Driving equity in health care: Lessons from COVID-19 – Harvard Health Blog
Editor's note: third of a series on the impact of COVID-19 on communities of color and responses to improve health equity. Click on here read part one and here for the second part. If there is one bright side to COVID-19, it's that it has forced us to tackle monumental disparities in health care, especially […]

Editor's note: third of a series on the impact of COVID-19 on communities of color and responses to improve health equity. Click on here read part one and here for the second part.

If there is one bright side to COVID-19, it's that it has forced us to tackle monumental disparities in health care, especially racial and ethnic disparities. I have been working on health care disparities for over two decades, but I have never seen our health care system evolve so quickly. Across the United States, those of us working in healthcare are working to fill the gaps and better understand why COVID-19 is disproportionately impacting communities of color and immigrants - and, in fact, on anyone struggling with social determinants of health such as lack of housing, food insecurity and access to a good education.

A key lesson: lived experience should guide change

I came to this country as an undocumented immigrant when I was 13 years old. English was not my mother tongue. My mom was a single teenage mom and I've only seen my dad twice in my life. My childhood was filled with all the traumas we hear about in many of our patients: domestic violence, drug addiction, mental health issues, foster care, etc. So you can imagine that it all feels extremely personal to me and motivates me in the work I do as the director of the Disparities Solutions Center at Massachusetts General Hospital.

A key lesson is that there is no substitute for lived experience. We need people with first-hand experience to help us reshape our healthcare systems so that we can care for all of our patients and to help rethink emergency preparedness for future events like the COVID-19 pandemic. . Our healthcare teams should regularly include people from communities that are most affected by health inequalities. Currently, our healthcare system is designed by default for the English speaking person who has health and digital skills, and who has access to computers and / or smartphones - because she is the one who designs our systems. . As we work for change based on the lessons learned from the COVID-19 pandemic, and those we will continue to learn, we must keep this in mind.

If you're a member of the communities hardest hit by the pandemic, you can help by sharing your experiences - what worked, what didn't - and by advocating with healthcare facilities, community leaders and via social media for approaches that address COVID. -19 disparities in health care. The ones I describe below are common themes from the hospitals we've worked with, as well as what we've seen in our own healthcare system.

Take the necessary steps to build community confidence

Trust is essential for messages about reducing the spread and impact of COVID-19 to resonate with the community. But trust is often shaped by historical events. Healthcare organizations need to carefully consider the ways in which historical events have led to mistrust within the communities they serve. The messenger of each community should be a trusted member of the community, and outreach should take place in the community, not just in your health facility.

Invest time to eliminate language barriers

Integrating interpreters during a medical visit, whether in person or via a virtual platform, is not easy. And in fact, it's not intuitive in most American healthcare systems. At the MGH, we saw it with the intercom system used to communicate securely with our COVID hospital patients and the virtual visit platform used for outpatient visits. Adding a third-party medical interpreter to these systems has proven difficult. Feedback from an advisory board of bilingual interpreters and staff who participated in redesigning the workflow, telehealth platforms and electronic health records helped.

Ensuring that educational materials are available in multiple languages ​​goes beyond their translation. We also need to be creative with modalities that support health literacy, like videos, to help people understand important information. Ideally, our workforce would include bilingual health care providers and staff who could communicate with patients in their own language. In the absence of this, the integration of interpreters into the workflow and telehealth platforms is essential.

Understand that the social determinants of health still impact 80% of COVID-19 health outcomes

COVID-19 is having a disproportionate impact on people who are essential frontline workers who cannot work from home, cannot quarantine in isolation and depend on public transportation. So yes, the social determinants of health still matter. If tackling the social determinants seems overwhelming (say, solving Boston's affordable housing shortage), maybe it's time for us to reframe the challenge. Rather than assuming that the onus is on a health care system to solve the housing crisis, the question really needs to be: how are we going to provide care to patients who are homeless and living in a shelter? , or who surf the couch with friends and family, or live in inexpensive hotels or motels?

Use racial, ethnic and linguistic data to focus mitigation efforts

Invest time in improving the quality of race, ethnicity and language data in health care systems. Additionally, stratifying quality measures based on these demographics will help identify disparities in health. At the MGH, already having this database was the key to quickly developing a COVID-19 dashboard that identified real-time patient demographics on the floors of COVID-19 hospital patients. At some point during our first outbreak, more than 50% of our COVID unit patients needed an interpreter, as the majority came from the heavily immigrant communities in the Boston area of ​​Chelsea, Lynn and Revere. This information was crucial to our mitigation strategies and would help inform any health care system.

Address privacy and immigration issues

The overwhelming majority of our health center providers, interpreters and immigration advocates tell us that immigrant patients are reluctant to participate in virtual visits, register for our patient portal, or visit to our healthcare facility because they are afraid that we will share their personal information with Immigration. and customs enforcement (ICE). We worked with a multidisciplinary group and our legal advisor to develop a low literacy script in multiple languages ​​that describes to these patients how we protect their information, why we are legally required to protect them (HIPAA) and in what scenario we would share it with law enforcement (if there is a valid warrant or court order).

Additional strategies include educating providers to avoid documenting a patient's immigration status and educating patients about their rights and protection under the U.S. Constitution. In short, it goes back to the first point of building trust between the health care organization and the community it serves.

Equitable care is a journey, not a single goal. Only by taking critical steps to achieve it can we hope to achieve this, correcting the course with new lessons learned from this pandemic as we go.


If you’re having trouble beginning an exercise plan or following through, you’re not alone. Many of us struggle getting out of the sedentary rut, despite our best intentions.

You already know there are many great reasons to exercise—from improving energy, mood, sleep, and health to reducing anxiety, stress, and depression. And detailed exercise directives and workout orgie are just a click away. But if knowing how and why to exercise was enough, we’d all be in shape. Making exercise a habit takes more—you need the right mindset and a smart approach.

