'We cannot just sit around and admire the problem' of health inequity: Nuñez-Smith

·Senior Reporter
·4-min read

The Biden-Harris administration has been keenly focused on health equity since taking office in January, as evidenced by executive orders and the creation of the Health Equity Task Force.

Yale associate dean of health equity research and internist Dr. Marcella Nuñez-Smith was named chair of the task force in December 2020, and immediately began working on the equity concerns surrounding the pandemic.

"We cannot just sit around admiring the problem anymore," Nuñez-Smith told Yahoo Finance Wednesday, as part of its week-long series Economics of Health.

It's why the goals of the task force go beyond highlighting the roots of the problems, as the first four meetings have shown. In addition to vaccine equity, the task force has also focused on mental health and systemic racism.

At the latest meeting, on June 1, the task force discussed "how discrimination and xenophobia put minoritized, marginalized and medically underserved communities at risk, including during the pandemic. Task Force members considered ways in which agencies and state, local, tribal, and territorial (SLTT) officials can best respond to and mitigate against xenophobia and discrimination in the United States," according to an official memo.

Each meeting ends with action items, including disseminating information for awareness and identifying areas of research to help guide policy. A key goal is also to identify the roles of the government and private sector.

"We have to be thinking about where incentives line up," Nuñez-Smith said.

Over the years, she said, research and data have piled up. Pilot programs have come and gone. Non-profits have emerged. But the needle has yet to move - in part due to a lack of a central body — public or private— to push for change.

Questions that need to be asked include, ""What exactly is a health dollar in our country? How do we think about financial ownership?" Nuñez-Smith said.

Other countries have taken approaches that focus on social services and safety nets, resulting in better health outcomes than what are found in the U.S. Yet the U.S boasts an unseemly health care spend, by comparison. More than 17% of GDP is spent on health care.

And it's going to take a multi-pronged approach, and more time, in order to build up lasting solutions, according to Nuñez-Smith.

In this image from video,  Jeff Zients, White House coronavirus response coordinator, speaks as Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and chief medical adviser to the president., Dr. Marcella Nunez-Smith, chair of the COVID-19 health equity task force, Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, and Andy Slavitt, senior adviser to the White House COVID-19 Response Team, appear on screen during a White House briefing on the Biden administration's response to the COVID-19 pandemic Wednesday, Jan. 27, 2021, in Washington. (White House via AP)
In this image from video, Jeff Zients, White House coronavirus response coordinator, speaks as Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and chief medical adviser to the president., Dr. Marcella Nunez-Smith, chair of the COVID-19 health equity task force, Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, and Andy Slavitt, senior adviser to the White House COVID-19 Response Team, appear on screen during a White House briefing on the Biden administration's response to the COVID-19 pandemic Wednesday, Jan. 27, 2021, in Washington. (White House via AP)

Learning from vaccines

Getting vaccines to the most in need was the first step for the government.

"We are learning a lot in terms of the vaccination campaign and what it takes" to understand the role of each players in the public and private sectors," Nuñez-Smith said.

Those lessons can be translated to achieve health equity broadly, and erase ongoing barriers or determinants of health.

"Why should it matter what door you walk through, why should it matter the zip code you live in and the health care that's closest to you?" Nuñez-Smith said.

As tech-savvy individuals easily found vaccines in the early days, the White House COVID-19 team sought connections with community centers and low-tech options like phone banks to reach the most vulnerable populations.

The actions taken are just the first step in understanding why technology is not the Holy Grail for health equity, similar to what was seen when telehealth first launched years ago. Back then, not everyone had video, Nuñez-Smith said.

Similarly, data and its potential impact on the health system is unknown, and bias built into the data is a blind spot.

"I've had such a learning in terms of data architecture in these past months, and understanding where some of those limitations are," Nuñez-Smith said.

After that, applying the learnings to change behavior and achieve better equity will be the next milestone. 

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