Arkansas Hospitals, Spring 2021

Page 31

COACH'S PLAYBOOK

A Crisis in American Health Care (and No, It Isn’t COVID-19!) by Kay Kendall, special to Arkansas Hospitals magazine It’s November 2020, and you’re the parents of a beautiful, 5-year-old daughter. Less than 15 hours after she tests positive for COVID-19 and is sent home from the ER, she’s dead. Did she die from COVID-19, or because her skin was black? You’ll never know. (This is just one of many similar incidents reported by media outlets over the past year.)

A NEW LOOK AT DISPARITIES

The disparities in health care and health outcomes have been known for decades, but nowhere have they been more evident than during this pandemic. Rather than focus on differences as they apply to infection and mortality rates, it’s time we take a broader, more strategic, longer-reaching look at the social determinants of health. Dr. Donald Berwick, known to many as a pioneer in health care’s modern qualitycare movement, refers to these disparities as the moral determinants of health.1 “Attacking racism and other social determinants of health is motivated by an embrace of the moral determinants of health,” Berwick says. “These include, most crucially, a strong sense of social solidarity in the U.S. ‘Solidarity’ would mean that individuals in the U.S. legitimately and properly can depend on each other for helping to secure the basic

circumstances of healthy lives, no less than they depend legitimately on each other to secure the nation’s defense. If that were the moral imperative, government – the primary expression of shared responsibility – would defend and improve health just as energetically as it defends territorial integrity.” Experts generally agree that four factors (and their weighted percentages) contribute to health: • Clinical Care Factors, including access to care, quality of care, and safe care. These contribute about 20% toward a person’s health and well-being. • Social and Economic Factors, including food security or insecurity, adequacy of housing and/or lack of housing (homelessness), employment security, adequacy of income, level of education, and community safety. These contribute about 40% toward a person’s health and well-being.

• Behavioral Factors, including choice and quality of diet, amount of physical exercise, drug use, and mental health. These determine about 20% of a person’s health and well-being. • Environmental Factors, including quality and availability of safe water and clean air, and availability of safe transportation. These comprise the remaining 20%. In his seminal opinion piece, “The Moral Determinants of Health,” Berwick paints a compelling picture of how these moral determinants combine with startling effect on life expectancy. “From midtown Manhattan to the South Bronx in New York City, life expectancy declines by 10 years,” he says. “[That’s] six months for every minute on the subway. Between the Chicago Loop and [the] west side of the city, the difference in life expectancy is 16 years. At a population level, no existing or conceivable medical intervention comes within an order of magnitude of the effect of place on health.”

Editor’s Note: This winter, Kay Kendall interviewed Dr. Donald Berwick, Dr. Randy Oostra, and Dr. David Ansell to get their input on one of today’s most significant – and most frustrating – public health challenges: the ever-widening gap in health equity, and how social determinants play into every neighborhood’s health and its residents’ longevity. She asked these preeminent health leaders for their ideas on bringing health equity home to individual communities, and how hospitals can play a role in improving health inequities. Here is the result of those interviews. ARKANSAS HOSPITALS | SPRING 2021 29


Turn static files into dynamic content formats.

Create a flipbook
Issuu converts static files into: digital portfolios, online yearbooks, online catalogs, digital photo albums and more. Sign up and create your flipbook.