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Abstract: The burden of COVID-19 falls disproportionately on those who are minoritized, marginalized, and medically underserved in the United States.1,2 Despite incomplete and inadequate data, a clear pattern emerged early in the pandemic. Rates of COVID-19 infection, hospitalization, and death were higher among those identifying as Black, Latino(a), or Indigenous than among Whites; rural communities also experienced substantial COVID-19-related challenges.3 Many affected groups, such as people with disabilities and queer-identifying people and those involved in the carceral system, were invisible in public health data. Structural and systemic realities kept people who needed them the most separated from life-preserving ... Read More PubDate: 2022-12-19T00:00:00-05:00
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Abstract: The coronavirus disease 2019 (COVID-19) pandemic has been an awakening to the entire globe and has unveiled to the public long-standing and unaddressed social inequities in the United States (U.S.). Over one million people in the U.S. have lost their lives to this terrible disease,1 and the long-term health, economic, and psychological impacts—while still undefined in detail—are significant,2 and for many remain unaddressed. The impacts of the pandemic have been much greater among those who are historically marginalized;3 these groups include people of color, LGBTQIA+ populations, those living with a disability, immigrants, people living in rural areas, the elderly, and those with lower socioeconomic status ... Read More PubDate: 2022-12-19T00:00:00-05:00
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Abstract: Over time, 30–40% of all food that is produced in the United States (U.S.) every year is wasted.1 Simultaneously, 10.5% of U.S. households are food-insecure.2 Food insecurity is a complex problem with contributing factors such as systemic inequalities including poverty and racism.3 During 2020–21, the COVID-19 pandemic amplified this public health problem, worsening experiences of hunger for many Los Angeles County residents.4,5 Food insecurity is defined as a "household-level economic and social condition of limited or uncertain access to adequate food."6[para.13] The condition is associated with a number of negative health consequences including increased depressive symptoms, poorer physical health, and higher ... Read More PubDate: 2022-12-19T00:00:00-05:00
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Abstract: Refugee populations in the United States (U.S.) are underserved due to a variety of system-level barriers, including a lack of meaningful language access and unfamiliarity navigating the complexity of the U.S. health care system.1,2 During the COVID-19 pandemic, public health messaging in the U.S. has been produced mostly in English and Spanish. Appointment-scheduling for COVID-19 vaccines frequently relies on patients to access a web-based portal or call a hotline number by phone for an appointment at an unfamiliar vaccination location. These factors, combined with exposure to misinformation on social media,3 could lead to challenges with refugee communities understanding evolving COVID-19 vaccination eligibility ... Read More PubDate: 2022-12-19T00:00:00-05:00
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Abstract: Expanding Medicaid coverage has helped reduce coverage disparities and health inequities between people near or below the poverty line, minority racial/ethnic groups, and rural/urban communities and their counterparts by allowing them to access health care at little or no cost.1–5 However, reaching eligible populations in order to support their enrollment in coverage can be difficult, particularly in the cases of immigrant, tribal, and rural communities.6–9 In 2019, more than one quarter of uninsured Americans were Medicaid-eligible and over one-third were eligible for subsidized coverage purchased through the Affordable Care Act Marketplace.10 Rural residents and people identifying as belonging to a racial or ... Read More PubDate: 2022-12-19T00:00:00-05:00
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Abstract: More than 235,000 people in Canada experience homelessness each year. This includes people living on the streets, in unsuitable living environments, or in temporary residences, motels, or other unstable housing.1 People with lived experience of homelessness (PWLEH) have worse health outcomes than people who are stably housed. These associations tend to be complex, varied, and bi-directional.2 Adverse outcomes associated with homelessness include a higher risk of infectious disease, serious traumatic injuries, drug overdose, violence, and death due to exposure.3,4 Homelessness can also affect outcomes for chronic diseases and mental health and substance use disorders.3,4 People with lived experience of homelessness ... Read More PubDate: 2022-12-19T00:00:00-05:00
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Abstract: Individuals who live in areas with limited healthy food access are more likely to experience chronic health problems such as, obesity, hypertension, and other health conditions.1–3 Living in areas with limited access to healthy food is not equitably experienced across populations.4–8 Specifically, Black and Latinx communities in the United States, and people who live in lower-income communities are less likely to have proximal or affordable healthy food retail options near their homes or in their neighborhoods.4–8 While increasing healthy food access by building supermarkets and grocery stores in underserved areas could be a solution, that process is often driven by corporate interests, can be too expensive for ... Read More PubDate: 2022-12-19T00:00:00-05:00
