Pandemic planning is incomplete without health equity at its core - MedCity News

As our country continues to reflect on the devastating impact of Covid-19, and the World Health Organization notes that “the end is in sight” of the pandemic, we must recognize and address the disproportionate hardships faced by Black and Latino communities over the past two plus years. Latino communities experienced some of the highest rates of infections, hospitalizations, and deaths rates compared to other racial and ethnic groups in the US, were largely forgotten and excluded when testing and vaccine efforts were planned and implemented. In addition to the continued spread of the virus in our communities, there has been a dearth of programs to support families and individuals whose economic, educational, housing and nutritional needs are at risk due to the pandemic.

As new bivalent boosters become available and demand for monkeypox vaccines increases while at the same time federal funding for testing and vaccinations decreases, it is more urgent than ever to take the necessary steps to ensure that the needs of Latino communities are incorporated into future public health planning to avoid repeating mistakes that have led to unnecessary suffering.

Improving the visibility of Latino communities during public health crises

During the Covid-19 pandemic, cases in Latin American communities were underreported and underreported, leading to skewed reporting and reduced efforts to urgently address the impact of the virus. Latino invisibility was prevalent during the pandemic, as was Latino mortality 2.3 times higher than for white Americans, including younger Hispanics, who are more likely to be primary workers and therefore on higher risk of infection with 45% of adults having a job that requires them to work outside the home. Despite the availability of vaccines in our country, a staggering 35% of unvaccinated Hispanics feared immigration consequences when considering the vaccine, and 15% reported being asked for a Social Security number – which is not required by law for vaccination.

Despite these startling statistics, media coverage grouped Latinos with other communities of color, and while reporters emphasized the commonalities between groups, they failed to draw attention to the risk factors that specifically affected the Latino community. This includes access to health services and information in Spanish, masking and social distancing policies that were not realistic in multigenerational Latino homes, and fears and mistrust about immigration status. These disparities affected how the Latino community experienced the pandemic, yet little was done to offer culturally appropriate solutions until it was too late.

Addressing the unique needs of the Latino community

The pandemic has only shone a spotlight on what we in the public health community have been sounding the alarm about for years regarding the systemic inequities running rampant in our health care system. In the US, our system and payers have failed to adapt their processes and services to meet the cultural needs of the growing number of Hispanics expected to make up 30% of the population by 2050

We can no longer rely on a universal health care system that continues to ignore us and refuses to build trust in our Latino community. In addition to neglecting the cultural and health literacy needs of Latino patients, our community faces medical indictment from providers with implicit biases toward Latino lifestyle choices and belief systems that influence the way we think about our health. For example, a Latino patient may seek medical advice from family and friends before seeking health care from a physician for fear of being labeled “noncompliant” or receiving unrealistic recommendations for care.

To combat this, hospitals, practices, and providers must invest in developing and implementing training to understand the diverse cultures that make up the US Hispanic population. This includes the many protective factors such as social support systems and informal networks that have provided the community with much-needed resources and services when the existing system excluded them. It is also imperative that providers reflect the diversity of their patients – the more we can recruit providers who come from our community and can empathize with our traditions and values, not to mention our languages, the better chance we have of achieving true culturally relevant and competent care.

A better way forward

I hope that health equity will not become another trendy buzzword. We need to ensure that everything we’ve learned over the past few years is integrated into business goals, eventually becoming the fabric of our healthcare system. To get this right, there are several key elements to providing culturally competent public health services that will help us succeed.

First, we must integrate culture into care. As our community continues to grow, we must embrace the traditions and unique characteristics that make up our identity, rather than forcing our people to hide their language, vulnerabilities, or basic needs. This goes beyond the provision of translation services, which often lack cultural awareness. Providing Latino community care teams with providers who have deep and personal experience with our culture, traditions, and health perspectives is the only way to regain trust.

Additionally, addressing health coverage gaps is essential to improving access in our community. Much of our community and country do not qualify for state or federal subsidies or cannot afford commercial or employer health insurance plans. This gap has a significant impact on the Hispanic community in states that do not extend Medicaid benefits to people who immigrated to the U.S. or states with concentrated Hispanic neighborhoods where domestic labor is common and health benefits are often neither provided nor used. If these issues are not addressed, they will continue to play a role in the health care disparities faced by the Latino community.

New care models such as direct-pay primary and specialty care memberships support access, but there is a need to serve broader communities beyond the white and wealthy. Prominent players in the space have focused on developing seamless experiences for customers, but where these companies fall short is their ability to tailor services to the communities that need these solutions most. If these primary care models are to succeed, improving access must be part of the overall growth plan.

In addition to improving cost and accessibility, communities must be able to engage with care teams that look and sound like them, while providing culturally appropriate care in their homes, neighborhood clinics, and through virtual services. These new solutions typically rely on technology to open the door to care. We know that technology alone will not solve systemic problems in the health care system, and to be successful, technology must enhance established care relationships so that these touchpoints help patients and providers build stronger connections for achieving better health outcomes. Innovative solutions can and should preserve the culture and traditions that make the Latino community strong.

We are at an inflection point as a society where we must change our perspective on what it will take to ensure that ALL patients are seen, heard and cared for – both in everyday and dire healthcare scenarios. Our sisters and brothers are dying from preventable chronic diseases and no one is doing anything about it. We have to do something different. We need to stop pretending that our health care needs and access is fair. It just isn’t.

Photo: Nuthawut Somsuk, Getty Images

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