Theory to Practice Blog Post 2 -Rob Keller
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Gordon College *
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Medicine
Date
Dec 6, 2023
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docx
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Uploaded by SargentExplorationTurtle26
Situation:
Hello everyone! This week I will be discussing about a recent research letter published last month by various medical professionals from organizations like Harvard University, Tufts University, and Brigham and Women’s Hospital titled “
Disparities in SARS-CoV-2 Vaccination-
to-Infection Risk During the COVID-19 Pandemic in Massachusetts
” (Dryden-Peterson et al. 2021). They discuss that while overall vaccine access has greatly improved statewide, various factors that promote health inequities towards emerging majority racial and ethinic groups, such as African American and Hispanic communities, are spurring other majority groups to have better access to the vaccine that these emerging majority demographics due to, i.e., “large hospital systems and mass vaccination sites”, which are difficult to fund in lower socioeconomic areas (Dryden-Peterson et al. 2021). While I will delve deeper into the health equity related theories in relation to this scenario, this letter is relevant to me due to my career in healthcare administration. I live in the nearby state of Rhode Island, and these health equity issues regarding
the various social determinants of health such as politically related structural racism, health literacy, digital divides, and healthcare access, when it comes to the COVID-19 vaccine are equally present. Moreover, these issues are common areas of discussion that I partake in during my everyday career, and thus I believed this to be highly pertinent to discuss here.
Health Equity Theory for Discussion:
As aforementioned, the formal health equity related theory or notion I am focusing on is the idea of the social determinants of health that are related to emerging majority racial and ethnic groups accessing the COVID-19 vaccine. When trying to figure out how we can modify a healthy behavior or change a health outcome for a population, determining the various factors (political, cultural, behavioral, etc.) that are contributing (the social determinants) is absolutely critical. Here we need to determine what factors are causing the ratio of people living in lower socioeconomic communities being vaccinated compared to those infected with COVID-19 to be so low. While the authors here hint at some of the possible determinants when they mention how “Massachusetts prioritized large hospital systems and mass vaccination sites rather than strategies to mitigate structural racism recommended by others”, I want to dive deeper and discuss some of the strategies that could prove effective towards providing vaccine access to demographics living in lower socioeconomic areas (Dryden-Peterson et al. 2021).
What's Truly Going on Here:
As highlighted by Dryden-Peterson et al., while efforts in Massachusetts (where I was once a public health practitioner before moving to the state of Rhode Island) have been overall effective in providing a mass vaccination effort, their methods have been ineffective towards ensuring that
individuals from various emerging racial and ethnic groups have been fully vaccinated. The
authors talk about how the “SARS-CoV-2 vaccination indicated structural disparity in vaccine distribution with lower vaccine coverage to infection risk in communities with increased socioeconomic vulnerability and larger proportions of Black and Latinx individuals” (Dryden-
Peterson et al. 2021). This increased vulnerability could be due to the political determinant of health for these communities receiving minimal federal and local funding towards developing vaccination sites, providing vaccination education, etc. Additionally, when it comes to this negative health outcome of having more infected individuals than vaccinated ones, these communities face other social determinants of health such as medical mistrust of healthcare professionals which itself has a horrific history worthy of another blog post, a digital divide that creates obstacles for individuals from the communities to access information about where they can get vaccinated, and so on. Overall, these social determinants that are spurring limited vaccine
access and higher COVID-19 infection rates for individuals from emerging racial and ethnic groups living in communities of lower socioeconomic status, will only worsen if they are not properly addressed. We as public health practitioners must not only discuss these issues, but also think of ways that can address these specific social determinants of health to better serve these communities and increase the rate of vaccinations compared to infections. Unfortunately, however, this health equity theory/model does not take into notions such as perceived risk and perceived benefits from the Health Belief Model (a widely popular model for health behavioral change). While we can address the determinants of structural racism, we will need to ensure that we remain culturally competent and have history at the forefront of our thoughts (which can directly address the notions of perceived risks and perceived benefits) when we attempt to address the COVID-19 vaccine related health inequities that intimately tied to medical mistrust and vaccine hesitancy within these communities.
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Moving Forward:
By focusing on the social determinants of health that are contributing to this health outcomes and various health inequities, I have become more aware of how these determinants, or those similar, are affecting my local community. Moreover, since I work within healthcare administration, and often interact with communities of a lower SES, these same health inequities that surround COVID-19 vaccine access, also affect issues like healthcare access, morbidity rates, and so on, which are major equity issues in my communities/ daily work. Thus, when I come across, for example, other situations where medical mistrust is prevalent, i.e., when a patient is electing whether or not to receive surgery, my messaging for them will be conveyed keeping this and the other aforementioned social determinants of health in mind. Now there are numerous avenues that we as public health practitioners can take when addressing this health inequity. Both of the following videos highlight some of these possible methodologies:
https://www.youtube.com/watch?v=s8dK3s5xGos
https://www.youtube.com/watch?v=gw0-xAmsYNw
As these two videos highlight, and as aforementioned, through no fault of their own, people of emerging majority groups living in lower socioeconomic communities are facing numerous health inequities during this current coronavirus pandemic. These historically marginalized communities have faced similar, if not the same, inequities when it comes to their healthcare and their health. Thus, what we do moving forward is key. We must not only provide the political and
financial resources for these communities, like those I mentioned in Massachusetts and Rhode
Island, to combat these inequities, but we must also address the social and cultural determinants that affect COVID-19 vaccine access inequities, if want to ensure the effectiveness of this type of
intervention against COVID-19 for these emerging majority racial/ethnic groups and lower SES communities. If we don’t start here, will we truly ever be able to combat all of the many other health inequities these New England communities, and those like them, face? We must develop initiatives that provide platforms for these individuals to discuss medical mistrust. We must provide inputs of all kinds, from financial to cultural, for this issue. Even having anonymous surveys within these communities could be a crucial initial step. By addressing the health inequities discussed here, we can better prepare ourselves to address the many other health inequities these communities face by using the skills and knowledge we gained as public health practitioners during this pandemic.
I’m excited to read everyone else's thoughts on this issue!
References:
Dryden-Peterson S., Velásquez G.E., Stopka T.J. (2021). Disparities in SARS-CoV-2 Vaccination-to-Infection Risk During the COVID-19 Pandemic in Massachusetts
. JAMA Health Forum.2(9):e212666. doi:10.1001/jamahealthforum.2021.2666
CDC. (2020). Community, Work, and School.
Retrieved 1 October 2021, from https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/index.html
CDC. (2021). Health Equities and COVID-19
. Retrieved 1 October 2021, from https://www.youtube.com/watch?v=s8dK3s5xGos
Yale School of Medicine. (2021). Understanding COVID-19: Health Equity
. Retrieved 1 October 2021, from https://www.youtube.com/watch?v=gw0-xAmsYNw
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