NEJM: 5 Recommendations to Mitigate Social Risk Factors During Pandemic

Mass General Brigham's chief patient experience and equity officer details effective ways to support frontline workers and assist communities afflicted with the coronavirus.

A Boston-based health system executive writes in an article published in the New England Journal of Medicine (NEJM) Monday morning that the coronavirus disease 2019 (COVID-19) has had a disproportionate impact on communities of color nationwide due to unaddressed social risk factors.

Thomas D. Sequist, MD, MPH, chief patient experience and equity officer at Mass General Brigham, (formerly Partners HealthCare), analyzed data related to the coronavirus outbreak in both the Navajo Nation and Chelsea, Massachusetts. 

Despite differences in size and location, Sequist found that both communities have struggled to contain the spread of the virus due to existing social and health vulnerabilities. He concluded that "embedded structural racism" has contributed to a "perfect storm" for COVID-19, one that must be acknowledged by healthcare leaders going forward.

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Sequist's piece is the latest NEJM article to highlight the social risk factors that plague the healthcare industry and negatively impact communities of color nationwide.

In early June, following the killing of George Floyd by a Minneapolis police officer, NEJM published a series of articles related to structural racism in healthcare and the impact of COVID-19 on communities of color.

Below are five recommendations Sequist offers for healthcare organizations and frontline workers to mitigate social risk factors during the pandemic.

1. Fund programs that address social risk factors like food deserts and housing insecurities 
   
   Sequist writes that the pandemic has exposed weaknesses in the nation's public health system along with "structural factors of racism and other forms of systemic bias," which continue to hamper communities of color.
   
   "Healthcare delivery systems like mine have attempted to step up to fill the gap during this pandemic; however, this is neither sustainable nor sufficient as a long-term solution," Sequist writes.
    
2. Boost Indian Health Service (IHS) funding to assist Native American communities

   Highlighting the more than five-year life expectancy gap between Native Americans and average Americans, Sequist says the IHS is "not funded at levels that would enable delivery of high quality care."
   
   "This promotes a system of healthcare rationing that would be unacceptable in any other segment of U.S. society, yet we tolerate it among Native communities and often decline to speak of it," Sequist writes.
   
   Related: Nurses Must Fight Against Racism. ANA's President Shares How

   Last year, an IHS hospital in South Dakota was cited for inadequate medical care and leadership problems in a series published by PBS NewsHour and The Wall Street Journal. 

3. Establish and maintain programs to increase the provider supply in communities of color
   
   Sequist calls on an increase in diversity among the clinical workforce, both through medical school and various training programs.
   
   He writes that a national strategy must be enacted to boost financial aid opportunities and recruiting efforts in order to bring underrepresented minorities into healthcare.
   
   "Equally as important, we need to support programs that enable training of local community members to develop a sustainable workforce and support economic development in these communities," Sequist writes. "Federal intervention could support training of medical technicians and other health professionals."
    
4. Improve communication efforts with communities

   Health systems must be able to effectively communicate with the communities they serve, Sequist recommends, not only in terms of promoting materials across multiple mediums but also in preferred languages as well.
   
   He cites data from his own organization that more than one-third of patients hospitalized with COVID-19 did not speak English as their first language.
   
   Related: Social Determinants of Health: Lead or Partner  
   
   Sequist writes that similar problems plague the IHS, which rely on younger family members to communicate with elders who do not speak English. a dynamic that he says is "not acceptable."
   
   "We cannot continue to provide care in a one-size-fits-all fashion– equitable care requires us to meet our patients’ needs, whatever they may be – and it all starts with effective communication," Sequist writes.

5. Make sure communities of color aren't abandoned by technology
   
   In his final recommendation, Sequist writes that technology should target existing inequalities in healthcare delivery and prove its worth to vulnerable, underrepresented minority communities.
   
   He writes that funding is required to expand the technological infrastructure across the nation to improve broadband access and reach communities of color.
   
   "We can and must do better. We stand together in our mission to ensure that health equity is treated as an emergency, and that no one is denied the highest quality care because of who they are or where they come from," Sequist writes.
   
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