Data released by the Centers for Disease Control and Prevention (CDC) in June 2021 paints a grim picture: African Americans, Latinos, and American Indians and Alaska Natives (AI/ANs) — three of the most historically underserved populations in health care — were much more likely to contract COVID-19, require hospitalization, and succumb to the disease than white people.
- AI/ANs were 1.6 times more likely to contract COVID than white people, 3.3 times more likely to be hospitalized, and 2.4 times more likely to die from the disease.
- African Americans were 1.1 times more likely to contract COVID than white people, 2.9 times more likely to be hospitalized, and twice as likely to die from the disease.
- Latinos were twice as likely to contract COVID than white people, 2.8 times more likely to be hospitalized, and 2.3 times more likely to die from the disease.
These numbers can’t be ignored. The growing awareness of the problem among the public as well as by government policymakers, communities, and health care providers has added a sense of urgency to the dire and immediate need to close economic, racial, and cultural gaps in the provision of health care to underserved populations.
This guide highlights efforts underway to bring true health care equality to populations without access to the care they need by:
- Identifying the groups impacted by health inequities
- Assessing the reasons for the disparities in the provision of health care to underserved populations
- Devising approaches for overcoming barriers to health care
- Examining five specific strategies being implemented with the goal of delivering quality health care to everyone, regardless of ethnicity or social and economic situation
Underserved Populations in Health Care: What Are Health Inequities?
The first step in bringing equality to health care is to answer the question, what are health inequities?
- The World Health Organization (WHO) defines health inequities as "systematic differences in the health status of different population groups."
- Medical News Today adds that health inequities are "avoidable differences in health between different groups of people."
Health inequities lead to a negative impact on the living conditions, health care access, and overall health of underserved groups. However, everyone is hurt by unfairness in the provision of health care because it affects the economic, social, and political systems on which society depends. Conversely, everyone benefits when all members of our communities are healthy, which allows them to contribute their unique talents and reach their full potential.
These are among the populations chronically underserved in health care:
While life expectancy increased substantially for African Americans in the 20th century, the CDC reports that the gap in life expectancy between African Americans and white people in the U.S. widened to six years in 2020, the largest difference since 1998. Life expectancy for both groups declined from 2019 due to the COVID-19 pandemic:
- African Americans’ life expectancy was 72 years in 2020, down from 74.7 years in 2019.
- White people’s life expectancy was 78 years in 2020, down from 78.8 years in 2019.
A disproportionate number of Latinx/Hispanics are either below or between 100% and 199% of the federal poverty level (FPL), as the Commonwealth Fund reports.
- Latinx/Hispanics below FPL: 17%
- African Americans below FPL: 21%
- White people below FPL: 9%
- Latinx/Hispanics between 100% and 199% of FPL: 25%
- African Americans between 100% and 199% of FPL: 22%
- White people between 100% and 199% of FPL: 13%
In addition, the ongoing residential segregation of African Americans and Latinx/Hispanics limits access to health care services, increases their exposure to harmful pollutants, and exacerbates chronic health conditions, such as obesity and hypertension.
American Indians and Alaska Natives
The Journal of the American Medical Association estimates that 6.9 million individuals in the U.S., or about 2% of the population, identify as American Indian or Alaska Native. While the rates of cardiovascular disease declined overall for people ages 25 to 64 between 2000 and 2015, mortality rates from cardiovascular disease increased substantially for AI/AN people in that age group: 2.1% for women and 1.3% for men.
The increase was correlated with higher rates of diabetes, obesity, and smoking, all of which are higher among the adult AI/AN population. A lack of health care resources for this underserved group is thwarting greater public health education and monitoring.
The health risks to unhoused people in the U.S. constitute a full-blown health crisis:
- The average life expectancy of an unhoused person is just 50 years, according to statistics compiled by Policy Advice.
- A total of 20% of the unhoused population are children.
- Almost 4 in 10 sheltered unhoused people (38.6%) have a disability.
- One-fourth of unhoused people suffer from mental illness, 38% from alcohol abuse, and 26% from drug abuse.
