Scenario: You live on a modest income in rural McClellanville, Sout Carolina. You have terrible indigestion and a crushing feeling in your chest. These are classic symptoms of a lot of things, including angina – reduced blood flow to the heart – or even a heart attack. But you live 19 miles from the closest hospital on the Charleston peninsula and there is no bus service to your area.
So you don’t do anything and the pain goes away…for now.
Or rather, you are scrupulous about preventive medicine, keeping doctors’ appointments, and taking drugs prescribed for you. You work two jobs to feed your children and make ends meet, yet you carve out time to visit the doctor despite the lost income. You certainly can’t do that again anytime soon. The problem is, you have a prescription to fill and by the time you get home from work, the pharmacy has already closed. Consequently, a week passes before you begin taking urgently needed medicines.
Or, what if English isn’t your first language and understanding the flurry of instructions from harried healthcare providers leaves you bewildered? As a result, you don’t follow up on your care correctly, which ultimately leaves the system calling you “non-compliant.”
These are just three common scenarios describing the state of health care for tens of thousands of Lowcountry residents, most of them low-income, minority, uninsured, or otherwise at greater risk of poor health.
The Persistence of Health Disparities
Health disparities have been an epidemic in our country, long pre-dating the COVID-19 pandemic. Although coronavirus has complicated healthcare delivery, it has not altered the fundamental issues within the system.
In 2017, the Medical University of S.C., Roper St. Francis Healthcare, and Trident United Way organized a community collaborative to address health issues in the local area called ‘Healthy Tri-county.’ As a member of the collaborative, Lowcountry Graduate Center Director, Dr. Nancy Muller, who is an expert in public health, chairs the Maternal and Infant & Child Health Committee, representing one of five priority targets for goals and action plan.
Healthy Tri-county has conducted several community health audits and found that disparities tear at the fabric of health within the Lowcountry. Consider how much of a determinant race is to the health of an individual here in the greater metro-Charleston region: a non-Hispanic Black woman with a Ph.D. is likely to have a worse birth outcome than a Caucasian high school dropout.
Implicit Bias in the System
At a recent roundtable, sponsored by the Charleston Regional Business Journal, Anton Gunn, Chief Diversity Officer at MUSC Health, recounted his own experience as an educated Black professional, with the structural and systemic challenges of race in the healthcare system.
“When my wife was pregnant and she went into labor early on Christmas Day we had a clinician who was not listening to us at all and was really dismissive of our perspective,” he said. “She was making decisions about how she was going to deliver our daughter without taking what we were concerned about into consideration. This dismissiveness speaks to the implicit bias that some providers and some health care organizations have…”
Poor health inputs and outcomes plague more than racial minorities and the economically disadvantaged. Transgender individuals, immigrants and refugees, non-English speakers, and other ethnic groups all suffer barriers to good health.
Good Health Outcomes Begin with Access to Care
At the same roundtable, sponsored by Charleston Regional Business Journal, United Way Director of Health, Renee Linyard-Gary, said that access to care is the number one priority.
“Access is not just the traditional things we think about,” she said. “We think about health coverage as the immediate access to care but don’t think about … do I even have the transportation to get to service? People have other factors that are barriers to them getting into care. A big part of that is not knowing what resources are available to them.”
In a region that has a higher than average percentage of uninsured people, and an above-average rate of diabetes, stroke, heart disease, and other pathologies, structural changes are going to be necessary before outcomes improve and everyone has an equal opportunity to live healthy.
Success, says Mark Dickson, vice president of mission at Roper St. Francis, looks like this: “A healthier community for every family in our area.”
Focus of the Lowcountry Graduate Center
Dr. Nancy Muller, Director of the Lowcountry Graduate Center, points out that healthcare management and community wellness represents a priority area for its program partners because the Tri-county represents a medical mecca for the state and the southeast in terms of the number of people served by its providers. “Striving for equity in the health of our entire population also makes good business sense for all area employers because a healthy population is a pre-requisite for an educated and engaged workforce capable of high performance, high-quality output, and consistent productivity.”