Long before the pandemic struck, health experts already knew that perhaps the strongest predictor of lifespan, more than even family history or genetics, was a person’s ZIP code. Neighborhoods that bordered each other might have life expectancies that varied by as much as 30 years, caused by such nonbiological determinants as access to healthcare, education, nutritional food sources, environmental toxins, transportation, income, and other social factors.
That fact was brought front and center with the outbreak of COVID-19, which was expected to hit all demographics equally but instead inflicted far more death and disability on mostly Black and Brown populations than on White populations. Just six months into the pandemic, on September 27, 2020, the Healthcare Anchor Network, a coalition of 39 health systems in 45 states and Washington, DC, released a public statement declaring, “It is undeniable: Racism is a public health crisis.” The sentiment was echoed in April 2021 by Dr. Rochelle P. Walensky, director of the Centers for Disease Control and Prevention (CDC), and again this past December by Governor Kathy Hochul of New York.
Westchester County, at the epicenter of the initial wave of the pandemic, was a prime example. With some of both the wealthiest and poorest cities in the state, Westchester exemplified healthcare disparities. “We have known for years that many social determinants of health disproportionately affect minority communities,” says Dr. Mill Etienne, a neurologist with Westchester Medical Center (WMC) and vice chancellor for Diversity and Inclusion at New York Medical College. “The pandemic made it that much more obvious for everyone to see.”
By now, local public health leaders are well aware of the situation and have since ramped up their already robust attempts to provide health services to those more at risk and least able to survive that risk. “We are fortunate to have a very engaged population of patients who are active participants in their personal health and outstanding providers who are committed to educating our patients on the importance of preventive health measures,” says Dr. Patricia Calayag, chief medical officer, Westmed Medical Group. “This helps to close some of the gaps that historically have persisted in society as they relate to health equity and improve overall outcomes across our wide demographic of patients.”
Judith Watson has been serving the underserved for almost 30 years, first as a registered nurse and now as CEO of Mount Vernon Neighborhood Health Center (MVNHC). MVNHC and its seven satellite locations across the region form one of the nation’s Federally Qualified Health Centers, or FQHCs. These centers offer comprehensive, affordable, primary healthcare services to their patients, about half of whom are uninsured and undocumented. MVNHC serves about 20,000 patients, who make 130,000 annual visits; they pay on a sliding scale, “definitely affordable, as no one is turned away regardless of their ability to pay or immigration status,” Watson says. “In essence, we’re the safety net throughout the U.S., frankly, and here in Westchester County.”
Healthcare inequity, Watson says, is “much bigger than most people know. It’s pervasive even in the wealthiest areas.” The White Plains area includes unincorporated Greenburgh, for example, where many disadvantaged patients live.
“That gets lost because the region also includes Scarsdale and Hartsdale,” she says. “It’s not as obvious as in Mount Vernon, which is predominantly African American and one of the poorest cities in the state, or Yonkers.”
“In essence, we’re the safety net throughout the U.S., frankly, and here in Westchester County.”
—JUDITH WATSON, CEO
Mount Vernon Neighborhood Health Center
Watson, who has contracted COVID twice, possibly from when she helped administer COVID tests at a clinic, says that the New York Department of Health helped MVNHC set up the first walk-up COVID testing-and-vaccination facility in the county and one of the first in the state. The state government did so because, having identified those unhealthy ZIP codes, it understood that “lower-income people traditionally rely on public transit, so getting to New Rochelle could be difficult,” Watson says. Sadly, when vaccination numbers rose, the state pulled out, even though the vaccination rates in Mount Vernon and New Rochelle remain among the lowest in the state. “My legacy will be that I played a major part in the underserved of this county receiving health services,” she says. “Testing numbers decreased to about 20 a day, but now we are at 300 a day again,” she said in February.
Watson’s staff helps uninsured patients sign up for coverage under the Affordable Care Act, which can help pay for diagnostics and treatment for the many other chronic diseases, from diabetes and obesity to asthma and heart disease, that disproportionately affect disadvantaged populations. “We are now calling kids enrolled in our centers to come in to get up to date on their other vaccinations,” she says.
The workload is overwhelming, and staffing issues are hurting healthcare in all walks of life. “Everyone is exhausted,” she admits. “We were focusing on other issues, and now we are right back in it.” But she credits her 300 or so employees for staying resilient. “We have been doing it for 50 years. We don’t have a choice. When larger providers closed down, we rose to the occasion. Not one provider was out during the pandemic,” she says.