New Mothers and Women with Children
The rate of maternal mortality in the U.S. is twice that of the U.K.; HealthAffairs calls this a "national disgrace." African American women are more likely to have cardiovascular conditions and other preconception health risks that increase the likelihood of many pregnancy complications: hemorrhage, infection, hypertensive disease, and premature delivery.
In addition, infants born to women who are African American, AI/AN, or Native Hawaiian and other Pacific Islander (NHOPI) have higher mortality rates than infants born to white women. Women in these and other ethnic and racial groups are less likely to receive vital reproductive health services, such as Pap tests, mammograms, and contraceptives. They also face obstacles in receiving preventive care and mental health care.
People with Disabilities
The U.S. Census Bureau estimates that approximately 40.7 million people in the U.S., or 12.7% of the population, have a disability. The Catholic Health Association highlights three areas where people with disabilities are more likely to experience preventable health disparities:
- Adults with disabilities are 40% more likely to have obesity than those without disabilities.
- One in six people with a disability (16.7%) have been diagnosed with diabetes, compared with 7.4% of people without a disability.
- Rates of smoking among adults with disabilities are nearly double those of adults without a disability: 23.1% vs. 12.3%.
The United Nations Refugee Agency estimates that at the end of 2020, 82.4 million people in the world had been forcibly displaced, including 32 million children, or 42% of the total. A WHO report in June 2021 identifies the serious obstacles that refugees and migrants face in receiving necessary health care.
- They lack the required legal status.
- Their needs are perceived as secondary to those of native populations.
- They’ve lost contact with family and social support systems.
- They face communication, social, religious, and cultural barriers.
People with Limited English Proficiency
Limited English proficiency (LEP) has long been a primary impediment to health care for immigrant and ethnic populations. Language Magazine points out that language barriers between patients and health care providers worsened the toll of the COVID-19 pandemic. The magazine cites research that found LEP was "significantly associated" with COVID-19 outcomes.
- Public service announcements regarding the use of masks and social distancing weren’t available in many non-English languages.
- Much of the information that was available in Spanish was outdated or was poorly translated by online translation services, such as Google Translate.
Young Adults Who Lack Health Insurance
The number of uninsured nonelderly people in the U.S. increased from 10% in 2016 to 10.9% in 2019, representing 28.9 million individuals. The increase was greatest for NHOPI (3.4%), Hispanics (1%), and Asian Americans (0.4%).
- The top reason young adults gave for being uninsured was the lack of affordable coverage (73.7%).
- Other reasons were not being eligible for coverage (25.3%), not needing or wanting coverage (21.3%), and signing up for coverage was too difficult (18.4%)
People Who Are Eligible for Medicaid and Aren’t Enrolled in the Program
Recent expansion of Medicaid in response to the COVID-19 pandemic has led to millions of U.S. residents gaining health insurance coverage, yet in the 12 states that haven’t adopted expanded coverage, participation has stagnated despite millions more people qualifying for the program due to lost jobs and reduced incomes.
Because former President Barack Obama’s health care law, the Affordable Care Act (ACA), anticipated that low-income people would receive health care under Medicaid, the program isn’t able to fill the gap created by limits imposed by some states.
- In the 12 states that haven’t adopted Medicaid expansion, 4,340,000 people would be eligible under expansion, yet only 356,000 currently qualify for coverage.
- Many of these states have large populations of African American and other racial and ethnic minorities disproportionately affected by the lack of access to health insurance.
Resources for Identifying Health Inequities
- The New England Journal of Medicine, "Understanding and Mitigating Health Inequities — Past, Current, and Future Directions" — Researchers present a timeline that extends from the first government report on minority and ethnic health in 1985 to ongoing investigations on the effects of structural racism on health.
- Centers for Disease Control and Prevention, Health Equity Considerations and Racial and Ethnic Minority Groups — The article discusses the factors that affect health equity, including discrimination, occupation, education, income, and housing.
