Physicians may need to participate in redefining health care itself. (Photo illustration: wp paarz via Flickr)

The year 2020 brought us one of the deadliest pandemics the world has seen, and the United States has suffered painfully. A global new year resolution for 2021 would be to stay healthy – but the past year showed why this hope is a luxury for many. The unfolding chaos in this country is not just a product of a raging pandemic, but can be attributed to preexisting flaws in our society: Poor health care access, misplaced priorities, disparate resources and a history of continuous social injustice. The recent social awakening to enact change offers a flicker of hope.

For far too long health care providers have seen Black communities suffer worse health outcomes with illnesses, so the disproportionate loss of U.S. life from Covid-19 on minorities, in particular Black populations, should not be surprising. (The Covid-19 mortality rate for Black Americans is three times that of white Americans.) These dismal outcomes are a downstream impact of many social factors, including psychosocial and financial issues, that clinical care has historically not factored in as very real effects on people’s health.

The current crisis has taught us that where we live, what we eat and how we work are crucial elements of our health and well-being. The negative effect of housing insecurity and homelessness on health has been well described, including in a American Public Health Association policy statement on “Housing and Homelessness as a Public Health Issue” that describes that homelessness leads to 1.5 times to 11.5 times higher mortality rates. Homeless individuals are at higher risk for Covid-19, but become invisible victims due to lack of access to testing and care. Homelessness aggravates management of chronic illnesses such as hepatitis and diabetes, and Covid-19 is similar – and similarly compounded by poorly treated preexisting conditions. Inadequate housing is associated with increased mental health issues, with 20 percent of people experiencing homelessness reporting severe mental illness and 17 percent having a substance abuse disorder. The homeless are also disproportionately affected by food insecurity, an independent factor that contributes to health care issues and chronic ailments.

These social aspects of life have a profound impact on the health of individuals, but traditionally politicians are the ones dictating how to mold important elements of health care in a way that may be fiscally responsible but not medically sound. Medical outcomes need to be a part of the equation, and input from medical experts needs to be factored in when framing policy solutions for public health priorities.

As physicians, we need to pay heed to medical practice and participate in redefining health care itself. This includes reforming patient care by including medical management in and outside hospital bounds: Our responsibility does not start when a patient enters the hospital, or end with their departure. In addition to treating ongoing ailments, prevention of illness and maintenance of health need to be integrated into care. And medical opinions must be better incorporated into political allocation of resources for critical elements of health, such as housing and nutrition.

Medicine cannot function in a silo dictated by scientific principles only, since politics and its influence on the lived environment are key determinants of well-being. To institute concrete steps for improvement, medicine has to reconsider its at-times misplaced boundaries and be more comprehensive in its methodology. To prevent future health care crises of the scale of Covid-19, one of the challenges we will face in 2021 is how to take this lesson and transform how we practice medicine, and even how we play politics.


Sana Syed is senior medical director at Sanofi Genzyme, an assistant professor of neurology at Tufts Medical Center and a member of Harvard Women in Defense, Diplomacy and Development.

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