Just under a year ago, the novel virus known as SARS-CoV-2 started wreaking havoc in one country after the next.  Soon after the COVID-19 pandemic took hold in the US, data began to show that communities of color and low-income communities were at far higher risk for infection, severe illness, and death.  As dedicated health care workers, hospitals, and a range of care facilities scrambled to respond, gaps continued to widen between those most and least likely to be exposed to the virus through work or life circumstances, revealing long-existing health disparities and inequities. 

Wanda McClain is vice president of Community Health and Health Equity at Brigham Health in Boston and senior leader of the Center for Community Health and Health Equity at Brigham and Women’s Hospital, a long-term, multipronged effort to positively shift the trajectory for health outcomes in diverse populations.  Here, she answers our questions about health disparities spotlighted by the pandemic and ways to address systemic factors that help fuel them.  

Interview edited and condensed for clarity

The coronavirus has laid bare many vulnerabilities and inequities in our health care system.  How are you seeing this manifest at your hospital and in its broader community?

During the first wave last spring, we saw a higher percentage of Black and Latinx patients admitted to our hospitals and in our ICUs.  Early on, just looking at the names of our patients and at the patients in the beds, it was clear that we were seeing the impact hit communities of color in a very different way.  We also saw this in our local communities, where a lot of the work that I do takes place.  Looking at the data put out by the public health department, we could see that certain communities were either hotspots or emerging hotspots.

Now, as COVID cases surge again, infections and serious illnesses remain particularly high in communities of color.  We're also seeing increasing food insecurity.  I heard someone say that “food insecurity” is a neat euphemism, but what we're talking about is hunger.  I think they're absolutely right.

Additionally, we're seeing people impacted by potential evictions with the termination of the Massachusetts eviction moratorium in October.  So, issues of homelessness, or housing insecurity, are also front and center.
 

What approaches are you taking to address the systemic factors underlying health disparities in the short term and the long term?

There’s the work that we’re doing around COVID and the work we do in general.  Our COVID response addressed what we were hearing from the community: for example, that there was a lack of testing, particularly for people who did not have access to cars, since a lot of the testing available early on was drive-through.  We staffed pop-up and walk-in testing sites in hotspot communities and provided people with information and resources so that they would know how to keep themselves and their families and loved ones safe.  If they didn't have the capacity to self-isolate at home, we told them about resources in the city where they might be able to get support.  

In the long term, we continue to focus on addressing the social determinants of health (see Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity and Review of Evidence for Health-Related Social Needs Interventions).  We have a number of programs within the Center for Community Health and Health Equity that address four priority areas identified by our 2019 Community Health Needs Assessment, which was done in collaboration with all nine of the Boston teaching hospitals, the Boston Public Health Commission, community health centers and other local organizations.  The four priorities are housing stability, economic stability, and mobility; behavioral health, including mental health and substance use disorders; and access to services such as health care and childcare.  At Brigham and Women’s Hospital, we added issues of violence because of data from our priority communities and our long commitment to those who have been victims of domestic or intimate partner violence or community violence.

Are there promising examples of health systems partnering with companies in the health care space to tackle health care disparities or social determinants of health?

Among the programs I’m most proud of are our youth programs because of their potential for very long-term impact to transform people’s lives.  We forged a collaboration with seven Boston public high schools.  Every year, 100 high school students get year-round paid internships at the hospital.  One hundred percent of the kids in our program graduate from high school with our support, which includes tutoring and SAT prep, and go on to college.  All of them.  We’re seeing them graduate from college and go to grad school.  I’m very proud to say that a couple are just completing medical school.

We work with not-for-profit organizations like the Boston Private Industry Council, our local workforce development board.  Community leaders for industry sit on our Community Advisory Committee and also on our Equity Advisory Committee.  We have a number of partners in the housing space, including MassHousing, which has a leader on our community advisory committee and has helped us develop strategies to meet the needs people have.  For example, we participate in the collaborative Innovative Stable Housing Initiative with Boston Children’s Hospital and Boston Medical Center to provide a spectrum of housing support to increase housing stability.

With COVID, virtual visits became critically important.  We realized there are many disparities in access to technology and broadband that make it hard for diverse populations to take advantage of this and adopt it to the same degree as other populations.  We’ll be starting a pilot with an organization called Tech Goes Home to provide Chromebooks, training, and access to one year of broadband service.  We’re going to highlight that in our two community health centers, our most vulnerable patient population is people who are 65 and older with comorbidities, don’t have access to virtual visits, or who need support to access virtual visits.  

–Francesca Coltrera

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