Minority Health Care Disparities
Many of the diseases that are most prevalent among minority populations are preventable, raising hope among health care professionals that they can be rectified through better public health education and preventive care. The National Institutes of Health (NIH), an agency of the U.S. Department of Health & Human Services (HHS), has implemented the Minority Health and Health Disparities Strategic Plan 2021-2025 as part of the department’s efforts to chip away at minority health care disparities.
One goal of the NIH plan is to speed up the application of insights gained from clinical research into minority health care disparities to clinical practice and public health education. Among the factors being investigated are behavioral, biological, sociocultural, socio-ecological, and environmental characteristics that impact minority health disparities.
How Health Inequities Impact Minority Populations
Racial and ethnic minorities are disproportionately represented among essential workers and industries, placing them at higher risk of contracting COVID-19 and other infectious diseases, as the CDC reports. However, many other social, political, and economic factors contribute to the disparities in the provision of health services to minority groups.
- Poor health care access and use
- Gaps in education, income, and wealth
- More crowded living conditions
Addressing the disparities focuses on improving access to primary care providers for children and adults in minority groups, promoting health literacy, and increasing funding to publicly funded health maintenance organizations (HMOs).
The CDC notes that African Americans ages 18 to 49 are twice as likely to die from heart disease than white Americans, and African Americans ages 35 to 64 are 50% more likely to have high blood pressure than their white counterparts.
- Health coverage among African Americans has been boosted by the ACA, as The Commonwealth Fund reports. The percentage of uninsured African American adults declined from 24.4% in 2013 to 13.7% in 2016 before increasing to 14.2% in 2019.
- Chronic health conditions that have a greater impact on young African Americans than white people include high blood pressure (33% for ages 35 to 49 vs. 22% for white people), diabetes (10% vs. 8%), and stroke (7% vs. 4% for ages 50 to 64).
- Mental health issues are more prevalent among African Americans who live at or below the FPL, twice as many of whom report experiencing serious psychological distress than African Americans who live at twice the FPL or higher.
- Leading causes of death among African Americans are heart disease, cancer, and accidents.
The HHS states that only 50.1% of Latinx/Hispanics in the U.S. have private health insurance, the lowest rate of any ethnic or racial group. By comparison, 74.7% of non-Hispanic white people have private health insurance.
- Health coverage for Latinx/Hispanics increased as a result of the ACA, which saw the percentage of uninsured Latinos decrease from 40.2% in 2013 to 24.9% in 2018 before increasing to 25.7% in 2019, according to The Commonwealth Fund.
- Chronic health conditions among Latinx/Hispanics include higher rates of obesity than non-Hispanic white people, more instances of low birth weight infants, and more prevalence of diabetes. Puerto Ricans have higher rates of asthma, HIV/AIDS, and infant mortality.
- Mental health issues that Latinx/Hispanics are susceptible to include mental distress related to immigration and acculturation, as Mental Health America reports. Rates of serious mental illness and major depressive episodes are increasing for Latinos ages 18 to 49.
- Leading causes of death for Latinos are heart disease, cancer, and accidents.
While Asian Americans are less likely to live in poverty than the overall population (12.1% vs. 15.1%), certain subgroups have much higher poverty rates, including Hmong Americans (28.3%), Bhutanese Americans (33.3%), and Burmese Americans (35%).
- Health coverage among Asian Americans and Pacific Islanders (AAPIs) increased as a result of the ACA, according to figures compiled by the HHS. In 2013, 14.7% of the AAPI population was uninsured, but the number had decreased to 6.8% by 2019.
- Chronic health conditions that show a higher prevalence among Asian Americans than the general population include tuberculosis (16.7 incidence rate vs. 0.5 for white people), chronic obstructive pulmonary disease, hepatitis B, HIV/AIDS, smoking, and liver disease.
- Mental health issues are often untreated among Asian Americans because of the stigma attached to mental illness. Mental Health America estimates that 17.3% of Asian Americans will be diagnosed with a psychiatric condition at some point in their lives, yet Asian Americans are three times less likely to seek mental health treatment than other population groups in the U.S.
- Leading causes of death for Asian Americans are cancer, heart disease, and stroke.
