Bridging the Gap: The discover, teach, heal mission

Introduction from Vice Chancellor Steve Goldstein

Surviving an illness should not depend on race or social status. However, the number of COVID-19 infections and high fatality rates in minority populations in our country reveals all too clearly that at this time we do not provide healthcare and support for wellbeing equally. As an academic health system, the onus is on us to make sure this is not the case in the future.

Today’s essay is by Dr. Bernadette Boden-Albala, the Director of the UCI Program in Public Health and Founding Dean of our future school of Population and Public Health. She leads theactOC project, part of a partnership between UCI and Orange County, and the first study in California to offer an accurate picture of community prevalence of COVID-19. It paints a shocking picture. Among important study points, it reveals strikingly high rates of COVID-19 antibodies in minority communities in Orange County.

In this installment of the Bridging the Gap series, where we confront racism in the context of our tripartite mission to discover, teach, and heal, Dr. Boden-Albala shares how UCI Health Affairs is working to address gaps in health equity through research to define the problems, teaching to produce the diverse healthcare workforce of the future, and working to effect changes to reduce the societal burden of human disease and disability for all persons.

To achieve equity and inclusion, the goal must remain at theforefront. Please continue to share your ideas on how we can accelerate the pace of change with me at vcha@hs.uci.edu.

Closing the Gap on Health Disparities – Social Determinants of Health

By Bernadette Boden-Albala, DrPh, Director and Founding Dean Program in Public Health

Race should not be related to one’s risk for disease. But unfortunately, COVID-19 has unveiled itself as a disease of disparities. As the pandemic continues, data shows that thevirus disproportionally impacts Black, indigenous, Latinx and other people of color.

Across the country, the Center for Disease Control and Prevention found significant race gaps in COVID-19 deaths. At the national level, Blacks are dying at a rate 2.5 times higher than whites and non-whites under 65 are dying at a much higher rate of COVID-19 than white people of the same age group.

We’re seeing the unequal impact of COVID-19 on non-whites and disadvantaged communities persist at the county level as well. Through the actOC Surveillance project, UCI public health researchers tested a representative sample of Orange County for a wide range of coronavirus antibodies in partnership with the Orange County Health Care Agency (HCA) and found that Latinx and low-income residents in the region had the highest prevalence of coronavirus antibodies – with prevalence rates of 17 percent and 15 percent respectively.

The increased rate of getting sick and dying from COVID-19 that racial minority groups face in our country confirms an unfortunate truth that public health experts have known all along – your race can determine your health outcome.

Public health experts often refer to “social determinants of health” as the conditions of where people live, work, and play, to explain population health outcomes. That’s because our health is determined by these factors and play a critical role in our creating the disparities that influence individual health outcomes such as morbidity and mortality. Do you live in a healthcare desert with little access to health care and necessary resources? How clean is your environment, workplace, schools, or public spaces? These social determinants can shape an individual’s experience with chronic or infectious diseases, and significantly impact quality-of-life outcomes.

In the case of COVID-19, we see that social determinants like socioeconomic status, housing, employment, and access to health care directly lead to higher risk of infection or death. Disadvantaged communities with less capital and fewer resources are exposed to the dangers of the virus more frequently, whether that is due to lack of testing, poor quality healthcare systems, or harsh working conditions that make social distancing impossible. As society has shown us time and time again, these disadvantaged communities are most often racial and ethnic minority groups.

To address the association between social determinants of health and health inequities, public health experts, including those at the UCI Program in Public Health, are working hard to identify these disparities and close the gap.

The first step is to recognize and acknowledge that there is significant work to be done by healthcare systems and providers in order to gain the trust of diverse populations within society. Addressing social disparities in health requires us to look inwards as health leaders and to ensure our profession is inclusive and mindful. At the academic level, this means advocating for a diverse student body and maintaining mindfulness of institutional biases that may have developed over time. This allows us to fix structural racism in health care from the inside out, as well as the broader industry, from unfair health policies to hospitals and clinics to insurance plans.

This is why we’re making active efforts at the UCI Program of Public Health to ensure we represent a diverse student population. Currently, of the over 1,300 undergraduate and graduate students in public health, a large majority (over 60%) are first generation or low-income college students or underrepresented minorities.

UCI’s Program in Public Health also focuses on strategies to reduce social injustices by promoting equity across all areas of health, including social policies, healthcare organizations, and equal information access.

In our work, we acknowledge that health disparities are a symptom of parallel systematic and institutional biases and that the persistence of health disparities overtime, across generations, and in the context of dramatic changes in population composition can be attributed to structural racism.

For this reason, we are careful in our design of intervention strategies for COVID-19 mitigation and risk reduction and purposeful in how we aim to target social determinants. To reduce disparities, interventions should not just improve overall health – they must also decrease or eliminate gaps in disease risk and outcomes by race-ethnicity.

The COVID-19 pandemic has highlighted the devastating impact that social determinants of health continue to have on creating health disparities across the country. At UCI Public Health, we remain committed to closing this health inequality gap. This critical work is long and hard but with continued research and teaching, progress will be made.