Another local FQHC is Open Door Family Medical Center. Lindsay Farrell, president and CEO, credits the Biden administration for giving sites like hers “a lot of tools we didn’t have before,” such as “thousands of test kits. We are at the front of the line for vaccines and boosters, and the Biden administration has prioritized FQHCs.”
An FQHC, she says, is mandated to provide comprehensive and effective care. “With government money and accountability, the Department of Health and Human Services measures how well we provide services to minority communities. And we get results; we have the reduction in health disparities data to show it,” she adds, as they measure things like vaccinations by race, ethnicity, and socioeconomic status. Metrics also describe their outcomes in care for diabetes, obesity, infant mortality, and other conditions. “We report on health outcome data and where Open Door is relative to national benchmarks. That means you pay a lot of attention to that,” she says.
Addressing these issues means tailoring interventions to meet the needs of the community. And meeting those needs requires hiring people who resemble their patients. “We employ staff who are largely bilingual and bicultural. We have many providers of color. It is quite clear that to be effective, we must recognize that people prefer clinicians who look like them,” Farrell says.
“We employ staff who are largely bilingual and bicultural. We have many providers of color. It is quite clear that to be effective, we must recognize that people prefer clinicians who look like them.”
President & CEO, Open Door Family Medical Center
Educating the population on healthy behaviors is also key for conditions like diabetes. “We focus on lifestyle and behavior change,” like nutrition and exercise, she says. Even doctors need such education. “Clinicians get one semester of nutrition — I was shocked. They are more inclined to prescribe a pill than prescribe a healthy diet.” She partners with Tulane University’s Goldring Center for Culinary Medicine (“There really is such a thing,” she laughs) to teach clinicians how to eat healthfully.
Still, she remains optimistic. “I love prevention and wellness. The [healthcare] system will pay to amputate a leg rather than engage in healthy lifestyles, but reimbursements are changing for the better,” Farrell says, meaning insurance is now more likely to cover things like nutrition and exercise classes. “That’s good for everybody.”
The big guys are also heavily invested in improving care for disadvantaged county residents. Westchester Medical Center Health Network (WMCHealth) serves as the coordinator for the Hudson Valley Region Hub of the New York State Vaccine Network, a collaboration of healthcare providers to ensure the safe, equitable, and efficient distribution of the COVID-19 vaccine across Westchester, Rockland, Orange, Putnam, Dutchess, Ulster, and Sullivan counties. More than 2.5 million vaccine doses have been distributed as part of this program as of January, says Joshua Ratner, executive vice president and chief strategy officer for WMCHealth.
At the Hudson Valley Hub, “we work with the state government, the Department of Health, local health departments, many providers, and community organizations to ensure that the entire Hudson Valley has fair and equitable distribution of vaccines, as close to home as possible,” Ratner says.
Nearly 700,000 of those 2.5 million vaccinations were administered by WMCHealth workforce members, Ratner adds, and NYS mass vaccination facilities now exist at WMCHealth’s Westchester Medical Center, Maria Fareri Childrens Hospital, and Good Samaritan Hospital in Rockland County. “As an arm of that, we had a committee look at data and cultural issues around vaccine hesitation and set up a series of pop-up sites and other education events to be as effective as possible.”
“We anticipated that the vaccine rollout would be disproportionate in terms of access, and we have to be intentional about tackling these issues. We had to have a team looking specifically at equity distribution.”
—Dr. Mill Etienne, Neurologist & Chair, WMCHealth Equity Task Force
WMCHealth also launched a Health Equity Task Force this year. Its members, including public health experts, physicians, and community leaders, meet to identify vaccine access and distribution barriers and develop solutions to remove them, particularly impediments that affect underserved communities. Etienne chairs the task force. “We anticipated that the vaccine rollout would be disproportionate in terms of access, and we have to be intentional about tackling these issues,” he says. “We had to have a team looking specifically at equity distribution.” For example, there was an early CDC recommendation to give the vaccine first to people over age 70. “The problem was that non-White communities live shorter lives,” he says. (The CDC later revised its recommendation to apply to those over age 60.)
The WMCHealth task force worked with the NAACP, the Black and Brown Coalition for Educational Equity and Excellence, the United Way, and others to hear their concerns about vaccines. “Some were religious; some thought it would affect their genetics or cause other harm. We reassured them about their specific concerns,” he says. “That increased the number of people getting vaccinated.”
The task force also knew that many did not have the technology to access online vaccine registration, so they established mobile clinics to sign people up. These were held at houses of worship in neighborhoods with low vaccination rates, because “those were trusted places with trusted local leaders. Now, they feel more comfortable getting the vaccine,” he says.
