The COVID-19 pandemic has exposed for many the reality that vast inequities exist in the country’s healthcare system. This may be especially true for children and families, many of whom face barriers to access and unequal care outcomes due to many factors and social determinants of health.
Finding a solution to make child health care more equitable for all requires a complex approach and strategic partnerships, a group of pediatric health leaders and advocates said in a recent webinar hosted by US News & World Report. .
Providers and partners should consider a three-pronged approach to addressing the social determinants of health by working with individuals and families, communities and broader systems and policies, said Dr. Snehal Shah, primary care pediatrician at Boston Children’s Hospital Primary Care Center and Research Fellow at the Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion. “Healthcare entities could actually work in each of these spaces,” she added.
For example, “child poverty has been associated with many negative outcomes in children, and poverty is intergenerational,” Shah said. “Poverty reduction is actually a method of prevention,” she said, noting that federal and state policies that seek to increase resources and benefits have contributed to a reduction in child poverty.
“This is an example where individual providers and health care institutions can advocate for these policies and funding to increase some of the social supports not just for individual families, but for the population as a whole,” Shah said.
Pediatric care providers are also looking to expand access and overcome transportation barriers by leveraging virtual care and expanding their footprint in rural communities.
“We’ve been able to overcome that a bit through the use of telemedicine, which kind of flourished during the COVID pandemic,” said Dr. Douglas Graham, head of the Cancer and Blood Disorders Center. of Aflac. Atlanta Children’s Health Care. His center has also established a outreach clinic in Columbus, Georgia, several hours from the hospital’s Atlanta location, “where we go and provide care locally to sickle cell patients who are in the Columbus community instead of expecting that they can all drive to Atlanta.
That said, not all care can be delivered virtually or outside of the main hospital setting, Graham noted, and additional questions remain: “How can we continue this? How do we make sure the insurance is going to support that? How can our providers continue to provide this level of care? How can we address some of the challenges we’ve seen with telemedicine? he posed.
Community engagement efforts are key to moving the needle around equity, panelists noted, but there is no one-size-fits-all approach. “Whether you’re trying to reach families for sickle cell disease, for cancer research, for social determinants of health disclosure, for primary care, or for mental health,” taking the time to understand different communities and cultures – and building trust – is a critical step, said Dr. Anu Partap, medical director of health equity at Children’s cook Texas health care system.
“When we talk to communities and let our families tell us, ‘What message do we need to give you so you know we’re here to help?’ I think that’s when we start to really help families meet the social and emotional needs of their children, to help families trust us,” Partap said.
Another challenge exists in “the disparity in research that goes to certain diseases,” Graham said, so efforts must be made to invest more and diversify clinical trials, for example.
Beyond research, disparities in treatment options for individuals based on their race or ethnicity can further exacerbate health inequities, speakers noted.
For children with sickle cell disease or blood cancers like leukemia, blood stem cell or bone marrow transplants are a lifesaving treatment option. But disparities exist there too for patients looking for matched donors, said Erica Jensen, senior vice president of be the matchoperated by the National Marrow Donor Program.
“Patients don’t all have the same chance of finding a compatibility. Patients are more likely to be matched with a donor who shares the same ethnic background, but our current registry lacks diversity,” she said. “We’re doing everything we can to raise awareness of this disparity and work within local communities to get people from more diverse backgrounds on the Be The Match registry so we can save more patient lives.”
Groups like Be The Match work with pediatric healthcare providers and other partners to support and fund efforts to diversify and raise awareness of the transplant registry.
“When we started looking at the statistics and how difficult it is for people of color, and especially black kids, to be matched, we knew we had to do something about it,” Audrey said. Boone Tillman, Executive Vice President and General Counsel. d’Aflac, who has partnered with Be The Match and worked to support families affected by childhood cancer and sickle cell disease. (Aflac was a webinar sponsor.)
NBA Boston Celtics goaltender Marcus Smart also joined the Aflac and Be The Match collaboration to help spread the word and expand the pool of potential life-saving donors. Smart lost his mother and brother to battles with cancer, so taking steps to improve health outcomes is personal to him.
“Giving back means more than anything to me because I would want someone to do it for me if I was in this situation and needed it,” Smart told US News in an interview that aired as part of the webinar.
“It’s more than crucial for us to diversify, to be able to raise awareness, to shed light, to attract donors, especially in the African-American community,” Smart said.
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