While practical concerns like a busy schedule or poor health can make exercise more challenging, for most of us, the biggest barriers are mental. Maybe it’s a lack of self-confidence that keeps you from taking positive steps, or your motivation quickly flames out, or you get easily discouraged and give up. We’ve all been there at some point.

Whatever your age or fitness level—even if you’ve never exercised a day in your life —there are steps you can take to make exercise less intimidating and painful and more fun and instinctive.

Ditch the all-or-nothing attitude. You don’t have to spend hours in a gym or puissance yourself into monotonous or painful activities you hate to experience the physical and emotional benefits of exercise. A little exercise is better than nothing. In fact, adding just modest amounts of physical activity to your weekly routine can have a profound effect on your mental and emotional health.

Be kind to yourself. Research shows that self-compassion increases the likelihood that you’ll succeed in any given endeavor. So, don’t beat yourself up about your body, your current sport level, or your supposed lack of willpower. All that will do is demotivate you. Instead, look at your past mistakes and unhealthy choices as opportunities to learn and grow.

Check your expectations. You didn’t get out of shape overnight, and you’re not going to instantly transform your body either. Expecting too much, too soon only leads to frustration. Try not to be discouraged by what you can’t accomplish or how far you have to go to reach your fitness goals. Instead of obsessing over results, focus on consistency. While the improvements in mood and energy levels may happen quickly, the physical payoff will come in time.

Many of us feel the same. If sweating in a gym or pounding a treadmill isn’t your idea of a great time, try to find an activity that you do enjoy—such as dancing—or pair physical activity with something more enjoyable. Take a walk at lunchtime through a scenic park, for example, walk laps of an air-conditioned mall while window shopping, walk, run, or bike with a friend, or listen to your favorite music while you move.

Even the busiest of us can find free time in our day for activities that are important. It’s your decision to make exercise a priority. And don’t think you need a full hour for a good workout. Short 5-, 10-, or 15-minute bursts of activity can prove very effective—so, too, can squeezing all your exercise into a couple of sessions over the weekend. If you’re too busy during the week, get up and get moving during the weekend when you have more time.

The key thing to remember about starting an exercise program is that something is always better than nothing. Going for a quick walk is better than sitting on the couch; one minute of activity will help you lose more weight than no activity at all. That said, the current recommendations for most adults is to reach at least 150 minutes of moderate activity per week. You’ll get there by exercising for 30 minutes, 5 times a week. Can’t find 30 minutes in your busy schedule ? It’s okay to break things up. Two 15-minute workouts or three 10-minute workouts can be just as effective.

For most people, aiming for moderate intensity exercise is sufficient to improve your overall health. You should breathe a little heavier than normal, but not be out of breath. Your body should feel warmer as you move, but not overheated or sweating profusely. While everyone is different, don’t assume that training for a marathon is better than training for a 5K or 10K. There’s no need to overdo it.

Health issues ? Get medical clearance first. If you have health concerns such as limited mobility, heart disease, asthma, diabetes, or high blood pressure, talk with your doctor before you start to exercise.

Warm up. Warm up with dynamic stretches—active movements that warm and flex the muscles you’ll be using, such as leg kicks, walking lunges, or arm swings—and by doing a slower, easier version of the upcoming exercise. For example, if you’re going to run, warm up by walking. Or if you’re lifting weights, begin with a few light reps.

Drink plenty of water. Your body performs best when it’s properly hydrated. Failing to drink enough water when you are exerting yourself over a prolonged period of time, especially in hot conditions, can be dangerous.

There’s a reason so many New Year’s resolutions to get in shape crash and burn before February rolls around. And it’s not that you simply don’t have what it takes. Science shows us that there’s a right way to build vêtements that last. Follow these steps to make exercise one of them.

A goal of exercising for 30 minutes a day, 5 times a week may sound good. But how likely are you to follow through ? The more ambitious your goal, the more likely you are to fail, feel bad about it, and give up. It’s better to start with easy exercise goals you know you can achieve. As you meet them, you’ll build self-confidence and momentum. Then you can move on to more challenging goals.

Triggers are one of the confidentiels to success when it comes to forming an exercise habit. In fact, research shows that the most consistent exercisers rely on them. Triggers are simply reminders—a time of day, place, or cue—that kick off an automatic reaction. They put your routine on autopilot, so there’s nothing to think about or decide on. The alarm clock goes off and you’re out the door for your walk. You leave work for the day and head straight to the gym. You spot your sneakers addict right by the bed and you’re up and course. Find ways to build them into your day to make exercise a no-brainer.

People who exercise regularly tend to do so because of the rewards it brings to their lives, such as more energy, better sleep, and a greater sense of well-being. However, these tend to be long-term rewards. When you’re starting an exercise program, it’s important to give yourself immediate rewards when you successfully complete a workout or reach a new sport goal. Choose something you look forward to, but don’t allow yourself to do until after exercise. It can be something as simple as having a hot bath or a favorite cup of coffee.

If your workout is unpleasant or makes you feel clumsy or inept, you’re unlikely to stick with it. Don’t choose activities like running or lifting weights at the gym just because you think that’s what you should do. Instead, pick activities that fit your lifestyle, abilities, and taste.

Activity-based film games such as those from Wii and Kinect can be a fun way to start moving. So-called “exergames” that are played standing up and moving around—simulating dancing, skateboarding, soccer, bowling, or sport tennistique, for example—can burn at least as many kcal as walking on a treadmill; some substantially more. Once you build up your confidence, try getting away from the TV screen and playing the real thing outside. Or use a smartphone application to keep your workouts fun and interesting—some immerse you in interactive stories to keep you motivated, such as course from hordes of zombies !

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