August 17, 2020

The Social Determinants Of Health and COVID-19

By Accolade

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The research from the Centers for Disease Control and Prevention (CDC) is clear: social conditions have a huge impact on people’s health and well-being.

“As a medical community, we know that social determinants like housing stability, food security, and finances directly impact a person’s health, including their risk of chronic conditions like diabetes or heart issues,” said Dr. Shantanu Nundy, Chief Medical Officer at Accolade and a practicing physician in an underserved area of Washington, D.C. “And we also know that black and brown communities, because of systemic racism in our country, are more adversely affected by these social conditions than white communities.”

In a recent interview, National Institute of Allergy and Infectious Diseases head Dr. Anthony Fauci also cited these social determinants as driving the disproportionate impact the COVID-19 pandemic has had in the Black community in Washington D.C. and nationwide. “When [African-Americans] do get infected, given the social determinants of health which make them have a higher incidence of diseases like obesity, hypertension, and diabetes, they are at much greater risk of suffering deleterious consequences, including death.”

Social determinants, race, and COVID-19

As Dr. Fauci points out, COVID-19 is making existing racial inequalities in our healthcare system clearer, even as it intensifies their impact. National statistics on rates of the virus by race, including on hospitalizations and deaths, are slowly emerging, but the American Medical Association (AMA) put a fine point on the topic in a statement to the House Ways and Means Committee, stating that “The COVID-19 pandemic has revealed starkly the disproportionate impact of the virus on communities of color. The causes of the disproportionate impact are rooted in this country’s historical and structural racism and the social, economic, and health inequities that have resulted, and continue to result in, adverse health outcomes.”

Early data backs up the AMA’s assertion, demonstrating that an outsized number of African American and Hispanic/Latino people are being hospitalized and dying from the virus. And as research continues, there’s a growing body of data from numerous sources reinforcing the case. An article in the May 18 issue of The Lancet reviewed several studies on COVID-19, driving home the point that “Many social determinants of health—including poverty, physical environment (e.g., smoke exposure, homelessness), and race or ethnicity —can have a considerable effect on COVID-19 outcomes.” The authors, physicians Elissa M. Abrams and Stanley J. Szefler, highlighted research published in the Journal of the American Medical Association showing that the U.S. infection rate for COVID-19 is three times higher in predominantly black counties than in predominantly white ones, and the mortality rate is six times higher.

That’s in line with other data from the front lines of COVID care. A recent study from the Sloan School of Management at Massachusetts Institute of Technology (MIT) found that COVID-19 death rates correlate with age, race, and socioeconomic status, among other factors. According to this research, African Americans have a higher rate of death from COVID-19 than other races. Research from the Polis Center at Indiana University – Purdue University Indianapolis (IUPUI) showed that black residents of Marion County, Indiana, tested positive for COVID-19 at a rate nearly twice that of white residents. And as of July 1, the COVID Racial Data Tracker, a collaborative effort of the COVID Tracking Project and the Boston University Center for Antiracist Research, found that across America, Black people are dying from COVID at a rate 1.5 times higher than their population share.

Ending or reducing these health disparities in COVID care and across the healthcare system will require many changes. Chief among them is ensuring that we begin to not only understand social factors as integral to wellness, but also prioritize equitable access to healthcare and to conditions that promote healthy lifestyles.

How Accolade supports healthcare access

At Accolade, it’s our mission to help every person to live their healthiest life. We know this encompasses physical, emotional, and financial well-being and stability, and believe that our model of personalized healthcare advocacy can make a positive difference for all patients. Our Accolade Health Assistant® representatives engage with members through secure telephonic and messaging channels, listen to their health concerns, and work to understand and overcome the obstacles members encounter in accessing healthcare. Accolade’s brand of personalized listening and engagement lays the groundwork for whole-person care for every individual.

“Our ability to get to know people as individuals is how we provide the level of support that we do,” said Dr. Nundy. “Our nurses and Health Assistants not only help members find the right in-network doctor for them or affordable medications that are on formulary, they will find out if someone needs help with bus routes or other transportation means to a medical facility or with home delivery of medications – and they will actually look up that route for them or help sign them up for those services. We do everything we can to make sure that person gets the care they need.”

If you’re interested in learning more about how Accolade can help support the health of your employees during the COVID-19 pandemic and beyond, you can visit our resources page for more posts.