HARTFORD INSTITUTE FOR GERIATRIC NURSING |
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Dear Friends,
COVID-19 marched throughout our country over the past 20 months exposing the strengths and weaknesses of our healthcare system. One of the phenomena that became so visible was the impact of health disparities on health outcomes and sadly health disparities became a major risk for mortality.
Health disparities are preventable differences in the burden of disease, injury, violence, or in opportunities to achieve optimal health experienced by socially disadvantaged racial, ethnic, and other population groups, and communities. Health disparities exist in all age groups, including older adults.
Many factors contribute to health disparities, including genetics, access to care, poor quality of care, community features (e.g., inadequate access to healthy foods, poverty, limited personal support systems and violence), environmental conditions (e.g., poor air quality), language barriers and health behaviors. Our guest column this month speaks to this phenomenon and looks at some of the ways our country will need to move to create systems to mitigate the factors that lead to health disparities.
We at HIGN wish all of you a very Happy Thanksgiving.
Warmly,
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Tara A. Cortes, PhD, RN, FAAN |
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Dismantling Structural Inequities Behind COVID-19 Aging-Related Disparities
Jasmine Travers, PhD, MHS, RN, AGPCNP-BC
Assistant Professor
NYU Rory Meyers College of Nursing
Prior to the distribution of the COVID-19 vaccines, adults 65+ accounted for 14% of the COVID-19 infections in the U.S., yet they comprised 80% of the COVID-19 deaths. There was no question, therefore, that older adults would need to be prioritized to receive the COVID-19 vaccine. However, little attention was given as to how this group would actually access the vaccine or to the fact that societal structures have historically hampered this vulnerable population from equitable access to needed resources and services.
Structural inequity refers to the systematic disadvantage of one social group compared to other groups with whom they coexist, and it is deeply embedded in the fabric of society in which resources and opportunities are differentially allocated. The most commonly disadvantaged groups affected by structural inequities are older adults, racial/ethnic minorities, low-income groups, socially isolated and homebound individuals, and those who live in rural settings.
In the case of older adults’ access to the COVID-19 vaccine, this inequity especially occurs in relation to barriers around internet use, transportation, and digital literacy. For example, although the internet was the primary source for scheduling vaccine appointments early on in the pandemic, in 2018, more than 1 in every 4 Medicare beneficiaries did not have access to the internet. Those without internet access were more likely to be 85 years or older, members of racial or ethnic minority communities, and those from low-income households. The average monthly cost of internet access is about $70, which can be out of reach for people with limited incomes. And for the almost 13.8 million older adults in the U.S. who live alone, asking for help with tasks such as registering online for a vaccine or getting to the appointment may not have been an option. In addition, between 2 million and 4.4 million older adults are homebound. Most are in their 80s and have multiple medical conditions, such as heart failure, cancer, and chronic lung disease, and many are also functionally limited and cognitively impaired, making it difficult for them to travel to appointments and wait in long lines to get the vaccine.
Vaccine access, however, is just a microcosm of the structural inequities experienced by older adults and particularly those with fewer resources. These inequities exist in access to healthcare (e.g., lack of accessible pharmacies, hospitals, and providers), in availability of healthy foods (e.g., more likely to see a bodega in low-income communities than a Whole Foods store), in opportunities for socialization (e.g., walkable neighborhoods that are clean and safe), in a lack of affordable housing, and in a lack of access to community resources (e.g., parks, schools).
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Fig 1. Communities in action: Pathways to health equity. National Academies Press, 2017
The conceptual model titled, Communities in action: Pathways to health equity, and developed by the National Academies can help in working towards community solutions to promote health equity for older adults (Figure 1). First, we need to understand the context in which health inequities exist, which is the outermost circle and background. Structural inequities encompass policy, law, governance, and culture, as well as race, ethnicity, gender or gender identity, class, sexual orientation, and other domains, any of which can refer to actual or assumed characteristics.
These structural inequities produce systematic disadvantages, which lead to inequitable access to the social determinants of health (e.g., transportation, housing, financial resources, and healthy physical environments) and ultimately shape health outcomes. Structural inequity is an umbrella concept that encompasses specific mechanisms that operate on the intrapersonal, interpersonal, institutional, community, and systemic levels of a socioecological model (Figure 2).
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Fig 2. SOURCE: Concept from McLeroy et al., 1988.
The COVID-19 pandemic has provided a microscopic view of how structural inequities affect the vulnerable older adult population. We must now address the deeper, more entrenched barriers that hamper their equitable access to services and resources, not only in relation to the COVID-19 vaccine, but in many areas that affect their overall health and well-being.
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Webinar: Changing the Landscape of Health and Healthcare Equity
Tuesday, December 14th at 1pm EST
Join us as HIGN Executive Director Tara Cotes hosts a panel of experts to discuss ways to eliminate preventable health disparities and achieve equitable healthcare.
Presenters:
Jasmine Travers, PhD, RN
Professor, NYU Rory Meyers College of Nursing
Jennie Chin Hanson, MS, RN
Former Chief Executive Officer, American Geriatrics Society
Susan C. Lynch, JD, DrPh
Senior Trial Counsel for Elder Justice, Civil Fraud Section, Civil Division, US Department of Justice (DOJ)
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Consider Making A Donation to HIGN
For 25 years, HIGN has shaped the landscape of
geriatric healthcare for older adults.
Your support helps us:
- Provide online interprofessional education globally
- Inspire future geriatric nurse leaders
- Create innovative models of care for older adults
- Spearhead community initiatives to promote healthy aging
- Inform policy through advocacy for older adults
We ask that you make a donation today to support our efforts.
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2021 Gerontological Certification Review Course
The Gerontological Certification Review Course is a collection of 13 modules that provide an overview of gerontological nursing content aligned with ANCC GERO-BC test plan. This package also includes two practice tests. The tests are an opportunity for the nurse to practice questions that are of a similar style to what you can expect on the exam with rationales to guide remediation and support learning.
Click here to learn more and purchase.
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HIGN Highlights
Professor Daniel David is a finalist and silver award winner in the The John A. Hartford Tipping Point Challenge. The project "Uncovering Palliative Care Need in a Medicaid-funded Assisted Living Facility" is an academic, public housing partnership between NYU Rory Meyers College of Nursing and The New Jewish Home.
Professor Chenjuan Ma is an author on two new publications: 1) Pinto, S., Ma, C., Wiggins, F., †Ecker, S., Obodai, M., Madeline, S. (In press) Forgotten Front Line: Understanding the Needs of Unionized Home Health Aides in Downstate New York During the Covid-19 Pandemic. New Solutions: A Journal of Environmental and Occupational Health Policy ; 2) Ecker, S., Pinto, Sanjay, Sterling, M., Wiggins, F., Ma, C. (In press) Working Experience of Certified Nursing Assistants in the Greater New York City Area during the COVID-19 Pandemic: Results from A Survey Study. Geriatric Nursing
HIGN-Affiliated Faculty have a number of presentations at this week's Gerontology Society of America conference. See the GSA program to learn more.
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