Hawaiians and Other Pacific Islanders
The U.S. Census Bureau estimates that the median household income for NHOPIs in the U.S. was $66,695 in 2019, compared with $71,664 for white people. The number of NHOPIs living at or below the FPL was 14.8% in 2019, compared with 9% for white people.
- Health coverage rates for this population group are less than that for white people: 65.8% had private health insurance in 2019, compared with 74.7% of white people. The HHS notes that 12.3% of NHOPIs were uninsured in 2019.
- Chronic health conditions among NHOPIs are exacerbated by the group’s higher rates of smoking, alcohol consumption, and obesity than those of the general population. The TB rate for this group is 37 times higher than that for white people; hepatitis B and HIV/AIDS are also more common among NHOPIs.
- Mental health issues are less common among NHOPIs than in white people, including serious psychological distress in adults (10.1% vs. 12.7%) and major depressive episodes (3.5% vs. 8.5%). However, the HHS reports that suicidal thoughts, plans, and attempts increased sharply for Asian American and NHOPI young adults and adults ages 26 to 49 between 2009 and 2019.
- Leading causes of death for NHOPIs are cancer, heart disease, and stroke.
American Indians and Alaska Natives
Cultural barriers, geographic isolation, and low incomes negatively affect the quality of health care available to AI/ANs. While 22% of AI/ANs live on reservations or other trust lands, 60% live in metropolitan areas — the lowest metropolitan percentage of any racial group, according to the U.S. Census Bureau. The median annual household income for AI/ANs was $49,906 in 2019, compared with $71,664 for white people.
AI/ANs have higher rates of mental illness and suicide than other population groups. They’re also more likely to be obese, experience substance abuse, and be victims of sudden infant death syndrome (SIDS). In addition to having higher rates of diabetes, liver disease, and teenage pregnancy, AI/ANs are nearly seven times more likely to contract TB than white people.
- Health coverage among AI/ANs increased following the passage of the ACA. In 2013, 26.9% of the AI/AN population was uninsured, decreasing to 19.1% in 2019. The HHS estimates that 51.9% of AI/ANs had private health insurance in 2019, while 42.1% relied on Medicaid or public health insurance.
- Chronic health conditions that are more prevalent among AI/ANs than in the general population include unintentional injuries; diabetes; obesity; SIDS; liver disease; hepatitis; and TB, which is seven times more common among AI/ANs than among white people.
- Mental health issues, including suicide and substance abuse, afflict AI/ANs at a greater level than other population groups. In 2019, suicide was the second leading cause of death among AI/ANs ages 10 to 34. The death rate from suicide among all AI/ANs is 20% higher than that of white people.
- Leading causes of death for AI/ANs are heart disease, cancer, accidents, liver disease, and cirrhosis.
Resources on Minority Health Care Disparities
- American College of Surgeons, Health Care Disparities Resources — The site links to reports and publications that discuss the causes of disparities in health care for underserved populations and potential remedies to address the disparities.
- U.S. Department of Health & Human Services, Health Disparities Resources — Among the resources linked to are guides for medical school curricula, language access services, and cultural competency.
Barriers to Health Care Access
The challenges the health care industry faced in responding to the COVID-19 pandemic exposed the most daunting impediments to the provision of health care to underserved populations.. The 2018 National Healthcare Quality and Disparities Report from the Agency for Healthcare Research and Quality (AHRQ), an HHS agency, predates the pandemic response but confirms that Black, indigenous, and people of color (BIPOC) communities receive worse health care than white people in approximately 40% of the quality measures.
These are among the most common barriers to health care access:
Lack of Health Insurance
The HHS found that uninsured adults across racial and ethnic groups are at least twice as likely as their white counterparts to avoid seeing a doctor. Patients who establish a strong personal connection with their health care provider are more likely to take better care of themselves. They’re also more likely to trust the health care profession.
- One in 10 adults report that they delayed or went without getting health care due to its high cost.
- The rate was 15% for Latinx and 13% for African Americans.
- Adults who most need medical care are twice as likely to delay or go without it than those who need care less.
- Among uninsured adults, 36.5% delay or go without medical care due to its high cost.
