RISE looks at recent headlines concerning social determinants of health (SDoH).

US COVID-19 vaccine rollout underscores health inequities

The United States has struggled to ensure equitable COVID-19 vaccine access during the initial rollout of vaccinations, leaving vulnerable communities disproportionately impacted by COVID-19 with limited access to vaccines, according to a recent study conducted by the Centers for Disease Control and Prevention (CDC).

To monitor vaccination coverage from Dec. 14, 2020–March 1, 2021, the agency used the CDC Social Vulnerability Index (SVI) to categorize counties nationwide as low, moderate, or high social vulnerability counties and then evaluated vaccine administration data of almost 50 million U.S. residents in 49 states and the District of Columbia for individuals who received at least one COVID-19 vaccine dose. 

The CDC found that vaccination coverage nationwide was higher (15.8 percent) in counties with a low SVI and lower (13.9 percent) in counties with a high SVI, which the agency views as “a finding largely driven by socioeconomic disparities.”

Although most states lacked health equity in their vaccination coverage, there were some, such as Arizona and Montana, that accomplished higher vaccination coverage in their counties with higher vulnerabilities. States that achieved more equity were able to do so by prioritizing individuals in racial/ethnic minority groups in the early stages of the vaccine rollout, actively monitoring and addressing barriers to vaccine access, providing vaccines to vulnerable communities, offering free transportation to vaccine sites, and working with community partners, tribal health organizations, and the Indian Health Service.

“As vaccine supply increases and administration expands to additional priority groups, CDC, state, and local jurisdictions should continue to monitor vaccination levels by SVI metrics to aid in the development of community efforts to improve vaccination access, outreach, and administration among populations most affected by COVID-19,” wrote study authors.

Robert Wood Johnson Foundation policy brief series targets SDoH

The Robert Wood Johnson Foundation (RWJF) has released three policy briefs that include evidence-based recommendations to support people through the COVID-19 health crisis and advance health equity.

“The pandemic has exposed a stubborn, harsh truth about life in America: People’s ability to live a long and healthy life depends to a significant degree on the color of their skin, how much money they have, and where they live,” wrote RWJF.

The policy brief series, Federal Policy Recommendations to Advance Health Equity from the Robert Wood Johnson Foundation, focuses on key social determinants of health (SDoH): housing insecurity, food insecurity, and access to and quality of health care.

The three policy briefs in the series include:

  1. Improving Housing Affordability and Stability to Advance Health Equity: To keep individuals “stably housed” amid the pandemic, RWJF recommends policymakers strengthen and extend the eviction moratorium issued by the CDC, issue a moratorium on utility shut offs, provide additional funding to tenants and landlords to prevent evictions, and provide additional funding for homeless shelters and services.
  2. Increasing Access to Supplemental Nutrition Assistance Program (SNAP) to Advance Health Equity: For the remainder of the COVID-19 pandemic and economic recession, RWJF advises policymakers to maintain higher SNAP benefits and federal support for state administrative costs, ensure the lowest-income households are eligible for emergency SNAP allotments, continue Pandemic Electronic Benefit Transfer into the new school year, and continue to suspend SNAP work requirements for adults under the age of 50 without children. RWJF also provided recommendations beyond the pandemic.
  3. Increasing Access to Affordable and Comprehensive Health Insurance: To maximize health care coverage through existing channels, RWJF recommended administrative considerations, including to increase enrollment in the Affordable Care Act (ACA) marketplace, reverse current policies that may limit coverage in the ACA marketplace and Medicaid, and maintain protections established under the Public Health Emergency. RWJF also provided legislative recommendations, such as additional incentives for states to provide Medicaid, an increase in affordability of Marketplace coverage, and an expansion of postpartum access to Medicaid. Click here to read RWJF’s policy brief series in full.

Medicare beneficiaries with chronic conditions disproportionately impacted by COVID-19

The COVID-19 pandemic has posed significant challenges to Medicare beneficiaries managing chronic conditions, according to a recent study by The Commonwealth Fund. A significant portion of Medicare beneficiaries live with one or more chronic condition, leaving the Medicare population with an increased risk of contracting the virus.

Reviewing literature on the impact of COVID-19 on people with chronic conditions and policies from the Centers for Medicare & Medicaid Services, researchers found that 80 percent of Medicare beneficiaries hospitalized with COVID-19 had hypertension and 51 percent had chronic kidney disease. Other leading chronic conditions included diabetes, ischemic heart disease, Alzheimer’s and dementia, heart failure, COPD, and asthma. Additionally, due to the pandemic, beneficiaries were unable to access health services and household supplies such as medical care related to COVID-19 (34 percent), groceries (29 percent), cleaning supplies or hand sanitizer (27 percent), and prescription medications (24 percent).

Due to uncertainties around the length of the pandemic, researchers are calling for targeted policies to alleviate the outcomes of disrupted care, including an equitable adoption of telemedicine, waivers to allow acute care outside of hospitals, and continued regulatory flexibility and extension of CMS waivers to improve access to care.