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A Systems Approach to Addressing Covid-19 Health Inequities

In this article, the authors suggest that by setting clear health equity objectives, disaggregating data by REAL, and implementing strategies informed by social context, we may prevent or lessen health inequities and be better positioned to address the underlying contributors to health that require more equitable infrastructure and broad changes in policies.

Racial and ethnic minorities are dying from Covid-19 at alarmingly high rates, which demands immediate action. Health system leaders cannot allow other priorities to interfere with a commitment to address health inequities. Vanderbilt University Medical Center (VUMC) has embedded strategies to mitigate health inequities in its Covid-19 Command Center. A key strategy is the creation of interactive dashboards, which are reviewed daily and allow disaggregation by race, ethnicity, language, and ZIP Code. Of the first 45,954 patients tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at VUMC, 2,310 had limited English proficiency (LEP). The positivity rate for patients with LEP was 26% compared with 6% for patients with English as a primary language. In addition to alerting local and state health departments of these higher rates, we created multilingual resources, assessed our interpreter services capacity, and engaged trusted community organizations. Early lessons learned at VUMC may help others implement a systems approach and immediately begin addressing Covid-19 health equity.