Lack of Financial Resources
The Centers for Medicare & Medicaid Services (CMS), an HHS agency, estimates that national health care expenditures grew by 4.6% in 2019 to $3.9 trillion, which represents 17% of the U.S. gross domestic product (GDP). The agency forecasts that by 2028, national health care expenditures will reach $6.2 trillion, representing 20% of GDP. These figures are much higher than the amount spent on health care by other developed countries.
- The Children’s Health Fund estimates that 20.3 million children in the U.S. (28% of all children) are unable to access the health care resources they need, due primarily to the high cost of care.
- Financial barriers include high copays, high deductibles, and unaffordable prescription drug prices.
- More than 13.1 million children are in families who are unable to pay their medical bills or are struggling to pay medical bills.
Lack of a Regular Health Care Source
Even when underserved populations are insured or are able to pay for their health care needs, they may be challenged to find a convenient provider. The Health Resources & Services Administration (HRSA), an HHS agency, identifies 7,359 health professional shortage areas in the U.S. where 85 million people reside. The HRSA estimates that 15,445 primary care professionals are needed to address these shortages.
- Research published in the CDC’s National Health Statistics Reports found that adults in the U.S. who lived outside a metropolitan statistical area had less access to health care and used health care services less often.
- More than half of all health professional shortage areas for primary care, dental care, and mental health care are in rural areas, yet the number of hospitals in these areas continues to decline.
Legal Barriers Faced by Immigrants
The political and social response to the COVID-19 pandemic demonstrates clearly that a person’s immigration status serves as a social determinant of health. Several immigration-related factors influence a person’s health:
- Stressors that occur before and after migration
- Laws and policies that influence an immigrant’s access to health care services and benefits
- Health care services that vary based on the person’s legal classification of immigration status
Living environments, working conditions, and environmental factors also affect the ability of immigrants to access health care services. Legal barriers may be predicated on the person’s country of origin, race or ethnicity, age, socioeconomic status, and immigration status.
Also complicating health care for immigrants are the various state laws relating to who qualifies for health insurance coverage and inconsistent federal policies related to immigration. As of 2018, 23% of authorized immigrants and 45% of unauthorized immigrants lacked health insurance.
Lack of Transport, Long Waits for Appointments, and Other Structural Barriers
The American Hospital Association reports that each year, 3.6 million people in the U.S. are prevented from receiving the health care they need because they don’t have access to a vehicle, they’re too far away from their health care provider, or they face some other transportation obstacle. Physicians Practice notes that missing medical appointments due to transportation issues or other infrastructure-related matters has a cascading effect:
- Patients’ continuity of care is interrupted.
- Patients are challenged to maintain treatment regimens.
- Patients lack the support they need to make healthy decisions.
Patients who repeatedly miss medical appointments undergo fewer cancer screenings, have worse chronic disease control, and are more likely to require acute care and emergency services. In addition to compromising patient outcomes, the inability to make scheduled appointments increases the overall cost of medical care.
Lack of Health Care Providers in Urban and Rural Areas
The HRSA’s directory of health professional shortage areas includes both urban and rural areas of the U.S., yet the reasons for the shortage of health care providers in cities and lightly populated regions are similar. The National Rural Health Association highlights the unique challenges that health care providers in rural areas face:
- A high patient-to-primary care physician ratio
- A greater proportion of poor people
- Few transportation options
- Lack of high-speed internet access
However, residents in rural areas face unique challenges in accessing the health care services they need. For example, rural settings have a higher rate of fatal and injury-causing automobile crashes than urban areas, and fewer mental health services are available in rural settings despite the high rate of suicide among rural youth.
Twenty-five million people in the U.S. are estimated to have limited English proficiency (LEP) that compromises the quality of the health care they receive. The American Medical Association estimates that Hispanics with LEP have worse health care access, are less healthy, and receive fewer preventive services than English-speaking Hispanics.
While state and federal regulations require that health care providers offer patients with LEP trained interpreters during their care, a shortage of available interpreters and the shortcomings of audio and video equipment present barriers to communication for LEP patients.