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Abstract: The Chicago Department of Public Health's (CDPH) 2019 Maternal Morbidity and Mortality report¹ detailed the disparate rate of maternal morbidity, mortality, and associated factors experienced by women of color in the perinatal period, informing the planning and development of CDPH's universal nurse home visit and coordinated perinatal referral system: Family Connects Chicago (FCC). Family Connects International (FCI) is an evidence-based universal support service for families with newborns that seeks to support maternal-infant health, family well-being, and social needs through a nurse home visit and connections with community resources in the first few weeks after a baby is born.2 A critical component of the FCI ... Read More PubDate: 2022-12-19T00:00:00-05:00
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Abstract: Disease burden, clinical outcomes, and access to high-level care vary across racial and ethnic groups, secondary to socioeconomic or cultural oppression, intergenerational geographic construction promoting segregation and oppression, and genetic and biological factors in a limited subset of case studies and disease etiologies.1 In the early years of clinical trial design, it was thought that narrow patient selection criteria would allow for better detection of clinical efficacy as the results would not be diluted by confounding factors.2 It was quickly realized that this approach led to contradictory results between clinical trials on the same intervention and between trial performance and real-world ... Read More PubDate: 2022-12-19T00:00:00-05:00
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Abstract: The nation's quest to dismantle persistent health disparities is marked by policy innovations to promote equitable health. Approaches to interpreting, translating, and monitoring health-related policies can activate key multisectoral partnerships between the federal, state, local governments, and private organizations to foster and sustain community-centered health care and health equity. In these partnerships, the federal government provides funding, strategic direction, logistical support, and encourages further collaborations based on the synthesis of national and local data as part of a singular strategic vision. Through these strategic visions, state and local governments allocate resources, disseminate best ... Read More PubDate: 2022-12-19T00:00:00-05:00
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Abstract: Digital health holds promise to improve health and health care in a scalable, cost-efficient way. Technologies spanning clinical care, communication, administration, and analytics continue to proliferate in the health care industry1 and to receive billions of dollars in investment annually.2 Yet digital health approaches often lack a focus on health equity. Very little of the robust private investment in digital health is directed to ventures led by members of historically excluded groups,3,4 and privately developed digital health solutions rarely focus on marginalized populations such as those with low incomes or with complex medical and social needs. For example, a recent analysis demonstrated that most digital ... Read More PubDate: 2022-12-19T00:00:00-05:00
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Abstract: In West Virginia (W.V.), a rural state with the second lowest life expectancy in the nation,1 lung cancer accounts for more mortalities than breast, colorectal, and prostate cancers combined.2 There are widespread disadvantages in accessible health care (more than 96% of WV counties are designated as medically underserved),3 education (only 21.3% of residents have a bachelor's degree),4 and employment options (multigenerational poverty is prevalent).5 Innovative methods for cancer screening are essential.West Virginia has the highest prevalence of adult smoking in the nation, with a smoking rate of 22.6% compared with the national rate of 15.5%.6 In the United States, cigarette smoking is linked to 80–90% of lung ... Read More PubDate: 2022-12-19T00:00:00-05:00
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Abstract: Compared with urban areas, rural communities in the U.S. tend to be older, have more underlying health conditions and higher rates of poverty, and less access to health care.1 In addition to exacerbating longstanding rural health care workforce shortages, the COVID-19 pandemic has strained rural hospitals that were already struggling to remain financially viable.2 For most rural communities, local hospitals are vital sources of care, yet hospital closures throughout rural areas have created substantial service deserts. Since 2010, at least 140 rural hospitals have closed,3 and 453 are vulnerable to closure.4Compared with rural communities with stable hospitals, those with hospitals at risk of closure have higher ... Read More PubDate: 2022-12-19T00:00:00-05:00
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Abstract: Americans who live in poverty are at known risk for poor health outcomes. Inequitable systems limit their ability to make healthful choices and impede access to timely, high-quality medical care. Families with young children are particularly vulnerable; for example, the high cost of childcare keeps low-income parents working long hours at multiple jobs, away from their children. Anti-poverty, family-targeted interventions represent an opportunity for progress; they improve long-term health and interrupt cycles of generational disadvantage.1The American Academy of Pediatrics has labeled Poverty and Child Health a strategic priority, encouraging coordination between health systems and community-based social services ... Read More PubDate: 2022-12-19T00:00:00-05:00
