The COVID-19 crisis has shined a light on the existing discrepancies in the healthcare system, with patients of color more likely to test positive for and suffer more severe health consequences from the novel coronavirus.
In addition, said panelists at Equal Access to Care for All Communities, a recent HIMSS Global Health Equity Week webinar, the bias faced by people in vulnerable communities makes it harder to fight the disease.
“The stress of being discriminated against your entire life, working and fighting and struggling to get access to income, to get access to education, to get access to care … those things mount up to potentially, maybe thwart our ability for our immune system to fight something like COVID,” said Carladenise Edwards, senior vice president and chief strategy officer at the Henry Ford Health System.
“That cortisol release that individuals have over their lifetime is going to change the ways in which they can respond,” agreed Sam Shah, founder and director of the Faculty of Future Health at Ulster University in Northern Ireland.
“Structural institutionalized problems we have … go beyond the things we can see,” Shah continued. They’re “ingrained and entrenched in society.”
So, in public health emergencies like the COVID-19 pandemic, said Dr. Dominic Mack, director of the National COVID-19 Resiliency Network, “We see the pile-up of disparities come to bear.”
The healthcare system in the United States often focuses on individual health rather than population health or social health, said the experts.
As a result, it becomes difficult to implement long-term systems that will benefit large groups of people, such as those for chronic disease prevention among underserved communities. Mack noted, for example, that COVID-19 testing lines are extremely long in certain parts of cities, suggesting that those with the most need have the fewest resources.
Edwards cited the scholarship of economists Anne Case and Angus Deaton: “The design is intentional to continue the proliferation of capitalism and the disparities [between] the haves and the have-nots,” said Edwards.
So given those deep, entrenched disparities, how can healthcare IT play a role in addressing them? Interoperability and data integration can be a useful tool for getting a sense of other factors in patients’ lives that could be affecting their health, said the panelists – but they’re not enough on their own.
“Data is not a patient,” said Mack. “When you look at a patient … you cannot just control one aspect and one determinant and think it’s going to solve the whole problem. It’s a systematic approach.”
In fact, said Edwards, “We have all the data and information we need.” She pointed out that we know, for instance, that Black men have the lowest life expectancy regardless of income level. Though she said we should still collect data, she asked, “How much more information do we need for institutions, for systems to decide to do something about it?”
Shah argued that much of the available data isn’t usable anyway – that it’s chaotic, “jumbled-up,” and not reflective of lived realities. “Just making the data more transparent” and using it to better plan patients’ treatment, he said, could be a good starting place.
However, technology can also be used in a harmful context, panelists said.
Moderator Dr. Walter Suarez, executive director of health IT strategy and policy at Kaiser Permanente, noted that artificial intelligence and machine learning can reproduce the bias of their creators, or not take into account factors that affect some communities differently than others.
There’s also the risk, said Edwards, of “exacerbating discrimination in other areas if one’s privacy is violated.” In the United States, she continued, many fear “how our health data specifically is being used.”
“The system has to incentivize the development of the technology specifically for those populations” that have historically been overlooked, said Mack.
In anticipation of another pandemic or natural disaster, he said, “We need specific disaster planning for those communities that are disproportionately impacted.”
Still, said Edwards, “I do feel quite optimistic” about using IT to bridge the gap for those who don’t have access to care.
“We have been able to leverage technology to get resources to them,” she said. However, technology “hasn’t eliminated the disparities between those who have and those who do not have. The gap seems to continue to widen.”
One step systems can take, she said, is “ensuring that we all commit to caring for people as individuals …. Everyone gets the same level of care and treatment regardless of their race, their gender, their economic status.”
“If we live with those values and profess those values that’ll be a little dent in some of the things we’re seeing,” she said.