By Karen Conway, vice president of healthcare value, Global Healthcare Exchange (GHX).
The cost of healthcare disparities has been long and deeply felt by patients and their families, but it wasn’t until the high rates of COVID-19-related hospitalizations and deaths among persons of color made headline news that the broader societal impacts of health disparities became more widely known. In response, health systems are prioritizing health equity and leveraging new tools and data to support their work.
At a physiological level, the presence of underlying chronic disease increases the risk presented by COVID-19. The incidence of chronic disease(s) is increasing among all Americans, but the prevalence is much higher among the poor, which includes a higher percentage of individuals of color compared to the overall White population. Health inequities among communities of color are further exacerbated by structural and institutional racism, which experts say “harms health” because of negative factors in their physical, social, and economic environments and a propensity to develop maladaptive coping behaviors (e.g., smoking, alcohol, etc.).
A Community-Level Issue
Increasing rates of chronic disease create a self-reinforcing cycle that threatens the well-being of entire communities (and the health systems that serve them). Individuals suffering from chronic disease have higher rates of absenteeism, which limits their wealth building potential, the productivity of their employers and the tax base of their communities. This, in turn, increases poverty and the impact of the social determinants of health (SDOH) that contribute to higher rates of chronic disease. The combination of chronic disease (as an inflammatory condition) and the psychological stress of racism have been shown to cause physiological changes that raise the risk of contracting additional chronic diseases.
Hospital performance is also tied to economic well-being. Research documents a correlation between the quantity and quality of local economic resources and the clinical performance of hospitals, which under value-based payment models, can also impact financial performance. With chronic disease responsible for nearly 90% of national health expenditures, it’s continued rise threatens our national economy and the ability to fund needed healthcare for the poor and aging. In other words, this is not just a social issue; it is an economic imperative. A 2021 Institute for Healthcare Improvement (IHI) study found that 58% of healthcare executives ranked health equity as one of their organization’s top three priorities, up from 25% in 2019.