The COVID-19 pandemic is highlighting an uncomfortable fact the healthcare industry has struggled with for years: the American health system, designed with the best of intentions, sometimes fails those who need it most. Though many hospitals and health systems have developed robust community wellness programs, the message is failing to penetrate low-income and minority communities, who continue to rely on the ED as their primary source of care.
The Role of Education
Education that resonates with underserved people goes beyond healthy living tips. Suggestions like taking long walks and eating more produce seem impossible to people living in neighborhoods with unsafe streets and no nearby grocers. Tailoring outreach to address the concerns, challenges, and assumptions of specific groups yields better results than one-size-fits-all messaging.
Health systems around the country have done an excellent job designing services such as wellness clinics and low-cost immunization programs. But building the programs is only half a solution unless they reach the people who need them. People cannot take advantage of a program they do not know exists, and they will not use it if they do not understand how it benefits them.
Community wellness programs have a better chance of success if the marketing team is brought in early on. That way, when the new offering is ready to launch, marketers know who it is intended to help and can target publicity to that audience.
People are more inclined to attend events like health fairs and immunization clinics when they are held in the neighborhood, giving outreach staff a chance to hear concerns and explain available services. This also gives staff a chance to see the community, which may lead to discovering healthcare gaps they did not know existed.
The value of face-to-face interaction cannot be overstated. In a recent study on a Navajo reservation, the Centers for Disease Control and Prevention found low-income people with diabetes were more successful at controlling their disease when they worked one-on-one with a community representative from the tribal health system. The health representatives were trusted members of the community who understood the society, language and traditions of the at-risk people they were helping.
Partnering for Better Outcomes
In some parts of the country, hospitals and health systems are partnering with community development organizations to improve health outcomes. In Detroit, for example, Trinity Health has invested more than $30 million in community development initiatives such as affordable housing and day care. The goal is to improve public health by improving living environments in impoverished neighborhoods.
Preventive care is a key component of a healthy environment, but people living in poverty rarely seek such care. Because they are more likely to be uninsured or underinsured, low-income patients often put off addressing symptoms or treating chronic conditions until they reach crisis level—when treatment is both more expensive and less effective.
Health systems committed to addressing gaps in preventive care can partner with insurance companies to better outcomes for low-income patients. Insurance partners may offer incentives to encourage high-risk members of basic plans to actively manage their health. Meanwhile, health educators might target wellness programs to the high-risk uninsured, providing access to free or low-cost clinics and screenings.
Getting care to low-income, at-risk populations has been a longtime struggle for the American medical profession. Great strides have been made with the development of community outreach programs within hospitals and health systems. To take the next step, it will be necessary to expand partnerships beyond the health system’s walls. The attention COVID-19 has brought to this situation could create momentum for a new era in healthcare access.
Astha Bhatia, BDS, is a clinical scientist in the field of hematology and oncology, a dental surgeon and public health professional (drasthabhatia@gmail.com). She is currently employed as an associate director of Clinical Development at Immunomedics in New Jersey. Immunomedics was recently acquired by Gilead.