What does curbing the health divide look like in Philly?
COVID-19 exposed a long-existent health divide among communities in the city, but it extends far past the virus that shut the world down.
When speaking about the health disparities facing Black and Brown communities in Philadelphia coming out of COVID-19, Dr. William Gray, chairman of the American Heart Association, cardiovascular system disease chief at Main Line Health and co-director at its Lankenau Heart Institute, pointed to social determinants as some of the biggest reasons they exist.
They also run the risk of “snowballing” should nothing be done about them in the aftermath of COVID-19.
Gray was speaking at the recent AL DÍA Health Equity: No Matter Where You Live Roundtable, which dove into the issue of health disparities and highlighted the work of some organizations fighting against racial bias in healthcare and other social determinants of health.
In Philadelphia, one’s zip code is still often one of the biggest determinants of overall health and life expectancy.
Gray began by talking about how Black and Latinx populations in Philadelphia have higher rates of smoking, and consumption of sugary drinks and food high in sodium and saturated fat.
Such patterns of consumption lead to increased cases of hypertension, type II diabetes, obesity and eventually heart disease. During the pandemic, all were deemed high-risk of developing more serious cases of COVID-19, leading Black and Brown communities in Philly and across the country to die at higher rates from the novel coronavirus.
“However, I want to make it clear that these health-related decisions are often not made by choice, but are determined by the lack of access and the opportunity to make healthy choices,” said Gray.
Lack of healthy food options is just one of the many social determinants of health in Philadelphia’s Black and Brown communities. According to Gray, new determinants are found “almost monthly.”
As with many long-standing societal issues, these social determinants are not solved with a silver bullet, and require multi-pronged approaches from federal, state, city, and community organizations to really have an impact.
It starts, said Rev. Lorina Marshall-Blake of Independence Blue Cross, by going to trusted messengers in the community.
“You have to meet people where they are,” she said, before mentioning a partnership IBX has with a number of faith-based organizations in the city.
With Congreso de Latinos Unidos, the organization has been the trusted messenger in North Philadelphia’s Latino community for the past 40 years.
Judy Emmons, its director of primary care, spoke about the organization’s Mission 2 Impact approach to services, as one of the ways Congreso combats social determinants.
The five pillars to Congreso’s services all deal with either something affected by a social determinant, or a social determinant in itself. They are health, housing, education, workforce development and parenting.
“One of the strengths of our Mission 2 Impact strategy is that it emphasizes the individuals and families exist in an environment that can either help or hinder their well-being,” said Emmons.
In other words, it recognizes the existence of social determinants and is then able to attack them with a tailored, multi-pronged approach.
Specific prongs to that approach are everything from parenting classes for expectant mothers and housing counseling, to work readiness seminars and HIV prevention programs for members of the surrounding community.
“By addressing multiple social needs for patients and not just their physical health needs, we’re able to promote equity and ensure that our patients have success in achieving their long-term health goals,” said Emmons.
In March 2021, Congreso also opened a daily COVID-19 vaccine site in addition to its ongoing testing services for the virus, hoping to bridge more gaps in vaccine access for Philadelphia’s Latino community.
Gray and Marshall-Blake also emphasized the importance for bigger organizations like theirs (Main Line Health and Independence Blue Cross, respectively), to partner with community orgs like Congreso to provide further support.
Another facet of community engagement discussed at the roundtable involved the importance of including more diverse subjects when researching things like heart disease and diabetes.
When it comes to the former, Dr. Aditi Kalla, assistant professor of clinical medicine at Temple University’s Lewis Katz School of Medicine, said the more diverse pools of study subjects have allowed researchers to pinpoint more at-risk populations.
“The face of heart disease used to look one way, and we’re realizing maybe there are more faces to this,” she said.
Screening for a number of risk factors for heart disease has also transformed. Specifically, Kalla mentioned how looking for high cholesterol could show signs very early in life, as opposed to the previously-thought correct age of 35.
“For a lot of these populations, we need to start screening at the age of even eight years old,” she said.
In addition to more diverse pools of subjects for studies, Kalla also highlighted the diversity of the scientists and researchers actually conducting them as another positive trend to bridging health inequities.
Those scientists from specific communities have unique insights into them, and can identify some of the risk factors that contribute to the prevalence of hypertension, high blood pressure and cholesterol.
That goes a long way in not just helping those with risk factors better manage their situations, but also prevent them from developing in the future for younger patients.
“Knowing what those targets are, it’s not a one-size-fits-all situation. Getting to tailor that to my patient, it’s a game changer,” said Kalla.
Another facet of health specifically brought to light by COVID-19’s impact is mental.
For that portion, the roundtable turned to Marshall-Blake, who highlighted a partnership between the Independence Foundation, the Children’s Hospital of Philadelphia, and Girard College to support the mental health needs of the school’s student population.
“Never has there been a more critical time, I believe, to recognize that mental health is important,” she said.
Amid the pandemic, Marshall-Blake said students’ lives were “upended” as schools closed and parents lost their jobs. Add that to the already low emphasis on youth mental health, especially in communities of color, and crisis was in the cards.
It makes it all the more important to address mental health needs early, as they often reveal themselves later in life.
“You have to nip it in the bud,” said Marshall-Blake.
She also mentioned another initiative from the foundation that is targeting mental health support for frontline workers.
The entire AL DÍA Health Equity: No Matter Where You Live Roundtable can be found below.