By Elena Marks
President and CEO
Ventilators. ICU beds. Personal protective equipment. In the ongoing battle against COVID-19, they’ve become vital parts of the health care arsenal. Hospitals are facing shortages and budget concerns as they scramble to find enough supplies to help heroic health care professionals save lives. Right now, this arsenal is urgently needed to win this war.
But when faced with health challenges, whether it be a pandemic such as this one or chronic diseases, we often focus on treating symptoms rather than underlying causes. This in turn has created a society and an economy that are extremely vulnerable in response to a public health emergency. In the long run, the answer to better health outcomes or even defeating future pandemics is to refocus investment in health, not just more health care. We must advance ways to work further upstream to prevent a health crisis from happening in the first place and building resiliency for when it does come.
Working upstream means addressing non-medical, social factors that are so often the underlying causes of poor health, often labeled social determinants of health. It’s about tackling those tough issues such as poverty rates, safe neighborhoods, affordable nutritious food, healthy housing, and so much more. These challenges are particularly relevant for people with chronic conditions, many of which are also associated with these factors. During this COVID-19 crisis, it’s the people who suffer from underlying chronic conditions who are at the greatest risk of becoming very sick or dying as a result of exposure to the virus. In fact, vaccine scientist Dr. Peter Hotez at Baylor College of Medicine says the American South is likely to experience the next big COVID-19 outbreak not because of a lack of stay-at-home orders, but because of the high rates of poverty, diabetes, and high blood pressure. These are conditions that health care alone can’t fix.
Tragic outcomes can be prevented more effectively if we invest in those non-medical, social factors that are at the root of health issues including chronic conditions. Diabetes is a largely preventable disease, but not through medicine or health care. Its prevention is based on lifestyle changes that some people can make but do not, and many others would like to make but aren’t able to. For example, doctors may tell a pre-diabetic patient to exercise daily and eat healthier foods, but if that patient has to work two part-time jobs, can’t safely walk in her neighborhood, and doesn’t have grocery store options nearby, how can she follow her doctor’s advice? Without help with non-medical factors, this patient and many more like her are more vulnerable on a day-to-day basis. When an event like a pandemic hits, those families are put at an even greater disadvantage.
Tragic events are experienced even more deeply by people who are already vulnerable; low-income communities or those living in a neighborhood that just doesn’t have access to the services that you need to be healthy. Couple that with the fact that Texas has the highest uninsured rate in the entire country, you get people who may need medical attention during this crisis but can’t, and so they’re are at another disadvantage.
The U.S. has underinvested in community-based, preventive approaches to improving health. And that’s particularly acute for low-income and vulnerable populations because they often don’t even enjoy the benefits that access to good health care brings. If we begin to balance our resources a little more effectively, we might be able to not only improve health, but also reduce actual health care costs. At the Episcopal Health Foundation, we’re partnering with organizations across Texas to support programs and policies that improve health, not just health care. But philanthropic funding only goes so far.
Better health comes with building communities with a strong health infrastructure. This will mean that when the next crisis hits—and there will be a next time—we’re more resilient to it. Resiliency comes with public policies that care for people and families through paid sick leave, parental leave, and childcare. Resiliency comes when state lawmakers expand Medicaid or come up with another plan to ensure all Texans have access to affordable medical care. Resiliency comes when the health care system and health insurance pay for prevention such as fresh food prescriptions, home remediation for asthma patients, and exercise programs. Communities change when systems change—and after COVID-19, something has to change to make all communities healthier across the board.