The coronavirus pandemic has presented an opportunity for government to lead the charge on expanding access to care and address long-standing health equity challenges within the U.S. public health system, according to a leading public health official.
Dr. Anne Schuchat, the principal deputy director for the Centers for Disease Control and Prevention, outlined how COVID-19 has exposed longstanding disparities related to the structural or social determinants of health.
“In the U.S., we’re at 240,000 deaths directly attributed to COVID, and analysis of excess, all-cause mortality suggests that there have been 100,000 deaths indirectly related to the pandemic, potentially due to delayed or deferred care and worsening of chronic conditions,” Schuchat said during a Monday event hosted by the National Academy of Public Administration.
Americans have high rates of chronic conditions, such as cancer, obesity and heart disease, Schuchat said. This puts tens of millions of people at an increased risk for severe health complications caused by the virus. In fact, the CDC estimates that 6 in 10 adults in the U.S. have one chronic disease, while 4 in 10 have two or more.
“It’s not a coincidence that we have such a high burden of hospitalizations and deaths in the country because we have a population that has illnesses that are preventable or untreated chronic conditions,” she said.
Schuchat noted that the pandemic highlights “the harsh health disparities that have been long recognized, but persist,” as research findings show that certain racial and ethnic groups are particularly vulnerable to hospitalization and death due to COVID-19.
“Systemic factors contribute to many of the COVID health disparities. Racial and ethnic minority populations are more likely to be essential workers, [and] higher rates of underlying medical conditions and lower rates of health insurance also are concentrated in many communities of color,” she said.
“We really feel that the factors that have led to severe outcomes from COVID-19 would have been mitigated years ago if we were investing in the prevention efforts, the environmental efforts, and really, the public health system,” she added.
One silver lining of the pandemic is that it has forced the country to look at the stark inadequacies plaguing health care by using telehealth.
“We’ve seen rapid uptake of telehealth borne by necessity, but facilitated by regulatory adjustments,” Schuchat said. “This could improve efficiency and convenience of some health services and enhance access for many rural populations and others."
The agency is also applying a health equity lens to its public emergency response efforts to a degree that previously didn’t exist.
“[In] my 32 years here at CDC, this is the first emergency response where we have a chief health equity officer embedded in our emergency operation center at the higher level of [COVID-19] incident-level structure,” Schuchat said.
To garner public trust in communities that have been historically underserved and are struggling with the virus, the agency has since expanded on-the-ground, community outreach programs to inform at-risk groups about COVID-19 vaccination and immunization through Vaccinate With Confidence.
Using social media, CDC is finding lead voices within communities to inform the public about COVID-19 and combat misinformation about vaccines. The insights gathered from this program will help plan and design educational campaigns and programs that will be sustainable in the long term, said Schuchat.
She emphasized that combating the spread of the pandemic starts with communities, while achieving health equity to limit preventable illness and death means addressing factors outside of CDC’s scope.
“To truly invest in the public health system, it’s more than the data and the laboratory and the workforce; it’s also the community-based activities that make it easier for people to stay healthy," said Schuchat. “[The] environment that you live in, the social determinants — housing, transportation, education — are really drivers of public health in our country and others.”