The COVID pandemic has highlighted many of the deficits inherent in the current structure of our health care system. The fact that health insurance is often tied to employment has come home to roost in this difficult time of increased unemployment. Prior to COVID, certain rural counties that Wake Forest Baptist Comprehensive Cancer Center provides services to had uninsured rates of 20-30% -- those numbers are likely even higher now. I recently had the opportunity to write a guest column about the importance of Medicaid expansion for the state of North Carolina. While finding a way for individuals, families and communities to have healthcare insurance is important, access to care goes beyond just having an insurance card. This newsletter reviews the social determinants of health with the hope that collectively, we can work towards improving access to health and well being for all.
Access to Care
FACT: People without insurance coverage have worse access to care than those who are insured.
Why is this significant? Access to care allows everyone to get care for chronic conditions, illness prevention, and disease progression (especially cancer). Going without insurance coverage can have serious health consequences, as individuals are not able to receive preventive care and delay cancer screenings and other important wellness visits.

This ultimately results in more serious health problems and later stage cancer upon diagnosis. The financial consequences of not having health insurance can also be extremely significant. Medical care is the #1 cause of bankruptcy in the United States. Of those who file for bankruptcy due to health issues, approximately 80% are due to cancer. Employer based healthcare is often the way people have access to insurance. During COVID-19, we have seen how the sudden loss of employment contributes to loss of insurance and access to medical care.

 Access to care is a social determinant of health (SDOH) inextricably linked to where an individual lives. For example, certain states have additional resources and insurance coverage because of Medicaid expansion. Addressing social determinants of health is important for achieving health equity, and Medicaid expansion is key to providing access to health care for all. According to a recent analysis from the Kaiser Family Foundation, about 4.7 million uninsured US adults could become eligible for Medicaid by 2021, if the remaining 12 states expanded (which includes 2.8 million who were already uninsured before COVID-19). North Carolina now remains one of a dozen states without Medicaid expansion. If our state expanded Medicaid, over 500,000 North Carolinian's would become eligible for the coverage they desperately need. 
What are Social Determinants of Health?
According to the Centers for Disease Control & Prevention (CDC), SDOH are the conditions in the places where people, live, work, and play that affect a wide range of health risks and outcomes. The five key areas in the image below depicts the social determinants of health and how they impact everyone. For example, while poverty often limits access to healthy foods and safe neighborhoods, more education is a predictor of better health. This means educational attainment often leads to economic stability, housing stability, and health care coverage. 

For additional information, the Kaiser Family Foundation has additional information about the role of SDOH in promoting health equity, which you can access here:
SDOH in Rural Communities   
Rural communities have unique needs and are often overlooked as it relates to access to care. They also have higher rates of certain health risk factors, such as smoking, and health conditions, such as cancer. The Rural Health Information Hub (RHIB) has created a SDOH in Rural Communities Toolkit where you can get information, training modules, and resources to support organizations implementing programs to address social determinants of health in rural communities across the US. You can access the toolkit here:
Wilkes Medical Center Hematology & Oncology Clinic
The Wake Forest Baptist Health System is proud to announce the opening of a hematology and oncology clinic at Wilkes Medical Center. This new 7,000 square foot facility includes a reception area, renovated pharmacy, 9 exam rooms, and 12 chemotherapy infusion bays. This expansion now makes high-quality cancer care closer to home for our patients living in that region and improves access to care for our rural communities. You can learn more and take a “virtual tour” here:
In The Community
The Office of Cancer Health Equity (OCHE) participated in a COVID-19 testing event on August 24, at Morning Star Baptist Church in Winston-Salem. The event was organized by The Old North State & Twin City Medical Societies. Thanks to generous donations from Clemmons Food Pantry and Winkz Productions, OCHE staff was able to hand out bags with educational materials, face coverings, hand sanitizer, and nonperishable food items.
Please visit and follow us on social media for more updated resources moving forward:

The Office of Cancer Health Equity Team

Director: Karen Winkfield, MD, PhD
Assistant Director: Kathryn Weaver, PhD, MPH
Program Manager: Carla Strom, MLA
Hispanic Patient Navigator: Maria Alejandra Combs, JD, OPN-CG
Rural Patient Navigator: Emily Britt, MSW
African American Navigator: Alexis Daniels, MS
Community Health Educator: Aeriel Diaz, BA, CHES
Community Research Coordinator: Kelsey Shore, CCRC
Community Outreach Coordinator:Elias Berhanu, MPH
P: 336-713-3665