- Only 13% of hospitals comply with all four National Standards for Culturally and Linguistically Appropriate Services (CLAS) in health care.
- Health insurance payers limit reimbursements for interpreter services because the payers question the cost-effectiveness of the services.
- Remote interpreter services rely on stable internet connectivity and are less effective than in-person translation, especially when patients are in emotional distress.
Older people are more likely to require access to health care services, yet they’re also more likely than younger adults to lack funds, have impaired mobility, and have less access to technology. Recommendations submitted as part of the National Academy of Medicine’s initiative to set health care priorities include six approaches to improving health care access for older people.
- Bolster the health care workforce through scholarships, loan forgiveness, clinical internships, and professional training.
- Invest in public health efforts to address the health care needs of older people.
- Fund efforts to eliminate social, structural, and economic barriers to health care access by people age 65 and over.
- Provide more telehealth services for older people and improve the quality of remote interactions.
- Offer more palliative and end-of-life care for treating serious illnesses and dementia.
- Develop new approaches to long-term care and support services for chronic illnesses.
Resources on Barriers to Health Care Access
- U.S. Department of Health & Human Services, Healthy People 2030 — The goals of the Healthy People 2030 government program can be browsed by health conditions, health behaviors, populations, settings and systems, and social determinants of health.
- The Commonwealth Fund, Advancing the Public Option in 2021: Leveraging Existing Federal Authority to Assist State Efforts — In the absence of action at the federal level to implement a public option for improved health care access, public-option initiatives implemented by state governments can be bolstered by executive authority.
How to Overcome Health Disparities: 5 Approaches
Government agencies, community groups, and health care providers are responding with a range of efforts intended to close the gaps in health care for underserved populations. Programs that the federal government, technology companies, and community groups have initiated are leading the way.
1. Federal Government Initiatives
Work that the HHS and other federal agencies are doing to improve the provision of health care to underserved groups focuses on three areas:
- Expanding access through health centers that serve as safety nets to prevent infectious diseases and address other health needs
- Promoting health care professions through training of new workers and continuing education for existing health care employees
- Transitioning from a fee-for-service model to value-based care that emphasizes quality care and cost containment
U.S. National Institutes of Health UNITE Initiative
The goal of the NIH UNITE program is to identify and eliminate structural racism within NIH-supported organizations and throughout the scientific community by:
- Addressing barriers to racial equality in biomedical research
- Creating an equitable and civil culture for research work environments
- Increasing inclusivity and diversity in science
The five committees that make up the UNITE initiative focus on stakeholder experiences; health equity, minority health, and health disparities; creating a culture of inclusion; transparency and accountability to all stakeholders; and promoting workforce diversity throughout the research community.
In the absence of congressional consensus on legislation addressing the critical problem of underserved populations in health care, federal executive orders can be a way to bring more equity and fairness to the provision of health care in the U.S. Two such executive orders that President Joe Biden issued in 2021 address existing federal health care programs and target equitability in the nation’s response to and recovery from the COVID-19 pandemic.
- Executive Order on Strengthening Medicare and the Affordable Care Act. This order creates a special enrollment period for the ACA to provide more coverage to people at risk of contracting the coronavirus. The executive order also called for a review of agency actions to ensure that they promote and support Medicaid and the ACA.
- Executive Order on Ensuring an Equitable Pandemic Response and Recovery. This order mandates that federal agencies take swift action to ensure that COVID-19 care and outcomes in communities of color and other underserved populations are equitable to all other communities.
US Department of Health & Human Services Healthy People 2030 Initiative
- Helping all people live healthy, thriving lives
- Eliminating health disparities and achieving health equity
- Establishing social, physical, and economic environments that promote health and well-being for all
- Promoting health development and healthy behaviors in all life stages
- Engaging health care leaders and public officials in implementing policies and taking actions that improve everyone’s health and well-being
2. Artificial Intelligence to Overcome the Shortage of Health Care Professionals
Current models of health care provision are unsustainable because demand for health services will soon overwhelm the capacity of health care professionals and providers. McKinsey reports that even if the health care industry created 40 million new jobs by 2030, it would still be 9.9 million jobs short of needed physicians, nurses, and other health care professionals.
