As the healthcare industry witnesses a deadly pandemic disproportionately claim the lives of Black patients, it now faces a reckoning over its role in the health disparities that exist throughout the country.
The COVID-19 pandemic has laid bare the stark health inequities as it has disproportionately infected and killed people of color. That striking reality was on display during a year marked by civil unrest amid calls for social justice following the killing of George Floyd, an unarmed Black man, by a white police officer who kneeled on Floyd's neck for nearly nine minutes. His death, caught on camera for the world to see, generated calls to re-examine race in America and the systemic structures that allow unequal treatment to flourish.
For their part, health system leaders and industry acknowledged the role and responsibilities their organizations have in closing the gaps in unequal health outcomes. Many noted those roles go beyond that of the immediate novel coronavirus, with some calling for affordable housing, investing in Black physicians, underserved communities, and shaking up the way the nation grades hospital performance.
Lloyd Dean, CEO of CommonSpirit Health, one of the nation's largest health systems, said deep-rooted disparities and racial inequities still keep millions from accessing healthcare. The nation's health system must achieve "more equitable and sustainable outcomes," Dean, one of the few Black CEOs to lead a major health system, said recently during J.P. Morgan's annual health conference. On a personal note, Dean shared that he almost lost a brother to the virus.
Black people across the country have died at an alarmingly higher rate compared to their White counterparts. In a study of Louisiana's largest health system, Ochsner Health, nearly 77% of those hospitalized with COVID-19 and 71% of those who died were Black when typically just 31% of Ochsner's patients are Black.
These grim statistics are evident in many regions across the country, including Chicago, Detroit and New York City.
Experts have explained that the reason Blacks are dying at higher rates is multifaceted, pointing to a number of factors that influence health.
Clyde Yancy, an academic cardiologist who studies health disparities at Northwestern University, explained in JAMA that where someone lives shapes their overall health and "in so many communities, race determines home."
Yancy, a Black man, characterized this moment as one of ethical reckoning due to the disproportionate suffering. "COVID-19 has become the herald event that now fully exposes the deep and chronic social wounds in U.S. communities," he said.
Although the executives paid lip service to the issue during JPM, it's unclear how far they're willing to go or what impact they can have to move the needle as addressing social determinants of health has been a buzzword in the industry for some time.
Health Affairs Editor Alan Weil, commenting on the burgeoning pressure on health systems amid the pandemic and fate of George Floyd, was skeptical that health systems would move beyond token gestures. They need to give up some of their power, whether that be tax rates, reimbursements, or other policies that impact their bottom line, he wrote in a provocative post in June titled "The Social Determinants of Death."
"I am not optimistic that the health care sector will address the real social determinants of health. That simply is not in its self-interest. At best, it will nibble at the edges of the economic determinants of health. After all, when you control $3.6 trillion, sharing a bit to buy food for patients is not that heavy a lift," he wrote.
Nevertheless, systems were vocal about making such efforts at the recent J.P. Morgan event, more known for a conference on dealmaking than a place where CEOs talk up social investing. Though it's not uncommon for executives to share initiatives that may help improve their public image.
For its part, CommonSpirit has committed to investing $100 million to Morehouse School of Medicine, a historically black college in Atlanta, to create more training opportunities for physicians, especially in communities of color, Dean said. To put that investment into context, the giant nonprofit system posted net income of $9 billion in 2019, though due to the pandemic it reported a loss of $551 million in its latest fiscal year ended June 30.
Marc Harrison, CEO of Utah-based Intermountain Healthcare said about 2% of the organization's investments are now funneled toward "social impact investing." That program has resulted in the creation of 500 affordable housing units.
Advocate Aurora, a major Midwestern system, said the disparity it sees is so prevalent it "screams out at you," CEO Jim Skogsbergh said during the conference in January. He said hypertension among Black patients is two times greater than its White patient population, noting the system had identified it has an area to invest resources in to try and close the gap.
For its part, Dallas-based Tenet said it's focused on making sure its workforce is reflective of the diverse communities the organization serves. CEO Ron Rittenmeyer said it has improved board diversity, and 58% of its board now reflects diversity by gender or ethnic background.
Even outlets that grade and rank the nation's top hospitals have re-examined the need to measure health equity.
U.S. News & World Report, which is well known for grading hospital performance, is weighing how it should factor in health equity in its hospital rankings. It's far from easy, Ben Harder, managing editor and chief of health analysis, acknowledged during a public webinar in January. Still, his outlet is committed to assembling a new hospital performance index based on equity even if it will be difficult to pinpoint who's responsible for identifiable disparities. "Judging the extent to which that community's hospital or hospitals are accountable is fraught. Attribution of responsibility in other words is tricky," Harder said.
Still, there is a long way to go to close the gaps in health in the U.S.
"Certainly, within the broad and powerful economic and legislative engines of the U.S., there is room to definitively address a scourge even worse than COVID-19: health care disparities. It only takes will," Yancy, the cardiologist from Chicago, said in JAMA.