Within the last 12 months, the intersection of a national health emergency with a sweeping social movement for racial equality has made the health and well-being of millions of America’s most vulnerable a central issue. Though health disparities have long been prevalent within the nation’s health care continuum, the COVID-19 pandemic has singlehandedly exacerbated a host of vulnerabilities, moving the pendulum from bad to worse, especially for minorities and underserved populations.
To complicate matters, there have been countless reports of widespread hesitancy, particularly in communities of color, even though they have been the hardest hit by COVID-19. A recent Kaiser Family Foundation poll showed that only 35% of Black and 42% of Hispanic respondents say they have already been vaccinated or want it “as soon as possible” compared to 53% of white respondents, with Black and Hispanic adults also among those most likely to take a “wait and see” approach when it comes to the vaccine.
With many health experts agreeing that the vaccine as the only way out of the pandemic and back to a sense of normalcy, the burden to gain buy-in and acceptance from the public has become increasingly heavy. For its part, AdventHealth has for many years been working on ways to better serve, understand and support communities most often associated with disparities in health outcomes. This focus culminated with the recent appointment of the health system’s first chief health equity officer, Alric Simmonds, MD, who is also a surgeon and serves as chief medical officer at AdventHealth Celebration.
We spent some time with Dr. Simmonds to get his perspective on health disparities, vaccine hesitancy and AdventHealth’s overall focus on health equity.
As the recently appointed chief health equity officer for AdventHealth, what is your primary focus in this role?
Our goal is to ensure that regardless of socio-economic status, gender, sex, age or race, every person we serve has equal opportunities to have equitable care and outcomes. Many health disparities are prevalent to varying degrees within underserved communities. Things like access to care, income and being underinsured or uninsured play a significant role in a patient’s health trajectory. We see this consistently in our community health assessments across the system. We want to provide interventions and solutions to the challenges that act as barriers for people in the communities we serve.
At times, people use the terms equity and equality interchangeably when it comes to health. Is there a distinction, and if so, can you explain the difference?
So, equity is not the same as equality. Here is a scenario to help illustrate the difference. You have two patients with the exact same condition who visit the same doctor and get the exact same diagnosis. Patient A is from an affluent community, he gets an electronic prescription that goes directly to his pharmacy. When he gets to the pharmacy, it's ready for pick up. He presents his card, pays his copay and takes his prescription home. On the other hand, patient B is not affluent. He rode the bus to the doctor and gets a handwritten prescription to take to his pharmacy. He doesn't have any money and doesn’t have insurance to cover his medication. Instead of going to the pharmacy, he rides the bus back home and places his paper prescription on the counter, hoping that he does not experience a health episode.
While these patients were treated equally, patient B is at far greater risk for a poorer outcome because of the gap in equity. That is the gap we are hoping to fill.
The COVID-19 pandemic has in many ways pulled the veil off of another crisis that has revealed itself in the disproportionately negative impacts we are seeing on minority communities. Why have communities of color been hit so hard by the pandemic?
Early in the pandemic, we understood that underlying health conditions were the main catalysts for poor COVID-19 outcomes for minorities, particularly Black and Hispanic. We have since come to realize that in many ways, factors like socio-economic status, where you work, how you get to work, the make-up of your household and so on all play a major role in your susceptibility to COVID-19 and your ability to survive should you become infected. If you rely on public transportation, you are likely at greater risk of infection. There are many mitigating factors that point directly to a person’s pre-existing health condition and their socio-economic status as key variables to their vulnerability.
Widespread hesitancy persists within communities of color when it comes to taking the vaccine. Where does that come from and how can we reverse this trend?
The hesitancy to accept the vaccine that we are seeing in minority communities comes from many different places. Whether it's feeling that the vaccine was rushed, a mistrust in the government or mistrust in the health care infrastructure, this hesitation comes from very real places and emanates from real experiences that are culturally ingrained. There is a well-documented history of mistreatment and manipulation in the American health care system.While we have come a long way, it really shouldn't surprise people when they see widespread hesitancy and resistance from groups that have experienced these misdeeds.
I think it's incumbent upon us as a health care community to be clear about the science, the efficacy and also the risk of not taking the vaccine when it's available to you. But I think as important as that is, we also have to be in a position to listen and even validate some of the concerns that people have. Because again, they come from places of sincere hurt and fear. I'm not saying we have to be an apologist for all of those hurts, but I do think we need to acknowledge them and try to meet people where they are. I think that with the way we care for our communities, and the mission that guides us, AdventHealth is uniquely positioned to address, engage and partner with our communities, stakeholders and consumers on these issues.
Moving forward a bit, what is next for AdventHealth from a health equity perspective?
We are in the process of understanding our data on health equity and health disparities. We will look at our own outcomes to better understand how factors like social determinants of health are influencing the attainment of health equity within our own system. It is our goal to develop benchmarks and best practices that can also be shared with other organizations as well as the community.
For us, this is essential work. We want communities to be better and healthier places because of our presence there. While much of that work happens inside the walls of our hospitals, we also understand the importance of moving that care outside the hospital walls and further into the community. This is a responsibility we do not take lightly. We view this as sacred work. Our mission charges us to view it that way, and I am so thankful to have the opportunity to play a part in it.