Automation and artificial intelligence (AI) promise to fill the gap by improving patient outcomes effectively and affordably in conjunction with human health care providers in these areas:
- Chronic care management
- Self-care, prevention, and wellness
- Triage and diagnosis
- Clinical decision support
- Care delivery
The first generation of AI in health care will automate repetitive, routine tasks, including much administration. The second generation will shift from hospital-based care to home-based care, including remote monitoring, alert systems, and virtual assistants. The third generation will be in clinical practice, including clinical decision support.
3. Smart Devices to Democratize Access to Basic Health Care
The health care industry is catching up with the personal digital revolution that’s seen smartphones and other intelligent devices become ubiquitous. Portables, wearables, and other consumer-facing technologies generate a vast amount of health-related data that can be gathered, analyzed, and applied to personalize health care, thus making health information more readily available.
Do-it-yourself health care makes patients true partners with health care providers in maintaining health and diagnosing and treating medical problems.
- Digital devices can serve as electrocardiogram (EKG) monitors, blood glucose monitors, and pulse oximeters.
- They’ve been designed to measure carbon monoxide in exhaled breath to support smoking cessation programs.
- They create a new "data pipeline" that links health data that patients report in real time to a dashboard that providers who are able to prescribe therapies or interventions that are delivered back to the patients can access.
4. More Sophisticated and Less Expensive Telehealth Services
The use of telehealth services expanded rapidly as a result of the COVID-19 pandemic, but the widespread use of the technology also highlighted shortcomings in the current versions of the services. HealthAffairs refers to the current state of telehealth technology as a "punctuated equilibrium," borrowing a phrase from the late scientist and educator Stephen Jay Gould.
While telehealth services enhance the availability and convenience of health care provision, they must go beyond cost savings to improve patient outcomes and the quality of care patients receive.
- Telehealth services can lead to an increase in patient "visits" because patients may not have sought help if the telehealth services weren’t available. This can actually increase costs for health care providers.
- Little effort has been made to address disparities in access to the technologies that telehealth services require, including broadband internet access, digital devices, translation services, and defined best practices for cultural and social competency.
- Some health issues can’t be addressed adequately via telehealth services, potentially increasing the workload for caregivers who have to follow up a telehealth session with an in-person visit.
- At present, few mechanisms are in place to measure the quality and effectiveness of telehealth visits or to understand how the technology affects patients’ experience. Regulatory and policy approaches are required that address the unique attributes of telehealth visits.
5. Increased Cancer Screening and Other Diagnostic and Preventive Care for Underserved Communities
Cancer is more prevalent in underserved populations due to social, environmental, and economic disadvantages of poor people and racial and ethnic minorities. The National Cancer Institute notes that African Americans have higher death rates for many types of cancer, including breast cancer and prostate cancer.
- Latina and African American women have higher rates of cervical cancer than women in other racial and ethnic groups.
- The AI/AN population has higher death rates from kidney cancer than any other racial or ethnic group.
- People living in rural Appalachia have higher rates of colorectal, lung, and cervical cancers than people who live in nearby urban areas.
The CDC’s National Breast and Cervical Cancer Early Detection Program has been successful in delivering cancer screening to women living on an isolated Navajo reservation. In addition, between October 2019 and February 2020 the program provided mammograms and other breast cancer screening to women in Arkansas who lived in 23 different shelters, facilities for battered women, rehabilitation centers, and prison release homes. It also worked with the New York State Department of Health to offer cancer screening tests; in one year, the program treated more than 26,000 people who lacked insurance or a regular doctor.
Building on the Link Between Health Care and Prosperity
Overcoming the challenges facing the health care industry in meeting the needs of underserved populations will require a concerted effort by government, communities, health care professionals, and patients themselves. Nurses and nurse leaders play a vital role in addressing the social, economic, and cultural costs of health disparities. All individuals and communities benefit when everyone has ready access to the health care resources they need to enjoy a long, healthy, productive life.