A new report found that low-income individuals, those who live in rural areas, and Black, Latino, or Native American people have less access to resources and face higher rates of illness, maternal deaths, and behavioral health and substance use issues, Kara Hartnett writes for Modern Healthcare.

Health inequity in America

For the report, Modern Healthcare partnered with the University of Southern California Annenberg School for Communication and Journalism to map the communities with the worst access to healthcare and highest levels of social vulnerability.

The researchers analyzed data from CDC's social vulnerability index and the Health Resources and Services Administration access scores to identify communities with common problems and unique circumstances.

In Evangeline Parish — a Cajun community in rural Louisiana — roughly 25% of people live in poverty. Among the 32,000 people who live in the area, more than 8,000 have disabilities, and 3,000 live on less than half of the federal poverty level.

In the Bronx, New York — New York City's poorest and northernmost borough — many residents have to wait months to see a medical specialist. Pregnancy-related deaths are eight times more likely than they are in nearby Manhattan.

Meanwhile, in Navajo County, Arizona, the number of uninsured residents is 16.4%, which is two times the national rate. In this community, middle-aged Native Americans have seen the largest increases in mortality in the United States — an increase that can be largely attributed to a surge in deaths related to drug overdose, suicide, and alcoholic liver disease.

"These communities possess unique characteristics that point to the U.S. healthcare system's shortcomings," Hartnett writes.

All three communities rank among the 99th percentile for social vulnerability, which was determined using 14 census metrics related to income and access to food, water, and transportation. In addition, the federal government has classified the communities as medically underserved.

"[These communities] have different demographics, built environments, belief systems and opportunities," Hartnett notes. "Within them are health disparities forged by long-standing political and economic forces. Their experiences are common, not exceptional." (Hartnett, Modern Healthcare, 3/5)

The drivers of health inequity — and how to address them

By Sophia Duke-Mosier and Julia De Georgeo

Why are there gaps in access?

Patients of color, low-income patients who are uninsured or underinsured, and patients with comorbidities are hit hardest by inequities. And these political and economic factor hinder care access.. 

Another reason these health disparities persist is largely because of the way our current healthcare system reimburses for care. Under a fee-for-service (FFS) model, providers are not incentivized to deliver the type of care that would address the root causes of patients' adverse social determinants of health (SDOH). 

The FFS model further disincentivizes providers from working with patients in these communities. In recent years, providers have increasingly prioritized patients in higher revenue communities, with many citing high burnout rates from consistently working with high-acuity patient populations and poor reimbursement from populations disproportionately insured by Medicare and Medicaid. 

Along with the FFS payment model, there are several other factors driving the gap in access to care, including:

• Segregation and redlining – Communities with fewer resources across all domains of SDOH, including lower-income, fewer resources, lower public education, and weaker public infrastructure have lower access to care.
• Revenue – Patients who are disproportionately uninsured or on Medicare and Medicaid do not generate as much revenue for private organizations, driving many organizations to shift their focus to areas that have historically generated higher revenues.
• Proximity to care – As organizations take flight from these communities, community members often postpone care and have lower access to primary care.
• High patient volume – The few providers that do accept Medicare and Medicaid end up providing most services for these patients.

6 ways further your health equity strategy

Many stakeholders want and are working to find solutions to care gaps in our system. But these well-intentioned stakeholders perpetuate the access gap with solutions that are misguided or do not fully address the problem.

In our research, we've learned ways organizations can avoid some of these mistakes and accelerate success in health equity by defining providers' role in addressing social determinants of health. To ensure that our solutions make an impact, we recommend the following:

1. Address the root causes of SDOH – Instead of simply putting a Band-Aid on existing issues with ad-hoc investments or patient-level investments, stakeholders should focus on the root causes of SDOH – intergenerational poverty and structural inequity.
2. Commit to long-term community involvement – Long-standing barriers to care can only be addressed with a long-term strategy.
3. Approach planning from grassroots to "grass tips" – Lean on members of the community to help identify root causes, build initiatives, and make investment decisions.
4. Expect to help community partners build capacity – Provide support beyond funding by tapping into organizational scale and existing infrastructure.
5. Plan for blowback amid disruption – When met with conflict, assume positive intent, be flexible, and get creative.
6. Prove commitment with significant internal change – Establish diversity and inclusion as a strategic pillar, accelerating community representation throughout your organization's workforce and leadership.