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Reducing Health Disparity

August 7, 2020

It has long been observed that different groups of individuals may have vastly different healthcare outcomes. While there is often a medical and genetic basis for some of this disparity, there has also been increasing focus on social factors that can influence health outcomes, often referred to as the “social determinants of health.” Five of the major social determinants include economic factors, education, healthcare access, community support, and housing. Over the past several years, the Illinois State Medical Society (ISMS) Annual Meeting has focused on improving health outcomes and decreasing health disparities. Although ISMS has traditionally focused on medical interventions, newer directives from the Annual Meeting have more broadly dealt with the social determinants of health. Whatever the means, the goal remains the same: improving the health of the citizens of Illinois.

In October 2018, the Illinois Department of Public Health (IDPH) released the Illinois Maternal Morbidity and Mortality Report, which documented that Black women have a six-fold higher death rate from pregnancy-related conditions compared to white women. Moreover, the IDPH review committees deemed that 72% of the pregnancy-related deaths were preventable. Some of the factors that contributed to the deaths include obesity, mental health disorders, substance abuse and violence.

This tremendous disparity in health outcomes spurred the Illinois General Assembly to action. ISMS strongly supported Senate Bill 1909, which would have expanded perinatal mental health screening and lengthened the postpartum coverage period to 12 months from the current 60 days. Although that bill was eventually extensively amended in the House, ISMS was able to help assure that Medicaid expansion for postpartum care and family planning would be included in the 2020 budget. ISMS will continue to support legislation to lower the rates of pregnancy-related deaths and to decrease health disparities in this area.

Even amidst a pandemic that threatens every human being on the planet, health disparities persist. There have been numerous local reports of higher rates of COVID infection and mortality among minorities. Nationwide data from the Centers for Disease Control and Prevention (CDC) indicate that as of June 13, 2020, the COVID-19 hospitalization rates were five times higher in Black patients and four times higher in Hispanic patients compared to the white population. Moreover, Hispanic individuals are almost three times more likely to be uninsured and Black individuals are almost twice as likely to be uninsured when compared to the white population.

A recent JAMA editorial by Drs. Hooper, Nápoles, and Pérez-Stable from the National Institute on Minority Health and Health Disparities described the COVID-19 disparities as being related to discrimination, economic factors, education level, healthcare access, individual behavior and biology. The two most quantifiable causes of these disparities are from a higher incidence of comorbidities and an increased difficulty in social distancing at home and at work. The authors conclude that “there is an obligation to address these predictable consequences with evidence-based interventions.” [i]

At the state level, ISMS has made numerous efforts to improve the health of Illinois residents. Telemedicine access has great potential to minimize health disparities, and this spring ISMS encouraged Governor Pritzker to sign an executive order mandating state-regulated healthcare plans to cover telemedicine services; we also support efforts that would make these provisions permanent. Another executive order extended certain civil liability protections for the health-care workers fighting coronavirus. With the unprecedented strain COVID-19 has placed on our healthcare system, many physicians have found themselves taking on more responsibility than they otherwise would. ISMS also advocated for the $150 million increase in funding for Medicaid, a program that directly benefits many of the groups hit hardest by these disparities. The upcoming session of the Illinois General Assembly is likely to include several bills to improve health outcomes and diminish health disparity, goals which ISMS fully endorses.

There is a lot of work that needs to be done to improve patient outcomes at every level. ISMS stands ready to meet the challenge.

Robert W. Panton, MD

Send your questions and comments to Dr. Panton.

[i] JAMA. 2020;323(24):2466-2467. doi:10.1001/jama.2020.8598

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