COVID and the SDoH

New study reinforces SDoH impact

Focus on the social determinants of health (SDoH) continues to intensify nationwide, and that means potentially higher costs of care for healthcare organizations. The recent study by NPR, the Robert Wood Johnson Foundation, and the Harvard University T.H. Chan School of Public Health has the industry buzzing.

The four largest cities in the U.S., Chicago, New York, Los Angeles, and Houston, are reconciling major issues that have them face to face with the SDoH. The impact is hitting their minority communities, mostly Black and Hispanic households, with an evident fiscal impact for the industry.

The survey, titled, The Impact of Coronavirus on Households in Major U.S. Cities, was conducted July 1-Aug. 3, with 3,454 adults of ages 18 or older polled. These individuals included the following:

  • 512 adults in New York City
  • 507 in Los Angeles
  • 529 in Chicago
  • 447 in Houston

All participants fell across several income categories:

  • <$30,000 annually (over the family of four cutoff for the poverty level)
  • $30,000 to $99,999
  • Over $100,000

Survey results from all four cities illustrated that at least 50 percent of respondents experienced the loss of a job or reduction in wages or work hours in their household since COVID began. 

  • Houston had the highest proportion of Hispanic and Black households reporting serious financial problems: 77 and 81 percent, respectively.
  • A total of 73 percent of Hispanics in New York City noted serious financial problems since the start of the pandemic, along with 71 percent in Los Angeles and 63 percent in Chicago.
  • A total of 69 percent of Black households in Chicago, 62 percent in New York City, and 52 percent in Los Angeles also reported serious financial problems.
  • Childcare issues plagued many populations, with respect to:
    • Finding physical activity spaces with enough distance from others or keeping children’s education going;
    • Accessing appropriate childcare to continue employment; and
    • Ongoing challenges with limited or no WIFI or broadband access:
      • In Los Angeles, 52 percent had trouble maintaining their children’s education, with
      • 54 percent reporting either serious problems with Internet connection or lack of a high-speed Internet connection, causing disruptions in completing schoolwork or employment related tasks.
    • Access to appropriate medical care was hampered, either via inability to access care or experiencing delays in care: reasons ranged from not being able to find a physician to delayed and cancelled medical procedures due to COVID:
      • All cities reported delays in care that led to negative health consequences: 19 percent in New York, 27 percent in Houston, 55 percent in Chicago, and 42 percent in Los Angeles.

Finally, all four cities had high numbers of their respondents report having someone in the household employed by the healthcare industry. A total of 73 percent of persons surveyed expressed serious concern about the safety of their family members on the job, with concern in L.A. the highest of all four cities, at 78 percent. The report makes for interesting reading, with the PDF located in our weekly folder.

The pandemic continues to further grow concerns associated with the SDoH and the massive fiscal impact for healthcare organizations. Are your non-COVID patients coming in sicker due to avoiding care? If so, they potentially will cost more to care for. Our Monitor Mondays Listeners Survey asked that very question, with the survey results here.

Programming Note: Ellen Fink-Samnick, a member of the RACmonitor editorial board, is a permanent panelist on Monitor Mondays. Listen to her live reporting on SDoH every Monday at 10 a.m. EST.


Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP

Ellen Fink-Samnick is an award-winning healthcare industry expert. She is the esteemed author of books, articles, white papers, and knowledge products. A subject matter expert on the Social Determinants of Health, her latest books, The Essential Guide to Interprofessional Ethics for Healthcare Case Management and Social Determinants of Health: Case Management’s Next Frontier (with foreword by Dr. Ronald Hirsch), are published through HCPro. She is a panelist on Monitor Mondays, frequent contributor to Talk Ten Tuesdays, and member of the RACmonitor Editorial Board.

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