Early data assessing the primary language of those who received COVID-19 tests at Vanderbilt University Medical Center (VUMC), and tested positive, illustrates the disproportionate impact the pandemic is having on racial or ethnic communities.
Of the first 18,491 patients tested for the novel coronavirus, 1,063 speak 37 languages other than English, according to analysis of electronic health records by VUMC's Office of Health Equity. Although this group represents 5.7% of those tested, they are 19.4% of those positive and the highest number reside in two adjacent Nashville ZIP codes.
To prioritize access to care among all people amid the pandemic, the Office of Health Equity, led by Consuelo Wilkins, MD, MSCI, vice president for Health Equity for VUMC and associate dean for Health Equity at Vanderbilt School of Medicine, is leading a workstream within the enterprise's COVID-19 Command Center.
Wilkins and colleagues, Elisa Friedman, MS, Sunil Kripalani, MD, MSc, and others across VUMC, are working to disaggregate data by language as well as race, ethnicity, ZIP code and insurance status about who has been tested, tested positive, hospitalized or deceased.
"It's critical to draw awareness to the disparity in communication and access to treatment as well as the economic, cultural and societal factors that impact ability to navigate care. We're zeroing in on disaggregating the data by race, ethnicity and language because we can't address inequities if we don't know who they are," said Wilkins, who is also executive director of the Meharry-Vanderbilt Alliance.
Black and other racial and ethnic communities as well as low-income or other vulnerable populations, such as homeless or incarcerated individuals, are at higher risk of severe outcomes and death from COVID-19. Wilkins is using the rapid flow of real-time data to improve and institute protocols that prioritize health equity across local and national health systems.
The group's efforts to alleviate inequities in Nashville's Spanish- and Arabic-speaking communities reflects gaps spotlighted in early data analysis.
VUMC's COVID-19 health equity workstream is an example of the rapid response needed to address disparities during a pandemic. Teams designing pandemic preparedness plans can prioritize health equity by recognizing how underlying social, racial, political and economic factors drive health inequities, and establishing channels and guidelines that push through barriers, Wilkins wrote in a recent paper published in the Journal of Health Politics, Policy and Law. The paper was coauthored by Philip Alberti, PhD, senior director, Health Equity Research & Policy at the Association for American Medical Colleges, and Paula Lantz, PhD, MS, associate dean for Academic Affairs and professor of Public Policy, James B. Hudak Professor of Health Policy at Gerald R. Ford School of Public Policy at the University of Michigan.
Entrenched health inequities can impede a comprehensive public health response from informing people, such as lower income essential workers, who need evidence-based outreach. Health systems' rapid response during a pandemic must put health equity at the forefront.
Wilkins and her co-authors highlight the importance of breaking down silos between institutions, agencies, and other organizations during pandemics. Reaching communities with detailed, easy-to-understand information, for example, may require partnering with trusted community organizations. In a pandemic, access to timely, expert information is critical and the health of neighborhoods and the larger community depend on nimble communication tactics that actively work to push information to those who need it but may not know where to look.