Video: The pandemic, health disparities, and lessons we re-learned about ourselves

At the 2021 Inland Northwest State of Reform Health Policy Conference, key leaders from both the private and public sectors of health care came together to discuss health disparities based on race, gender, and economic status revealed through the COVID-19 pandemic. These leaders were Sen. Emily Randall, a member of the Senate Health & Long Term Care Committee; Zeke Smith, president of the Empire Health Foundation; Ka’imi Sinclair, PhD, co-director of Partnerships for Native Health at the College of Nursing at Washington State University Health Sciences; and Bill Ames, executive health care director of Eastern Washington at Genentech. 

 

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The conversation spanned topics from vaccine mandates to workforce shortages and resiliency, but all panelists emphasized their support of community-based solutions to public health problems, with a specific focus on inclusivity and increasing health equity across the state. Randall stated:

“Since our country was founded, we have had not just barriers, but denials of care and coverage and mistreatment of some members of our community, communities of color. And we know this even more now that we’ve lived through this last year and a half.”

To address these health inequities, the panelists outlined some of the efforts their organizations have been focused on.

Sinclair highlighted her group’s work doing community-engaged research in Alaska Native, Hawaiian, and Pacific Islander communities across the country, as well as COVID-19 surveillance. She noted that the Marshallese community, in particular, has been disproportionately affected by COVID-19, representing only 1% of the Spokane County population but nearly 30% of COVID-19 cases between March and May 2020. 

Randall commented on her legislative work to address insurance access disparities in the state through the establishment of health equity zones. During this past legislative session, she also worked on policy to create the universal health care commission, and to expand postpartum Medicaid coverage. She noted that 6.2% of Washingtonians were uninsured in 2018, and the highest majorities within that population were Black, Hispanic, and American Indian.

Smith said that one of his focuses during the pandemic was on developing pathways for Native American and indigenous students to join the health care workforce, as the gaps in representation of communities of color increase when more education requirements are imposed for certain health care professions. Smith stated:

“All of the challenges that the system presents for health care workforce professionals are exacerbated for individuals of color, who are entering a field where they don’t see many other folks who look like them, where they may or may not be able to serve in communities they want to, and that the cultural identity they bring to the table is, in many cases, asked to be put to the side…

Part of what the [Center for Native American Health] is about is to try to cultivate and create a space where we recognize there’s value in people being able to bring their identity to the table, whether that’s cultural, whether that’s about their gender, whether that’s about their sexual orientation..”

Randall echoed his statements, stating the need to build a resilient health care workforce by “…ensuring that our nurses and frontline care providers in situations like this have the tools they need.” She also stated the need to build pipelines into the workforce for underrepresented communities through graduate school reimbursement and financial aid programs for low-income families.

Sinclair emphasized the need to support and train community health workers specifically, stating: 

“American Indian communities and Latino communities have a long history of community health workers — promatoras — who can be trained to provide some of the prevention and secondary care that needs to happen in communities so that we don’t have to rely on people going into the doctor all the time or into the clinic, or even accessing telehealth for every single thing.”

Sinclair also brought up technology inequities in health care, and discrepancies in access to telehealth services in the state. She commented on the need to provide communities with more access to the technologies and internet access that are necessary for telehealth. 

Randall added that increasing access to telehealth and improving the experience was a big topic of conversation in the past legislative session. She mentioned some policies being worked on to improve connectivity in communities, including policies that allow municipal governments to enter into retail broadband relationships, and investing in authorizations for more broadband expansions, particularly on tribal reservations. 

Smith made a final comment regarding his belief in the state’s ability to improve health inequities in local communities and health care systems.

“The pandemic has required us at multiple levels to make rapid and adaptive change to be able to address the needs of communities and populations that we work with … When I think about all the ways in which health inequities have been here in our community and our systems for a long time, it hasn’t really represented enough urgency for the system and for institutions like mine and others to make the change that’s required. 

I hope that part of what we take from this pandemic is we actually can make those changes when we desire it and when we have a sense of urgency to do it. There’s a lot more that we have to do to be able to accomplish what we want around health equity in our communities.”