At the macro level, NYMC has made diversifying the healthcare workforce a top priority, Etienne says. The school hosts a “Medical Student for a Day” program, which identifies and exposes minority students to STEM subjects and shows them what it’s like to be a medical student. “This tells them we think they can become doctors. It increases the pipeline,” he says.
The medical school also works to educate students and even practicing physicians and other staff. “We have grand rounds, so physicians in every specialty understand issues of health equity in all fields,” Etienne says. “You can prescribe medications, but if [the patients aren’t] taking them, you’re wasting your time. You need a trusting relationship” between patient and provider to achieve equitable care, he adds.
“The health needs of our community are as diverse as our community itself,” says Dawn French, senior vice president, Community Relations and Marketing, White Plains Hospital (WPH). “We learned a long time ago that in order to effectively meet their needs, it is essential to partner with organizations throughout Westchester to better understand the issues our community members are facing and work collaboratively to develop solutions.”
Among those solutions is an annual Neighborhood Health Fair, established 40 years ago in partnership with Calvary Baptist Church, El Centro Hispano, and the Thomas Slater Center, to offer a day of comprehensive health screenings at no charge for hundreds of community members who may not otherwise have the access or resources to receive healthcare. In 2018, WPH developed the Healthy Community Initiative (HCI), partnering with key stakeholders in the community including the same partners from the health fair — in addition to the City of White Plains, White Plains School District, the Ministers Fellowship Council, the White Plains Housing Authority, Feeding Westchester, the White Plains Youth Bureau, and the YWCA.
The pandemic tested this collaboration, as WPH relied on those community partners who are “trusted resources within their communities to help convey messages about the importance of wearing masks, social distancing, and ultimately getting vaccinated,” French says. “For many individuals, we knew we had to make it easy to get vaccinated, and that meant going to them.” WPH sponsored vaccine pop-up locations throughout the county to vaccinate tens of thousands of people.
“We realize that each employee’s unique experiences, perspectives, and viewpoints add value to our ability to create an exceptional culture and deliver the best care.”
—DEAN AKBAR, Senior Director, Human Resources & Organizational Development, White Plains Hospital
Internally, WPH prides itself on its diverse workforce, says Dean Akbar, senior director, Human Resources and Organizational Development. “We realize that each employee’s unique experiences, perspectives, and viewpoints add value to our ability to create an exceptional culture and deliver the best care,” he says. WPH partners with organizations throughout the county to recruit disadvantaged and underrepresented candidates for positions throughout the hospital.
In 2020, WPH established a Diversity Equity and Inclusion (DEI) Committee, which develops and implements initiatives to focus on providing equitable experiences for staff. The committee has developed several employee-resources groups to ensure that voices of staff from varying backgrounds are heard, Akbar says. “We also offer continuous diversity education for staff and leaders, including programs designed to reduce individual biases and create awareness of cultural differences and diversity beliefs. Finally, we regularly review workforce metrics, including turnover, hiring, and promotions, to make sure our opportunities mirror the ethnic and racial makeup of the community.”
Patient populations with socioeconomic challenges have often had specific issues with the spread of COVID. For instance, for those living in multigenerational households or with several families or individuals sharing a home, “social distancing has become a real challenge, especially with children engaged in virtual learning much of last year,” says Westmed’s Calayag.
The pandemic initially caused “concern from a wide spectrum of patients, including people of color. We are still seeing some instances of hesitation among patients returning to the office for general screenings and preventive care,” she says, “though our patient volumes have mostly returned to prepandemic levels.” Calayag notes that Westmed prioritizes communication with all its patients. “We aim to be as inclusive as possible in all of our communication, often customizing our messages for demographics such as Spanish-speaking populations.”
Westmed, like most organizations across the country, is also experiencing the effects of the Great Resignation and staffing challenges. “We are working hard to recruit new team members to support the growing demand for care that reflects the diverse background, experiences, and cultures of the community around us, including physicians and advanced practice providers,” she says. Her staff undergoes “unconscious bias” training, “which we mandated for our management team,” to help them understand how bias can affect critical decision-making and even health outcomes. And a Diversity and Inclusion Council, launched in 2020, focuses on “enhancing inclusivity through the lens of employee education, vendor diversity, and community engagement,” she says. Diversity, she concludes, “is really an important topic that needs to be on the forefront of everyone’s mind when they are thinking about their organizational strategy for the future.”
“We aim to be as inclusive as possible in all of our communication, often customizing our messages for demographics such as Spanish-speaking populations.”
—PATRICIA CALAYAG, Chief Medical Officer, Westmed