The coronavirus pandemic has exposed an ugly truth: Millions of America’s most vulnerable citizens are almost completely cut off from essential healthcare, including access to the new coronavirus vaccines. The consequences for this population, and the nation at large, are devastating.
Already marginalized because of poverty, location or lack of education—known as social determinants—many of our neighbors are suffering disproportionately from the crisis. They were already isolated and missing doctor appointments due to lack of transportation or other factors. Widespread shutdowns have only made the problem worse. As a nation, we can’t afford to ignore this reality. If our at-risk populations cannot easily get vaccinated, our economy cannot reopen as quickly and we all suffer.
During the pandemic, those of us in healthcare vowed to be part of the solution for our most vulnerable patients. We staffed clinics in underserved communities, offered care through telehealth appointments and even enlisted prominent community leaders to transport patients to appointments. But millions are still not able to get vaccinated. This lapse is a wake-up call for all of us—and our leaders—to create and fund a healthcare system that serves all Americans.
Neglect at our own peril
Already, the Centers for Disease Control and Prevention recognizes how social determinants affect health inequality. Thankfully, the Biden administration is beginning to address this.
It plans to directly ship vaccines to as many as 40,000 U.S. pharmacies. The idea is to deliver care to “areas that are harder to reach to ensure that we have equitable distribution,” according to White House coronavirus response coordinator Jeff Zients.
But we can’t forget there are millions of Americans unable to even make it to the neighborhood pharmacy or vaccination site.
These are the underserved, aged shut-ins, the disabled, the homeless, the vulnerable and the isolated. They are diabetics, cancer patients, the elderly, or people whose illness or age leaves them unable to fully care for themselves.
Some lack reliable transportation to medical appointments. Others don’t have internet access or an email account to inform them of their eligibility. Perhaps they have trouble affording or using their mobile devices, causing them to miss notifications.
The breadth and the costs of this challenge cannot be overstated. Underlying health conditions make these people susceptible to the worst of the virus. And when they do get sick, they’re often the costliest to treat, because they’re the most likely to delay care until the threat becomes critical. Ambulance rides, emergency room admittances and hospital stays follow.
The cost of readmissions now approaches $50 billion a year. Nearly half of the nation’s hospitals face Medicare fines due to readmissions, losing valuable revenue that could have gone to care.
To leave our most vulnerable populations unvaccinated only elongates the strain on emergency care and staff already pushed beyond its limits. It also prevents our economy from fully recovering.
A matter of survival
For those of us in healthcare, our commitment is to extend a hand back to those who have been left behind. We will begin closing the gap caused by health inequalities by getting our most disadvantaged neighbors their vaccines.
For the nation at large, our economy is dependent on ensuring enough Americans get vaccinated so we can open back up and thrive. Now is the time for us to push our individual states and federal representatives to make reaching the vulnerable a high priority.
Our lawmakers should be trying to help all their constituents—including the elderly, the homebound and those with chronic morbidities—by prioritizing healthcare spending with an eye to social determinants and inequalities.
This is a matter of survival for more than patients alone. For healthcare systems to retrieve their own sense of wellness, we must return to something stable: where hospitals can break from the relentless strain, where doctors can resume elective treatments and surgeries, and where medicine can begin to repair its own financial and mental health.
We can achieve all of this if we remember where a person lives or their ability to access care shouldn’t determine whether they live a healthy life. The only thing that should determine that is their desire to have one.
Kathryn Stalmack is senior vice president and general counsel at ModivCare.