Skip to main content

Insights

An open letter to President Biden to address health inequality

A black woman and her child in a doctor's office. Jennifer Mieres, MD, and Michael Wright penned this letter to President Biden, offering several suggestions to fix health care inequity.

By rethinking health care, acknowledging structural inequality and giving voice to the underrepresented, we can finally provide health equity for all

Mr. President,

Like millions of Americans, I watched with hope and teary eyes as you took the oath of office in January, promising to heal a nation much in need of comfort. I was particularly moved by your citation of Psalm 30, which reminds us that while weeping may endure for the night, joy cometh in the morning.

But as health care leaders, we also know that for a new day to dawn in America, inspired words alone aren't enough. What we need right now is a concrete plan to fight the real plague claiming scores of Americans lives. And that plague, Mr. President, is health inequality.

It is so easy, in our overheated media climate, to dismiss such statements as mere political rhetoric. Having had the honor to be a member of the leadership team of a major health system, which serves, arguably, the nation's most diverse population, I have noticed first-hand the catastrophic and deadly effects of racial and economic disparities.

Take, for example, the COVID-19 pandemic: according to a recent report, based on data from Johns Hopkins University, the COVID-19 infection rate for white Americans is 23 per 10,000 people; the number spikes to 62 per 10,000 people for Black Americans and 73 per 10,000 people for Latinos. Things were hardly better before the coronavirus struck: Black Americans have an average life expectancy that is four years shorter than that of their white friends and neighbors, and suffer an infant mortality rate that is more than twice that of white Americans.

Why are the disparities so extreme? Why might one American fare so much better than another living just a few blocks away? The answer, of course, is complicated, and has to do with various criteria that impact the health and wellbeing of our communities.

And that, Mr. President, is where you come in.

As vice president under President Obama, you played a crucial role in fighting for the Affordable Care Act, the most comprehensive attempt at healthcare reform in decades. As president, you and your team have the opportunity to pass legislation that's even more profound, one that bypasses most of the obvious partisan road bumps while delivering acute care to those Americans who need it most. How? We suggest three areas of focus.

First, we should radically overhaul the way we think about health care. For too long, we've imagined the industry as a battleship, equipped with the latest technologically advanced weapons that would enable it to move quickly and decisively in the war against disease. This meant focusing on specialized treatment rather than taking a more holistic, prevention-based approach. It's time to reconsider. As studies increasingly show, we have a much better chance of getting and keeping more people healthy by taking a broader view of the factors that make them sick.

Take food, for example we are living in the most prosperous nation in the history of humankind, and yet more than 23 million of us currently live in food deserts, which means that they have no easy access to a supermarket selling fresh and affordable food. The evidence is well documented that when your diet consists mostly of highly processed foods, your chance of developing a host of highly detrimental conditions rises exponentially. We know that simple steps to provide more plant-based and nutritious foods can abort the path to heart disease, diabetes, and other chronic health conditions.

As a nation we can avoid spending a fortune managing the complications of chronic conditions and can take simple steps, as our health system has done, and adopt an important viewpoint of "food as health" by providing subsidized access to nutritious food. There's a lot the federal government could do to support such measures and make Americans healthier without spending a fortune.

Second, we must acknowledge one key component in the structural inequality currently plaguing our society, namely the growing prominence of the gig economy and the steady erosion of the human rights and protections that have been central to America for more than a century. Stripped of all the privileges workers have fought for decades to earn and keep, the current participants in the gig economy a number growing at a stratospheric pace -- are far more likely to suffer a host of health crises, from on-the-job injuries to economic distress that leads to substance abuse and lack of access to medical care.

Let's look at the example of Amazon. The behemoth corporation currently employs nearly one million Americans, making it the second largest private employer in the country. In 2018, the company itself reported a total recordable injury rate of 10.76 per 100 workers, three times as high as the injury rate across all private employers and twice as high as the injury rate in the warehousing industry, which is notorious for being highly dangerous. These employees deserve our protection. Keeping them healthy doesn't just mean giving them good health insurance or access to qualified physicians; it also means passing laws that honor the very protections previous generations of Americans struggled to bequeath to us.

Finally, making Americans healthy means thinking of health care as targeting not only a disparate host of sick individuals but engaging and establishing partnerships with entire communities, providing them with the education and resources they need not only to survive but to thrive. Making these communities traditionally ignored, or, worse, discriminated against feel seen, heard, valued, and respected is key.

America's plan for better health and wellness was published as the first National Prevention Strategy in June 2011. The plan calls for strong partnership and collaboration between the private and public sectors for a transition of the healthcare delivery model from a focus on sickness and disease to prevention and wellness. The plan provides the roadmap for the elimination of health disparities, empowered people, and healthy and safe communities, with the goal of increasing the number of Americans that are healthy at every stage of life.

Let's take this plan out of the archives and begin to weave prevention strategies into the tapestry of our everyday lives. It starts when children are in school, integrating more health programs into the educational curriculum. Healthy American communities are foundational to productivity, innovation, and entrepreneurship all essential components for the future of our country. We know that healthy people can contribute to their communities, work, support their families, and enjoy their lives.

In your earliest days in office, Mr. President, you signed executive orders designed to show at-risk underserved groups that the mighty power of the office of the president is at their disposal. Similar gestures aimed at promoting communal growth could go a long way.

I wish you the best of luck. Your success is our success, and we've never more urgently needed leadership that can keep us safe and healthy.

Jennifer Mieres, MD, is a cardiologist and chief diversity and inclusion officer at Northwell Health in the New York City area.

Michael Wright, EdD, is vice president for diversity and health equity at Northwell Health.

This op-ed appeared in MedPageToday.

Our representatives are available to schedule your appointment Monday through Friday from 9am to 5pm.

For a Northwell ambulance, call
(833) 259-2367.