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Abstract: The COVID-19 pandemic disproportionately affected the elderly, people with low incomes, and Black, Indigenous, and People of Color (BIPOC) with high rates of disease and economic hardship.1 Disruption to safety-net services acutely exacerbated food insecurity (FI).2 Schools, senior centers, and food pantries, which act as foundational food-access points, closed or limited their services. Unemployment reached historic levels, particularly for hourly-wage workers, further lowering incomes and limiting access to food.3 Simultaneously, farms nationwide had an overabundance of produce amid plummeting demand from closed restaurants, businesses, and schools.4In November 2019, our cross-disciplinary team of students ... Read More PubDate: 2022-12-19T00:00:00-05:00
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Abstract: In the U.S., people who have low incomes, whose primary language is not English, or who are immigrants, refugees, or members of racial and/or ethnic minority groups tend to live near one another.1–4 In areas of concentrated poverty, resources that promote or maintain health may be scarce or difficult to access.5,6 Morbidity and mortality are elevated for chronic conditions such as HIV, diabetes, asthma, substance use, and heart disease, which require consistent medical monitoring and dependable access to medications.7–11 Primary care providers, pharmacies, and other health-supporting resources in these communities may have policies and practices that result in real or perceived discrimination toward residents ... Read More PubDate: 2022-12-19T00:00:00-05:00
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Abstract: Populations affected by structural racism and economic inequities are at disproportionate risk of COVID-19 infection and subsequent severe outcomes due to underlying medical and mental health disorders and living conditions.1–6 Baltimore City has high rates of risk factors, with 20% of people living in poverty,7 10% with a substance use disorder,8 and more than 2,000 people experiencing homelessness each night.9 Additionally, congregate living in shelters and behavioral health facilities puts thousands of already high-risk people at greater risk of COVID-19.3,6,10 The needs of these special populations were recognized early in the pandemic,10–12 and the Baltimore City Health Department (BCHD) began working with ... Read More PubDate: 2022-12-19T00:00:00-05:00
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Abstract: Partnerships bring together institutional capabilities and human resources to tackle problems that are beyond the capacity of a single organization. Recognizing that health outcomes are affected by more than direct services, organizations are increasingly developing cross-sector partnerships to address patients' social needs.1 In the treatment and care of chronic conditions such as diabetes, it is crucial to address a patient's social determinants of health.2 Access to nutritious foods and stable housing, employment status, and immigration status are a few examples of social determinants of health that have a direct impact on a patient's ability to manage chronic conditions.3,4Even for successful partnerships, it ... Read More PubDate: 2022-12-19T00:00:00-05:00
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Abstract: National studies and contemporary reports continue to indicate racially and ethnically diverse communities were disproportionately affected by COVID-19, as they have been from the beginning of the pandemic.1–4 There is no quick fix to reaching these communities, but strategic multi-sector collaborations and intentional educational outreach to mitigate vaccination barriers are underway.5 CommonSpirit Health, one of the nation's largest nonprofit health systems, implemented multiple efforts to support communities during the pandemic, including coordinating locally-led testing and vaccine efforts. System-level workgroups such as the Vulnerable Populations Council6 engaged early to ensure messaging around vaccine ... Read More PubDate: 2022-12-19T00:00:00-05:00
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Abstract: Trust affects how health systems function, how patients engage with those systems, and the health results produced.1 There is a growing literature on the benefits of institutional and interpersonal trust during pandemics, such as lower fatality rates, increased testing participation, and greater willingness to be vaccinated under the Emergency Use Authorization authority of the Food and Drug Administration.2,3 The trust determination model of communication asserts that there are four pairs of factors establishing trust: caring and empathy; dedication and commitment; competence and expertise; and honesty and openness.4,5 There is less clarity, however, on how health systems can operationalize these factors to build ... Read More PubDate: 2022-12-19T00:00:00-05:00
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Abstract: Health and health care-related disparities and inequities observed in multicultural populations have been exacerbated by the coronavirus disease 2019 (COVID-19) pandemic.1,2 Historically medically marginalized populations, including Black and Hispanic communities use fewer preventive health services than White populations in the U.S.3,4 These racial and ethnic subpopulation groups are less likely than Whites to obtain primary (e.g., influenza vaccinations),5 secondary (e.g., colorectal screenings),6 or tertiary (chronic condition monitoring)7 preventive care. Not only do these multicultural populations experience barriers in access to care to prevent disease and worsening of existing disease, but they also have ... Read More PubDate: 2022-12-19T00:00:00-05:00
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