The Pandemic through a Public Health Lens

COVID-19 brings health disparities to the fore as never before

Data-driven public health science benefits both community leaders’ decisions and everyone’s quality of life.

The value of public health and its ability to improve life for everyone may, ultimately, be among the greatest lessons during the COVID-19 pandemic. When the time comes to look back and assess what was learned, the experts will have a clearer picture than ever before of how one virus has affected people of different race and background differently—largely due to data. “As a country, we need to learn the value of public health science for the public good,” said Bita Kash, PhD, MPH, FACHE, Occidental Petroleum Centennial Chair in Quality and Outcomes and director, Center for Outcomes Research, Houston Methodist. As an organizational researcher, Kash studies which organizational structures are needed to achieve optimal clinical outcomes, reduce waste and provide better health for all, including patients and health care providers. Due to coinciding current events, specifically the increase in COVID-19 cases and the close scrutiny of racial inequality, the media has brought health disparities in specific populations to public awareness like never before. Fairly early in the pandemic, media stories about higher rates of severe COVID-19 cases in minority populations, made the public aware of discrepancies in care, higher risk factors among minorities, and other social determinants of health. And the numbers have grown more alarming: By late July, the CDC reported the COVID-19 death rate among Hispanics/Latinos aged 30-49 more than doubled that of Whites in the same age groups.

The pandemic has provided opportunities to see things differently. Kash welcomes this alternative view, particularly against the backdrop of a study she had published in the April 2020 issue of Health Services Research. “An Exploration of Community Partnerships, Safety-Net Hospitals, and Readmission Rates” studied readmission rates in 1,979 hospitals, comparing those with close community partnerships and those without. Hospital readmission rates are an important measurement used by the Centers for Medicare & Medicaid Services to determine funding nationwide. But the study results were unexpected: The data did not clearly indicate that hospitals with community partnerships were truly achieving better health outcomes. Kash points out that while many hospital-community partnerships, including schools, public health agencies, and community providers, collaborate on some specific health problem or disease, they each may have different goals and thereby miss the mark of shared achievements, such as improving health for all at the community level. Kash suggests viewing the COVID-19 pandemic as a sort of reset button, bringing a new focus to well-intended and well-funded partnerships—and possibly a new population health data set that reveals different types of information about health inequities. She sees a new level of receptiveness in constructing a more unified message, effective communications and more purposeful actions taken by leadership across numerous health systems and community organizations, including schools, churches, businesses and social service agencies. The pandemic has created an opportunity for these established partnerships to share a clear purpose.

Cheon O, Baek J, Kash BA, Jones SL. An exploration of community partnerships, safety-net hospitals, and readmission rates. Health Serv Res. 2020;00:1–10. DOI: 10.1111/1475-6773.13287

For example, one message shared consistently by hospitals and community partners is to wear a mask when in public to reduce community transmission and protect the most vulnerable. This clearly defined message is based in public health science and provides opportunities for community organizations of every type to practice purposeful communication. While the hospitals can guide the message, the community partners must consistently present it from a united front across the community. Kash points out that once these channels are established, they can be replicated to focus on other diseases in the future. “Change begins with asking community leadership for support, but in the end, population health is a shared responsibility that must be valued and carried out by the whole community—and considered in its entirety,” Kash said. Driving public awareness of the value of data-driven public health science and how it informs experts on the spread of the virus can benefit both community leaders’ decisions and everyone’s quality of life. “People are beginning to see that public health protects them and their children from this virus,” Kash said. “If we want to address a health disparity, we need data to show that it does exist, in order to help reduce the disparity at both the hospital and community level in real time. This is how we are able to formulate evidence-based public health strategy, assuring better health outcomes for people of all races and backgrounds.”

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