April 10, 2020

This week, emerging data from states and counties demonstrated that Black communities are disproportionately impacted by Covid-19, as evidenced by elevated infection and mortality rates.

The field guide for defining providers' role in addressing social determinants of health

Experts link the root cause of these disparities to centuries of marginalization that have led to:

  • Higher rates of dangerous comorbidities, including asthma, heart disease, and diabetes;
  • Restricted access to key social goods, including affordable healthy food and stable housing; and
  • Limited job prospects that constrain the feasibility of social distancing, including health care, transportation, and food supply.

Institutional racism has deprived many Black Americans of economic opportunity, but socioeconomic status alone doesn't explain the disparate outcomes. Affluent Black Americans are more likely than their affluent white counterparts to live in low-income neighborhoods. These areas are typically further from trauma centers and closer to environmentally toxic sites, like oil and gas facilities, which can exacerbate dangerous comorbidities.

To ensure your Covid-19 response equitably meets the needs of all patients, we've outlined three key steps provider organizations should be taking.

1. Collect and share race-specific data from your COVID-19 cases

On a national level, the CDC has only just started to release small samples of race-specific Covid-19 data. Although such data is only currently available in a few geographies, this likely reflects insufficient data collection rather than rare pockets of inequity. Hospital leaders must face the problem head on as these disparities are likely widespread.

Leaders should help address this information shortage by regularly collecting, analyzing, and sharing race-specific Covid-19 data. Site-level data helps hospital leaders demonstrate the scope of the problem to staff, achieve organization-level buy-in for operational changes, and target prevention efforts to the highest-risk communities.

2. Target outreach and prevention in high-risk communities to suppress the spread

Provider organizations should tap into their existing community partnership networks to ensure safety guidelines reach the most at-risk communities. Together, they should draft guidelines on mitigating the spread of the disease, identifying symptoms, and seeking out testing and treatment. Guidelines should offer practical advice for those who are unable to practice extensive social distancing, including people who are experiencing homelessness or are incarcerated. All guidelines should use easy-to-understand and specific language rather than medical jargon (e.g., breathing problems vs. chronic respiratory condition). Task community partners—including food banks, shelters, barbershops, and churches—with helping to spread prevention guidelines.

In addition to improving their channels for general public health information, provider organizations should leverage their care management capabilities to proactively reach out to known high-risk patients. Community health workers and social workers may have the capacity and trusting patient relationships to make a difference. These staff should check in with patients to see whether their social needs may be impacting their abilities to practice protective behaviors, and then address those needs, reinforcing messaging on how to prevent infection.

3. Underscore the importance of maintaining patient-centered principles to avoid inequitable care delivery

The novel coronavirus has placed immense, unprecedented strain on provider organizations. Most hospital leaders remain focused on keeping their staff safe, patients alive, and operations afloat. Likewise, frontline staff continuously put their lives on the line to protect patients. But leaders and staff cannot overlook key tenets of patient-centered care as they fight to bring our society through the epidemic. In particular, providers must stay mindful of the effect that implicit biases can have on clinical outcomes.

In conversations with frontline staff, hospital leaders should underscore the importance of taking time to use patient engagement and communication best practices, despite the understandable pressures to work as quickly as possible. Site-specific disparities data can help to illustrate that these principles are as important now as they have ever been.

Is your organization taking a strategic approach to mitigate racial disparities in COVID-19 outcomes? Email Darby Sullivan at sullivada@advisory.com to share your approach.  

The field guide for defining providers' role in addressing social determinants of health

Read on to learn about potential ambitions for your strategy, five primary roles for becoming an effective community partner, and case profiles of best-in-class organizations working to address social determinants of health today.

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