At a session of AHIP 2021 Institute and Expo Online, the head of North Carolina's health and human services department and a health equity policy advisor in the Biden administration discussed how collecting and using data to achieve health equity is ultimately a policy decision.
At nearly every conference or meeting over the past year there is a session on health equity, but how does this goal become reality? For that, you need data, and advancing data initiatives and then acting on that information is a policy decision, according to speakers at a session at AHIP 2021 Institute and Expo Online.
“We know the problem is there,” said Mandy Cohen, MD, MPH, secretary of the North Carolina Department of Health and Human Services. Systematic data collection on race and ethnicity is needed to understand how to allocate time and resources, she said.
“When COVID started, we didn't have the data we needed to really make the informed decisions that I wanted to make,” Cohen noted. “We didn't know who was getting testing and where, what was that penetration into our African American community or our Latinx community. We didn't know who was getting hospitalized.” Infrastructure to build that had to happen “incredibly quickly so that we could map the solutions and we could map our resources to those.”
Those efforts paid off when COVID-19 vaccines launched; the state has race and ethnicity data for 99% of the vaccines administered in North Carolina, compared with 44% across the rest of the country, Cohen claimed.
Predictions that it would be too much trouble and effort to collect the data or that individuals would not answer the question did not arise, she said.
As an example, Cohen cited the state’s Medicaid program, which is transitioning to a managed care model starting next week, on July 1. Earlier this year, it announced the Health Equity Payment Initiative, which gave primary care providers with patients from the poorest zip codes an enhanced monthly payment. The 3-month initiative, running from April through June, is meant to improve or build upon services, such as creating permanent telehealth improvements; adding staff, such as community health workers; or investing in behavioral health.
Referring to the challenges of creating a mass vaccination effort “on top of structural inequality and systemic racism,” Cameron Webb, MD, JD, a senior policy advisor for equity on the White House COVID-19 Response Team, agreed with Cohen.
“You have to take those systems on head on, you have to really go straight at them and say, here is the problem. And in this crisis, in this moment, we're going to address it.”
In distributing the vaccines, Webb said the federal government wanted to make sure centers were acceptable, approachable, and accommodating, and that meant that new locations in the areas with the highest levels of poverty and disadvantage had to be built, and partnerships with community and faith-based organizations had to happen.
In addition, he said, creating access to vaccines through retail pharmacies was also critical. More than 90% of Americans live within 5 miles of a location where they can receive a vaccine, Webb said.