Pandemic puts spotlight on inequitable health outcomes

By Tiffiney Gray

The COVID-19 pandemic has put a spotlight on longstanding issues of inequitable health outcomes among Black, Indigenous, and people of color (BIPOC) communities and low-income populations. Disparities in cancer, cardiovascular disease, diabetes, obesity, and other chronic health challenges have been on the radar of medical and public health practitioners for decades. Such underlying conditions predispose individuals to poorer outcomes if they contract COVID-19, and although these physical health issues are urgent and essential, mental health needs remain urgent as well. 

In the months since the pandemic began, our community has seen hundreds of hospitalizations and deaths related to COVID-19, but we have also seen a spike in substance use, domestic violence, crisis calls, and emergency department (ED) visits — all signs suggesting a surge in mental health needs that parallels the pandemic’s trajectory in the most uncomfortable of ways. 

While one dimension of healthcare consists of medical services, many of the factors that influence mental health and emotional wellness are firmly situated outside of medical and clinical settings. Beyond the walls of the doctor’s office — or emergency department — a person’s housing, occupation, family dynamics, relationships, quality of food, access to recreation, and other social conditions deeply impact their health outcomes. 

The World Health Organization (WHO) identifies several social drivers of mental health that influence mental and emotional wellness over a lifespan. Factors like adverse childhood events, inadequate housing, stress over money and resources, job strains, relational problems, race and gender discrimination, and traumatic experiences — including daily microaggressions experienced by marginalized groups — are associated with common mental disorders like anxiety and depression, as well as severe mental illnesses like schizophrenia and bipolar disorder.

The WHO analysis underscores the need for community-level interventions that bridge both medical care and social interventions. Where medical care addresses physical and mental ailments through the diagnosis and treatment of disease, social care addresses the social determinants of health or upstream conditions that wield a strong influence on people’s ability to pursue the foods, housing, transportation, safety, physical activity, and overall life conditions that support good health. 

But what does social care look like for our community? An emerging program called Waco Connect has the potential to demonstrate both the service and the prospective savings associated with social care and social care coordination. Social care coordination is about identifying health-related social needs and connecting people to non-medical resources that address them.

Over the past eight months, Prosper Waco has engaged several partners from the medical, behavioral health, and non-profit communities to develop an intervention that addresses mental health needs using resources and levers outside of medical institutions. The intervention is slated to provide social care coordination through a team of professionals supporting Waco-McLennan County residents in navigating and accessing social resources that can promote mental health wellness, by improving financial stability, enhancing life skills, and encouraging self-care.

There are important health and financial outcomes that come from addressing social drivers of mental health. For individuals, gaining control over their mental and emotional health can have positive effects that spillover into family, school, and work settings.

Frequent ED visits and law enforcement callouts related to mental health come with a hefty price tag for the community. Waco Connect aims to reduce ED visits and law enforcement callouts by 20 percent or more. Such cuts could generate substantial savings or cost avoidance for city and county budgets, as well as hospital operations. 

In a community where 16.6% of adults report frequent mental distress, we want to see our neighbors access both the medical and social care they need to improve health. This type of lift requires a concerted community effort and a multi-faceted approach. 

Waco Connect is not a magic bullet, but it is one facet, one layer of support, that can help address social drivers of mental health. Several stakeholders in our community (Ascension DePaul Center, Ascension Providence Hospital, Baylor Scott & White-Hillcrest Medical Center, Family Health Center, Heart of Texas Region MHMR, Scott & White Health, and others) have provided expertise and energy in planning this service model, and we are all eager see it launch in the spring.

Tiffiney Gray is Prosper Waco’s senior content specialist for health.