One year after the start of the COVID-19 pandemic, the health disparities among Michiganders are even more apparent.
Blue Cross Blue Shield of Michigan launched the Office of Health and Health Care Disparities in December 2020. The cross-functional team addresses health disparities among members and develops strategies to address them and increase positive outcomes.
Bridget Hurd, vice president and chief diversity officer of BCBSM, said while the office of health and health care disparities is relatively new, the organization has had a long-term focus of addressing public health disparities in different ways. In May 2016, BCBSM established its health disparities action team, which led to the formation of this new office.
African Americans are two times more likely to have diabetes than Caucasians, for example, and are more likely to die because of it, Hurd said. African American women also are more likely to die during childbirth.
“These are statistics that occur over and over again,” Hurd said. “They have been around for a very long time. There are many factors and reasons that contribute to why we see these disparities, but understanding them is the first step, and then exploring the ways to address them become the second, third and fourth steps. It’s not always a direct line, because there are so many variables that contribute to it.”
The disparities BCBSM saw with COVID-19 were mainly in terms of morbidity and mortality, Hurd said. But already existing health disparities contributed to the disparities witnessed under the virus.
“If it’s a person who is diabetic or obese or has kidney disease – the places where we already see these disparities – they are more likely to have these severe outcomes,” Hurd said.
In the early months of the pandemic, 42.6% of COVID-19 cases were African Americans, who only make up 14% of Michigan’s population, according to BCBSM. Hurd said similar figures occurred among Hispanic, Latino and Native American Michiganders as well.
In terms of health coverage, the number of individuals who are uninsured has varied greatly because of the nature of COVID-19, Hurd said. Many individuals have repeatedly acquired and lost coverage because of job loss or because they became eligible for programs like Medicaid and Healthy Michigan. The wavering health care status of many individuals makes it hard to keep current data.
According to the Centers for Disease Control and Prevention’s (CDC) latest estimates, 30.4 million Americans of all ages (9.4%) were uninsured from January through June 2020. This is lower than — but not significantly different from — 2019, where 33.2 million persons of all ages (10.3%) were uninsured.
Additionally, data from the Kaiser Family Foundation found 5.8% of Michigan’s population was uninsured — as compared to 9.2% of the U.S. population being uninsured – in 2019.
CDC data also showed, among all adults aged 18-64, those who were poor (21.8%) and near poor (23.9%) were more likely than those who were not poor (8.8%) to be uninsured. Among adults in the same age range, Hispanic adults (26.5%) were more likely than non-Hispanic Black (13.2%), non-Hispanic white (9.7%), and non-Hispanic Asian (9.3%) adults to be uninsured.
“In terms of COVID, the key was getting information and educating people about preventing the disease … community outreach, putting testing sites in communities and making sure we’re playing a role in eliminating barriers,” Hurd said.
Another focus of BCBSM was food insecurity, Hurd added. As far as social determinants of one’s health, food insecurity proved to be high on the list, and BCBSM made corporate contributions to alleviate it. Additionally, BCBSM is developing a roadmap to address social determinants of health.
“Having that data is important, because it directs us to what we need to put our attention on,” Hurd said.
BCBSM also worked with the state and other entities to make telemedicine more available in the midst of the pandemic.
“Everyone doesn’t have technology, so there was a big focus on how we address that issue, and it hasn’t been completely resolved,” Hurd said.
A major piece of the office of health disparity’s work is unraveling unconscious bias in health care delivery. BCBSM last year kicked off an unconscious bias education program to its physician network, beginning with primary care physicians.
In the case of maternal health, Hurd said African American women are two times more likely to die during childbirth, sometimes because of the perception of pain management.
“This is unconscious in most instances,” Hurd said. “Pregnant women who are giving birth, for example, if they’re in pain and request pain meds, they’re often denied that, because the view is they’re exaggerating.”
Hurd continued, “If you look at folks with sickle-cell anemia, for example, and they present in the emergency room, they’re often turned away, and that’s a disease that often impacts Black people … the stereotype is that, because they’re a Black person, they’re only in the emergency room to get drugs.”
Bias occurs not only by race. The office of health disparity also keys in on the needs of LGBTQ+ and individuals with disabilities or who are overweight.
“Sometimes we have a perception about a person who has a certain kind of disability,” Hurd said. “And again, how we interact with them might change. It might be more deficient and not as complete as it needs to be to address their health care needs.”
Hurd said it’s important to understand and be honest about personal biases and not rely on fast judgments, which often is the case in health care because of the fast pace of the work involved.
“Even with COVID, there are stories of African Americans, when they go to a testing site – if they could get to it. That’s another important issue – that they were often turned away, even though they showed symptoms,” Hurd said. “They were told to go back home and sit it out, and a lot of that has been attributed to unconscious bias, because there’s a different standard of care for different people … does everyone act in this way? No. But the key is to become aware of it and address it if it shows up.”