen harder stimulants used. Although I have never seen anyone on cocaine win, it does make for super-engaging project presentations. The presentations were not good, mind you, just engaging… In the “Holy Moses, this guy is about to present when he is clearly high AF” sense.
During National Minority Health Month, we acknowledge the potential for health information technology (health IT) – from electronic and personal health records to online communities to mobile applications – to transform health care and improve the health of racial and ethnic minorities.
Lack of access to quality, preventive health care, cultural and linguistic barriers, and limited patient-provider communication are factors that aggravate health disparities.
By increasing our investment in health IT policies and standards, we can help improve the quality of health care delivery and make it easier for patients and providers to communicate with each other – a huge step toward addressing the persistence of health disparities.
The Pew Research Center’s Internet & American Life Project found in 2012 that African Americans and Latinos are more likely to own a mobile phone than whites and outpace whites in mobile app use, using their phones for a wider range of activities.
The study showed that African Americans and Latinos use their mobile phones more often to look for health information online. This has very important implications for personal management of health and interaction with the health care system.
However, barriers to widespread adoption of health IT remain.
For example, a 2014 consumer engagement report found that minorities were less likely to adopt online patient portals to access their health information than were non-Hispanic whites.