Guest column:

Health care should not be a partisan issue

Mon, May 11, 2020 (2 a.m.)

The current COVID-19 pandemic has changed our country. From altering social mores like hand-shaking changing to hand-washing, or a noon meeting changing to a Zoom meeting, the very aspects of life that we take for granted will be different moving forward.

As we remember and mourn the nearly 80,000 U.S. lives lost to this virus, we need to recognize that out of crisis comes opportunity. As we approach the other side of the peak of the current pandemic, we need to rebuild — not what we have had, but what we can become.

Disparities in health care are a moral issue. The fact that the mortality from COVID-19 in black, Latino or Native American communities is several times that of whites is alarming. Certainly, the reasons behind these differences are not completely known and are likely in part related to genetic differences in the way different ethnic groups’ immune systems respond to the infection.

However, we also know that COVID-19 mortality is related to preexisting conditions such as hypertension, diabetes, chronic obstructive pulmonary disease and obesity — factors related as much to the social determinants of health as to genetics. These social determinants of health include household incomes, nutrition, education and access to health care.

An additional, often overlooked, social determinant that affects lower income people disproportionately is the inability to socially isolate.

Because people who earn less money have less savings and tend to work in front-line jobs such as bus drivers, clerks and security guards, they often cannot miss work or work from home. This forces them to be more likely to be exposed to the virus. Once they get the virus, they are then more likely to die. And to make matters even worse, people from underserved communities are less likely to be tested for the virus in the first place, making quarantine and case tracking, necessary for containing virus spread, all but impossible.

What about Nevada?

Recent data shows that the Asian community of Southern Nevada makes up about 10.5% of our overall population, but Asians in Southern Nevada comprise 16% of COVID-19 deaths. Similarly, blacks make up 11% of our population but account for over 20% of COVID-19 deaths. Disparities in outcome from COVID-19 in Nevada parallel those from other states and the country at large.

What can be done?

Certainly, the use of telehealth has greatly expanded and matured during the pandemic. It is now becoming commonplace to see a provider via computer screen to avoid travel to a clinic or hospital. Telehealth is here to stay and is likely to expand in scope following the pandemic.

However, at-risk communities are technologically limited in their ability to use telehealth. In addition to a lack of available computers or smartphones, access to the internet with suitable internet bandwidth is a major limitation. One possible solution for the technology problem is to create a series of community hubs staffed by advanced practice nurses, social workers, or pharmacists in communities that are economically disadvantaged. These hubs could be connected via telehealth to a network of physician specialists and subspecialists, mental health professionals and dentists to provide more complex care and consultation. It is not difficult to imagine that these hubs could be placed in drug stores and pharmacies that already exist in the community.

Colocalization would have the advantage that many of these stores are already set up for “minute clinic” care services and if telehealth clinics are colocated in drug stores, medications could be dispensed on site. The fact is, good health needs to start in the community, not in the clinic or hospital.

In addition to expanding access, we need to address how we pay for care. The current pandemic has underscored the need for a health care system that covers all Americans. Disparities in care are real and not consistent with the principles that founded our country.

How we provide basic health care for our citizens has become a partisan issue, but the need to provide care for our citizens is something that affects all of us.

Economically, we all do better if our workforce is employed and our consumers are healthy. As we imagine life after COVID-19, let’s not settle on rebuilding the same systems of care. Let’s use our American ingenuity to create something better.

When it comes to health care, we are all in this together: Democrats and Republicans, viewers of CNN and viewers of Fox News, blacks and whites, men and women.

We are all Las Vegas.

Dr. Mark J. Kahn is dean of the UNLV School of Medicine.

Back to top

SHARE