Guest editorial: Reforms needed to ensure equal health outcomes for everyone

Randy Oostra and Michael Ugwueke

        To date, COVID-19 – the relentless pandemic – has cost the lives of approximately 400,000 Americans when, according to the Centers for Disease Control and Prevention, indirect deaths are factored.
        The virus has altered virtually every aspect of our way of life. In its wake, the pandemic places a harsh spotlight on a hard truth: structural racism in America causes fatal inequities in health care outcomes. We see this unfold as COVID-19 continues to kill, or leave chronically ill, African-Americans, Hispanics and other minority populations at statistically significant higher rates than whites.
        Sadly, COVID puts a fine point on a larger problem. More than ever in our lifetimes, we are reminded that racial discrimination principally explains social determinants of health that include educational attainment, employment status and wages, housing, and an array of environmental factors. The cumulative physical and psychological effects on minority communities and the poor leaves them substantially compromised both physically and psychologically. It is well documented that African-Americans and other minorities disproportionately experience heart disease, diabetes and mental health conditions that can be traced to the wear and tear from long-term exposure to chronic stress.
        It is unsurprising that studies among hospitalized COVID-19 patients show a high prevalence of stroke, as well as heart, kidney and liver disease, asthma, diabetes, high blood pressure and obesity. It is tragic that these conditions both disproportionately affect minority populations and substantially explain the excess number of COVID-19-related deaths among minority populations. What makes these realities worse is that health care in this country does not, on balance, proactively address social determinants of health. We are simply left trying, largely inadequately and at great expense, to lessen the impact of these patients’ conditions. 
        As has been noted frequently over the past few months, racism is truly a public health issue, the results of which we witness every day, all day. It would be spectacularly naïve to believe its effects do not harm us all. As leaders of two major not-for-profit health care systems, we are both passionately committed to transforming the U.S. health care system, and society, in a way that ensures equal health outcomes for all members of our communities. 
        It is way past time to get real.
        A crisis of this magnitude requires us to marshal all our experience and resources to design and implement health care policy that provides universal coverage and access to high quality health care. Among other things, this also must mean implementing policies that address social determinants of health and the disparities that result.
        We propose the establishment of a Congressionally-created, time-limited, national commission made up of health care industry leaders, business leaders, public health experts, and providers. The commission would make requisite policy recommendations to the Congress and provide the health care industry an opportunity to coalesce around, and publicly advocate for, necessary health care reforms. The commission could also guide Congress in meeting its commitment to provide optimal health care coverage via the Medicare and Medicaid programs.
        As health care CEOs who are joined by myriad colleagues advocating for this commission, we believe it is time for health care to be more socially responsible and rediscover its inextricable connectedness to public health. The nation rightly expects us to take a role in the improving the social and personal determinants of health; and to lead the way in lifting up public health so that the health and well-being of all can be attained.
        Let’s not ignore the lessons learned from the COVID-19 pandemic. We cannot legitimately claim to provide health care in this country when we cannot successfully care for the most vulnerable.
        Let’s work to eliminate the conditions that prevent quality health care, and work to create those that help achieve health equity.
        Let’s do more than we are paid to do. As a nation – indeed as human beings – let us work together to do what our conscience calls us to do.  
        Randy Oostra, DM, FACHE, is President and CEO of ProMedica. Michael Ugwueke, DHA, FACHE, is President and CEO of Methodist Le Bonheur Healthcare.


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