Healthcare Equity - Access for All

"We, the poor, are immune to the coronavirus," said Miguel Angel Barbosa, governor of Puebla, Mexico, in March 2020. An interview with Excelsior TV shared Barbosa's misguided message with the public., then later featured it in IS Global's 'A Pandemic Year in 10 Quotes' piece. Some viewers heard this quote and believed the coronavirus was not serious. The reality continues to be completely different from that message, especially for the "poor" described by Barbosa.

Many underprivileged continue to feel the brunt of the pandemic's effects while working in essential positions across the world. They do not have sick leave, lack access to healthcare, and cannot telework. Higher rates of severe sickness plague this group, along with worse economic and social consequences compared to more privileged populations. Differences link with social, economic and environmental disadvantages and only widen the gap between the haves and the have-nots.

Data from the CDC shared by Yale Medicine shows the pandemic widened health equity among several key groups even in America. People who identify as being a member of the Black, Latinx, Asian American, and Native American communities are roughly three times more likely to die from COVID-19 than non-Hispanic white people. Increased mortality rate could be even worse in some parts of the country that may be more economically depressed. The pandemic provides proof that health equity must be everyone's concern if our future includes access for all to quality healthcare.

HEALTH EQUITY DEFINED
In a report released in 2017, the Robert Wood Johnson Foundation (RWJF) defines health equity as an environment where "everyone has a fair and just opportunity to be as healthy as possible." Calling out several concepts in the piece, RWJF recognizes ethical and human rights principles as the foundation to finding consensus around this issue. Once definitions can be clarified, communities can begin building policies that enable every person to "attain his or her full health potential," as defined by the CDC's National Center for Chronic Disease Prevention and Health Promotion. Social positions or socially determined circumstances like poverty, skin color and gender will stop impacting how individuals access higher paying jobs, quality education, safe housing, and great health care. Obstacles that impede healthy living will be eliminated along with their consequences of powerlessness and access to resources.

Defining health equity is the easy part. Fostering an environment that breeds health equity creates a bigger challenge. Health equity doesn't come with a one-size-fits-all roadmap. Different people need different resources to achieve the same results. So, each environment fostering health equity will need to be customized. The "checklist" to achieve health equity for each person must be fluid and change to accommodate the challenges experienced by the individual.

Although moral arguments exist to promote the value of health equity, good health is crucial to having a nation that is secure and economically viable. For example, a healthy, productive workforce is required if our country wants to achieve a thriving and robust economy. Workers currently unhealthy may have trouble finding a job, and those who can find work may be less productive and generate higher care costs for businesses. Plus, the next generation could be challenged to overcome health disparities later in life resulting in fewer individuals able to lead a full and productive life, and fewer people able to join the workforce. When spending is focused on reactive healthcare costs, money decreases for families to invest in other economic drivers and funds dry up for community programs supported with tax dollars. A healthy community is the foundation to achieve all other successes.

THE ROLE OF ADHERENCE
Medicine plays an important role in a person's ability to stay healthy. Having the ability to pay for the medications is an additional piece of the puzzle. Health equity programs must be mindful of the challenges certain groups face when trying to adhere to their doctor-prescribed medications, then offer ways for those individuals to overcome those issues.

Helping patients understand prescription costs and savings options as seen with TroyRx's Patient Affordability Cloud is a start to equaling the playing field for achieving access and affordability for all patients. And then solutions need to take it one step further. The information must be presented to the patient as early as possible, when the medication is prescribed by providers and without extra steps from the clinician. A proactive workflow like the one described could empower disenfranchised patients to take a more active role in their care and avoid sticker shock when they pick up prescriptions at the pharmacy.

CONCLUSION
When the system is broken, everyone is impacted as seen during the pandemic. Hospitals filled with COVID sick patients force the cancellations of elective surgeries and impact the quality of care received by all patients within a health system. Supplies are depleted and shortages become commonplace when regions experience virus surges. Systems are pushed to the brink of collapse. While not a complete fix, health equity programs can ensure everyone starts on a more level healthcare "playing field." Disparities might be unintentionally created, but they exist, and they force us to acknowledge that a disadvantage is present. That's the only way to achieve the closing message conveyed in the Pledge of Allegiance written by Francis Bellamy, "...with liberty and justice for all."