2020: A year of R&R – reflection and resilience
Twenty-twenty will undoubtedly be one for the history books. As I reflect upon what the year has meant to me, there are so many things that stand out because it has been such an extraordinary year for everyone – particularly for those of us residing in the United States. From the Black Lives Matter Movement (#BLM), watching the tragic and senseless death of George Floyd, Breona Taylor, and so many more, too numerous to mention here; statewide protests, and a global outcry for social justice; to the contentious US presidential elections, bringing close scrutiny of the US electoral and democratic process; followed by the delayed, but ultimate victory of president-elect Joe Biden and the historic nomination of the first female and first black vice president-elect, Kamala Harris, (who just happens to have Jamaican roots, and is a graduate of Howard University-my alma mater).
The global pandemic, of course, and its impact – from world-wide lockdowns and travel restrictions, human loss, job loss and economic devastation – to the fastest to market safe and effective vaccine development, manufacturing and distribution management process in pharmaceutical history, that is currently being widely distributed throughout the world, now giving us all reason to be hopeful that after a tumultuous 2020, that 2021 will be a much better year.
IMPACTS OF COVID
Needless to say, the impact of the coronavirus disease 2019 (COVID-19), has had the most significant effect on the events of 2020. In my official role in Washington, DC, as the chief of staff for the District of Columbia Department of Health, I have had a front row seat to this pandemic. As the local public health agency responsible for responding to the pandemic in the capital of the United States, in March, our headquarters was instantly converted to the Emergency Operations Center for the city. We had to quickly pivot from a 600-member in-person workforce to 95 per cent of our members working remotely and continuing to serve the public, while rapidly onboarding another 400-plus team members to serve as our contact trace workforce, and working across governmental agencies to launch citywide free testing sites and stand up an impressive and costly 427-bed Alternate Care Site (ACS) in our convention centre that we have all been thankful we have not yet had to use.
From where I sit, the pandemic has had a paradoxical effect. I have lived in the United States for the past 30 years, and the most difficult pill for me to swallow has been observing who has suffered disproportionately from the disease – people of colour who look like me. They have suffered not because of their colour, race or genes, but rather because of the far-too-long ignored social and structural inequities that have persisted for many years, and that have led to widening cracks and chasms in the US, including the healthcare system. In Washington, DC, we are fortunate to have more than 95 per cent of our population insured, but the pandemic revealed what we already knew, that having health insurance does not necessarily translate into better health outcomes. In fact, studies have showed us that only 20 per cent of health outcomes are driven by clinical care alone (access, cost and quality). Instead, the pre-existing social and structural influencers of health, such as lack of transportation, low income, poor education, and housing, account for the other 80 per cent. The scenarios are similar for Jamaica, with the most vulnerable having suffered disproportionately from COVID-19 in terms of sickness, deaths and economics, largely through no fault of their own. Rather, it’s the inequitable social and economic systems in place that prevent everyone from achieving their optimal health and well-being.
Yet, as a result of the pandemic, so much of what had previously been viewed as impossible, suddenly became not only possible, but necessary, ushering in what I believe will be a new era of possibilities for health and healthcare, which still has a critical role to play, including solving access issues. The rapid adoption of telehealth, and the utilisation of new technologies and insurance reimbursement, all helped to remove barriers to access and enabled the delivery of quality healthcare remotely (including mental and behavioural services), to many that were most vulnerable, and the use is likely to continue post COVID-19. Consumers are now more aware and accepting of telehealth, and will demand that it remains an available option for accessing care.
I have long been a proponent of telehealth adoption, as far back as 1999, when I travelled to Jamaica to encourage the government and private organisations to work together to form public-private partnerships to invest in the development of a telehealth infrastructure to use as a tool to improve access to care, with particular emphasis on the vulnerable. With ubiquitous cell phone ownership and use, embracing telehealth as an additional tool for providing access to quality care and eliminating disparities is critical, post COVID. However, for the benefits to be fully realised, the decision makers must apply an equity lens, be cognisant of the needs of the most vulnerable, provide access to broadband and technology, and employ a health-in-all policies approach in order to not create more barriers.
So, as we close out this unprecedented year, and reflect on all that it has taught us – to be resilient and to never take the simple, yet really important things for granted – and transition into 2021, I hope that we will learn from this pandemic, stay safe, mask up, get vaccinated and seize the opportunity, when the time is right, to not just get back to normal, but to commit to get back to better than normal.
Dr Jacqui Watson is the chief of staff of the DC Department of Health. She is also the president and chief strategy officer of Health Concepts International, LLC www.HealthConceptsIntl.com