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There’s a common saying that health is wealth. The phrase is meant to articulate the fact that one’s most valuable asset is their health and well-being. And while it’s true you can’t necessarily buy these things directly, and that even those with excess funds can fall ill, it’s a privilege to be able to invest in your health.
The unfortunate reality is that not everyone has the same access to health care, whether that’s due to location, cost, or other factors. In addition, not everyone is treated the same when receiving that care. There are a number of elements that contribute to these inequities. However, there are local community organizations who are focused on mitigating these inequities and working toward a more equitable future. Here, we profile their work.
Improving access to healthy foods
Nearly one out of three adults in Massachusetts don’t know where their next meal is coming from, per a study by the Greater Boston Food Bank (GBFB). Many more subsist on diets that lack nutritional value — the root of many health issues — often due to affordability or opportunity. Communities of color and families with children are those most affected.
Feedback gathered from attendees of a free GBFB pop-up food market co-sponsored by Point32Health, the parent company of local health plans Harvard Pilgrim Health Care and Tufts Health Plan, showed that COVID, inflation, and job loss were the top contributors to this problem. “Food tends to be the last tradeoff, and it takes a long time to recover from an economic setback, which is why we are still seeing an increased need several years after the pandemic’s arrival,” says Catherine Lynn, GBFB vice president of communications and public affairs.
“Participants spoke at length about a desire for fresh produce, particularly for their children, which was viewed as healthy but prohibitively expensive,” Lynn says.
Of those who did not visit the market, but had wanted to, a lack of time, and conflicts with work and transportation — especially traveling long distances and carrying heavy bags while using public transportation — kept them from attending.
In some instances, a lack of awareness as to what services are available to support key needs is also present — particularly for those individuals who lack access to technology, or for whom English is not their primary language.
Haile Hernandez, Point32Health’s head of social determinants of health-health care services, oversees a team of community health workers that supports families facing barriers to healthy food access, as well as other health related social needs. He says that the insurer’s community health workers help its health plan members identify what their food needs are and identify barriers to access. The community health workers then connect members to community assistance programs, such as local food banks and soup kitchens, as well as help with applications to federal programs such as SNAP and Meals on Wheels. “We also provide culturally competent care to ensure members understand this service and its benefits, based on using their preferred language,” he says.
Accessing equitable support for substance use disorders
When it comes to accessing treatment or care for substance use, the inequities continue, especially for women and people of color.
Access to behavioral health and substance use care continues to be difficult for many people, says Jill K. Borrelli, LICSW, vice president of behavioral health at Point32Health. “The problem is exacerbated in communities of color and rural areas where there are fewer behavioral health providers available,” she says.
Joanne Peterson, the founder and executive director of Learn To Cope, a peer support network for families touched by addiction and recovery, says there isn’t enough treatment available for women in particular. “Any halfway houses, recovery homes, or sober houses are all for men only. There is barely anything out there for women — it has been a problem for many years.”
Support and resources for the loved ones of someone dealing with substance misuse is important too. “The effects of substance use disorder are experienced by family and friends. It is important that a family member or close friend [is] also taking care of themselves and getting support by learning how to cope, and identifying new ways to understand and manage their feelings and relationship with their loved one. Taking care of yourself and getting help through a peer support group, a therapist, or a pastor is crucial both for their loved one in recovery and themselves,” says Borrelli.
Peterson, who has worked in the field for more than two decades, notes that while some things have changed over time, there’s still a lack of adequate support. Learn To Cope aims to help with that by offering in-person and virtual meetings through 27 chapters in Massachusetts and one in Florida, as well as a private online forum supporting more than 12,000 registered members.
Apps and digital solutions are also taking a more prominent role in the full continuum of behavioral health needs, from stress management to addiction recovery. For instance, Borelli says, Point32Health continues to explore emerging innovations and new technologies that challenge the traditional substance use disorder (SUD) treatment model, like the company’s past collaboration with Spectrum Health Systems on an SUD Center of Innovation which helps uncover evidence-based solutions to support members throughout recovery.
“Treatment isn’t always just sitting in an office with a therapist,” Borelli says. “Integrated, whole-person care is really the best way to approach all health care.”
Closing the gap in pregnancy and postpartum care
Data from the CDC shows American Indian/Alaska Native and Black women are 2 to 3 times as likely to die from a pregnancy-related cause than white women. For women of color, maternal health inequity and reproductive injustice are ongoing concerns, say Yaminah Romulus and Dr. Jallicia Jolly, PhD, co-chairs of the steering committee of Birth Equity and Justice Massachusetts (BEJMA).
“One of the things we are witnessing in pregnancy and postpartum care are the ongoing barriers that exist across the reproductive health lifecycle,” Jolly says. “That context shapes a person’s experience before they enter a facility for care.”
Systemic racism and the lack of cultural humanity in the health care system can contribute to inequities in maternal health. The underrepresentation of people of color in the health care workforce, including community-based midwives and doulas, can lead to a general disconnect between providers and the people they serve. The absence of culturally-centered care can also result in a lack of autonomy for patients, which can contribute to trauma.
“There is research that Black patients receive substandard care. I have also observed that when they advocate for themselves, they are viewed as being aggressive by some health care workers who dismiss their concerns and justify the provision of low-quality care,” Jolly says.
One program working to counteract such inequities is TeamBirth from Ariadne Labs, a research and advocacy program that aims to improve both safety and dignity in childbirth by structuring the essential information that should be communicated during every labor assessment. The project, which is rolling out across Massachusetts in collaboration with Point32Health’s Harvard Pilgrim Health Care, Ariadne Labs, is currently in place in three Massachusetts hospitals and will be launched in nine more later this spring. The project works with patients and providers to “ensure every person, every time has the opportunity to participate in decision making,” says Amber Weiseth, DNP, RN, the director of the Delivery Decisions Initiative at Ariadne Labs and a research scientist at the Harvard T.H. Chan School of Public Health.
Two primary elements comprise TeamBirth — structured team huddles involving the patient, support people, and the clinical care team, and a shared labor and delivery planning tool.
Out of its pilot program, Ariadne Labs reported that 90 percent of TeamBirth patients believed their preferences made a difference in the care they received, and 98 percent reported their clinical team spoke with them in a way they could understand.
When it comes to closing the gaps in health equity, awareness and support are key. By listening to those affected and coming up with creative solutions, these various initiatives and organizations are making great strides.
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