Health disparities continue to impact communities of color, resulting in higher rates of illness and death, both from Covid-19 as well as from many common health conditions. William Shrank, M.D., chief medical officer of Humana, and Nwando Olayiwola, M.D., MPH, the newly appointed chief health equity officer of Humana, discuss what it will take to effectively address these inequities in STAT.
William Shrank: The healthcare community has increasingly recognized the outsized impact social context and race have on a person’s health, but the pandemic brought that fact into sharp focus, exposing the major health disparities that exist in our nation. Nwando, you have spent much of your career working on the issue of health equity, what do you think this moment has taught us about bringing about change?
Nwando Olayiwola: To tackle these disparities meaningfully, we need to understand their causes and not shy away from an understanding of structural causes. For instance, white Americans have outpaced Black and Brown Americans in Covid-19 vaccinations, and this can be for a myriad of reasons. While acceptance of vaccines is generally pretty high in Black and Brown communities, many are not able to get vaccinated because of structural and social barriers such as: initial low penetration of vaccine sites in underserved communities, lack of transportation to a vaccine site; inability to miss work to get the shot or, in many cases, two shots; or suboptimal broadband or internet access to research the vaccines or schedule an appointment; high digital literacy and literacy skills required to navigate vaccine platforms. Recent grassroots efforts to make the vaccines more accessible in underserved communities are working, with vaccination rates rising more rapidly among Blacks and Hispanics than the general population.1
Shrank: That raises a critical point about solving health inequities: the importance of partnering with those who are living and working in underserved communities to understand what the challenges are and develop the right solutions. Humana has seen substantial improvements in health outcomes through our Bold Goal initiatives where we partner with community-based organizations, the places where members congregate, and physician practices to create a social fabric, at the local level, that addresses social determinants of health by connecting patients with community-based services.
Olayiwola: Yes, listening and learning from those who are closest to the issues we are trying to solve is paramount. As physicians, we also need to take stock of our own attitudes and assumptions, as well as those of our peers. For instance, during one of my pregnancies, I became sick and went to the ER. The attending doctor assumed three things about me as a Black woman: I was single, I was poor, and I was suffering from anxiety. None of his assumptions were true and, in fact, I had a serious kidney infection. His biases against me could have cost me or my baby our lives.
Now, to turn the tables, earlier in my career I treated an elderly man with poorly controlled diabetes and continued to increase his insulin dose because he wasn’t responding to the medication. Little did I know, he was homeless, had no refrigeration, and wasn’t filling his prescriptions. I didn’t know because I hadn’t asked. This experience has stuck with me as a striking example of the influence of social needs on health.
Shrank: That, unfortunately, is often the case. This is why a care team approach can make such a difference, and why we’re using this model in our CenterWell Senior Primary Care centers, located primarily in underserved areas. Supporting the physician is a social worker, pharmacist and behavioral health specialist, all of whom have a role in addressing patients’ physical, social and emotional health.
Olayiwola: Health plans can play a critical role in advancing health equity. We can implement different whole-person, value-based care models and new ways of delivering care as we work with local organizations, government agencies, and medical practices to develop solutions for individual communities. While there are major systemic challenges to achieving true health equity, the pandemic has opened our eyes to the health effects of racism and poverty and opened the door to innovative ideas that will help us get closer to that goal.