University Hospital Exec: 'We Are Poised to Do Something About Health Equity'

The hospital's chief strategic integration and health equity officer says the coronavirus pandemic has opened eyes and made health equity a national priority.

To eliminate health disparities, it is essential to address "upstream" inequities, an experienced hospital health equity officer says.

Chris Pernell, MD, MPH, is the chief strategic integration and health equity officer at University Hospital in Newark, New Jersey. Additionally, she is a clinical assistant professor in the Department of Medicine at Rutgers New Jersey Medical School and a former adjunct associate professor at New York University College of Global Public Health.

HealthLeaders recently talked with Pernell about a range of topics, including how to address health disparities, health equity and health disparity initiatives at University Hospital, and the country's journey in tackling health equity and health disparities.

The following transcript of that conversation has been edited for brevity and clarity.

HealthLeaders: What are the primary ways to address health disparities?

Chris Pernell: It is important to back up and go upstream before we talk about health disparities. We need to talk about health inequities—the structural conditions or determinants that are unfair and unjust, which lead to differences in health outcomes. Those structural determinants are issues around where people were born, where people work, and where people age. We need to talk about access to affordable housing, access to quality education, access to safe and equitable healthcare, and access to green spaces. We know that place-based factors drive health outcomes and the disparities that we see.

If we start with the COVID-19 pandemic, which in recent data is the third leading cause of death in America after heart disease and cancer, and we look at how COVID-19 disproportionately impacted the African-American community in particular, that shines a light on disparities. For example, if you go to the Centers for Disease Control and Prevention website, the CDC has been tracking the differences in COVID-19 infections, hospitalization, and death across different populations. There are differences across Black, Latino, Native American, and Asian populations that are distinct. In particular, there are differences in hospitalizations. In data from March, Black people were 2.4 times more likely to be hospitalized with COVID compared to White people. Native American people were 3.1 times more likely to be hospitalized. Latino people were 2.3 times more likely to be hospitalized.

If you start to talk about death from COVID-19, it is roughly 2 times more likely in the Black, Latino, and indigenous populations compared to White Americans. This is not because of biological reasons, rather the reasons are related to risk of exposure, access to care, quality of care received, and pre-existing chronic morbidities.

Health disparities are formed because there is differential access to care, there is differential access to the quality of care received, and there are unjust and unfair differences in access to life opportunities such as housing and education. At those three fundamental levels, we see disparities that are amplified and highlighted in the COVID-19 pandemic.

If we think about the Newark community, like in all of New Jersey, heart disease is the leading cause of death in the Newark community. Like in all of New Jersey, cancer is the second leading cause of death in Newark. But something that is unique in Newark is the prevalence of asthma. Approximately 32% of people living in Newark have asthma. If you look at Newark's county, which is Essex County, only about 6% of the people in the county have asthma. It begs the question—why are people in Newark having higher rates of asthma? You have to look at environmental injustice issues.

HL: What are other examples of health disparities in Newark?

Pernell: Newark has primarily a Black and Brown population. The Newark population hovers around 50% Black and 36% Latino. Asthma is only one example of unique health condition prevalence in Newark. With chronic obstructive pulmonary disease (COPD), 16% of Newark residents have COPD but only 5.1% of people in Essex County have COPD.

In Newark, 16.4% of residents have diabetes, but if you look at the prevalence in the state it is 9.6% of the population. Another disparity is in obesity. About 36% of Newark residents have obesity compared to 27% of New Jersey residents.

HL: What are some of the health equity and health disparity initiatives that have been launched at University Hospital?

Pernell: Through our population health department, we have focused a lot on clinical prevention and bringing care to people where they are situated in the community. That involves partnering with community assets to deliver health screenings, such as screenings for high blood pressure and diabetes. We do screenings in a consistent and regular fashion to emphasize the power of prevention.

We are ensuring that our ambulatory practices are accessible to the community—accessible with time and availability of appointments. Our community members can be serviced for primary care, which is fundamental to solving health equity. We have a robust network of primary care and people have access to longitudinal care; we offer primary care services as well as specialty and subspecialty services through our outpatient practices.

We are making sure our care is being delivered in a community-integrated fashion, so we can reach health inequities that cause health disparities. We are ensuring that care is situated in the community where people reside.

For example, we are undertaking a project with the state housing and mortgage financing agency, as well as a local developer, to develop affordable housing close to the hospital. There will be about 16 housing units specifically geared toward patients who have multiple medical and social complexities that drive poor health or poor management of chronic health conditions. People will be identified by eligibility criteria, and they will be able to screen into these supportive housing units. They will have access to wrap-around services that address social needs and social determinants of health that are driving their health outcomes. As part of this project, we will be building a primary care health center, which will be open for not only the residents of the development, but also all residents of the city to have access to primary care and some specialty care.

Another initiative we have is the use of community health workers or community healthcare chaplains. These are credible messengers who have lived experiences that are socially and culturally fluent with the patient populations that we serve. They help navigate patients with social and medical complexities. They help people to connect with appropriate care. They help ensure that people have their social needs met. They work with chronic high utilizers of the emergency department. They work with patients who have a particular payer such as Horizon Blue Cross Blue Shield of New Jersey and have identified social needs.

HL: As a nation, where are we in addressing health inequity and health disparities. How far have we come?

Pernell: I am a public health and preventive medicine physician by training, and as someone who has been working in this space for many years, I can say that prior to the pandemic the conversation about health equity and health disparities was conceptual. Since the beginning of the pandemic, we have been having a more honest, more robust, and more comprehensive dialogue and solution-generating process around tackling health inequities.

The pandemic has been the collision of multiple pandemics, such as the collision of systemic racism with the pandemic. With the coronavirus, we have been able to describe in compelling ways what disparities look like. Black, Latino, and Native American populations are dying of COVID-19 at two times the rate of White Americans. We all have to pause and ask, "Why is this happening?"

The pandemic has afforded a richer dialogue, and that has afforded more complex solutions, and that has afforded an imperative in priorities around health equity. Not only do you see healthcare leaders having a conversation around health equity, but also you see the American public having a more honest conversation about what is driving health inequities. People are looking for solutions in a collaborative, cross-sector matrix approach.

If you think about the summer of 2020, as we were coming out of one of the first waves of the COVID-19 pandemic, and the public saw the murder of George Floyd. We saw protests on the streets, and that allowed us to have a more transparent and authentic conversation around systemic racism.

We are poised to do something about health equity. These next few years and decades will determine how sustained the efforts will be. I believe that we cannot turn back. Racism wastes human resources and wastes our potential. We cannot be as prosperous, we cannot be as great, and we cannot solve the dilemmas that we need to solve in the 21^st century if we are not taking care of all of our communities. We will never achieve our full greatness it we do not make health equity front and center of our priorities.

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