Social Determinants of Health in the Time of COVID-19

If there is one good thing to come from this pandemic, it might just be that it has ripped the blinders from so many people’s eyes about the grave disparities that exist in health and health care. With this virus, we see disproportionate infection and mortality rates between people of color and white people. But we also see similar disproportions between income discrepancies, housing conditions, and “essential” workers who don’t have the luxury of working remotely in self-imposed isolation.

I remember listening to a webinar hosted by The Institute for Healthcare Improvement (IHI), and Dr. Don Berwick made a bold statement about how people who could work from home, in a single-family dwelling, had such privilege when you contrast that with people who live in multi-generational housing and have to take public transportation to get to their jobs, where walking on crowded sidewalks invites new risks every day. Once made conscious of these differences, I saw these challenges in a new light.

And in another recent conversation with Dr. Randy Oostra, President and CEO of Promedica Health, he reminded me of the strong correlation between food insecurity and health. But in our body-shaming society, we are likely to be judgmental about someone who is obese, even children who are obese, and think they should be making healthier choices. People living on low incomes often can’t afford “healthier” foods and may live in a food desert, where the availability of fresh fruits and vegetables is limited or non-existent. What struck me in our conversation was that he had been applying these concepts in the Toledo community for 10 years, but only two years ago decided to conduct food insecurity assessments on his own workforce. Big surprise (to me, at least), his employees mirrored the local population with an average of 19% experiencing food insecurity, and single mothers and their families experiencing 33% food insecurity.

What does all this mean to us during this pandemic? I believe it means we need to be less judgmental about health disparities and to look for ways – large and small – to contribute to the greater good. Many food banks regularly have matching donation campaigns where your contributions are doubled or tripled. We need to look out for our neighbors, particularly the elderly and single mothers, who may be experiencing food insecurity but are too ashamed or proud to ask for help. We need to work with our communities to address homelessness.

The Baldrige Excellence Framework has long had an emphasis on societal contributions. It’s time for leaders of organizations from inside and outside of health care to redouble our efforts in these tough times. Where will you start?

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