Amid the darkest days of the tragic COVID-19 pandemic, there have been bright spots. For example, I’ve been moved to tears when I’ve seen the windows open in Milan or New York or heard the clapping in the streets celebrating the health care workforce.
However, while it’s been gratifying to witness that kind of appreciation, we also have to remember that clapping is a lot easier than fixing the social conditions that are creating and aggravating the stresses of so many people who work in health care, not to mention the populations they serve.
I can’t help but think about this every day because my daughter is a hospitalist in the Boston area. She’s been working hard during the COVID-19 pandemic. Day after day, she worries.
At work, she worries about her patients. She’s concerned about being exposed to the coronavirus and becoming a vector, carrying the disease home to her loved ones. She watches as a terrible disease plays out inequitably. Almost all of Jessica’s COVID-19 patients are Black and brown even though that is not true for the overall patient population who usually come to her hospital for care.
Notably, nearly every one of the younger seriously ill COVID-19 patients (those who are under the age of 60) whom Jessica sees is Black or Brown. In the United States, COVID-19 mortality rates for people of color are three times those for White people. But among the younger cohort of adults, those ages 24–54 years, young people of color are five to nine times more likely to die of COVID-19 than young White people — a staggering excess risk.
At home, Jessica worries about her two young children and her husband. They are a wonderful family, but the stresses are evident. Everyone is doing their best to cope, but a pre-adolescent is isolated in his house. A three-year-old misses her mom. A husband is dealing with his work and childcare, as well as the threat of COVID-19 being introduced into the household.
Every day, I hear the concern in Jessica’s voice and see it on her face. She’s doing okay and she appreciates the lucky circumstances of her life. She’s grateful for her wealth, social systems, and the neighborhood she lives in. She has a lot of advantages, but she still feels distressed.
Imagine what’s going on for members of the health care workforce whose support systems and resources are not like my daughter’s. What about the nurses’ aides and housekeepers at the hospital where she works who have less resilience in their bank accounts and their social conditions?
I don’t want to sound like a grouch, but when we applaud those who work in health care, we need to mean it. We need to follow through beyond the applause. We need to think bigger and broader. Here are four concrete ideas we should consider:
- At the organizational level, we need to address the income of health care workers. The legal minimum wage is not a sufficient wage to achieve healthy living in this country. Some organizational members of the IHI Leadership Alliance have stepped up and reexamined their wage structures. The University of Arkansas for Medical Sciences Medical Center is now guaranteeing a regional living wage to all its hourly workers as part of their efforts to address health equity in their community.
- Improve the overall benefit structure for health care workers. Over one million health care workers do not have health insurance. That’s shameful and it has to stop. The health care industry should make a commitment to provide every health care worker with proper health insurance, sick leave, and other benefits.
- Promote voter participation. Many in health care feel disempowered and a sense of disempowerment is a threshold to despair. People need to take power back. That happens at the ballot box. We are facing an election. I’m not telling people how to vote, but I’m saying we all need to vote. To encourage voter participation, companies in other industries send their employees email reminders and voter registration information. Some even hold bipartisan candidate forums. It would be great to see the health care industry doing similar things. Why not aim for 100% voting turnout for health care workers?
- Work with others to reform the criminal justice system. This may seem off topic when addressing the well-being of the health care workforce, but the biggest embarrassment in American social policy today is that we have 2.3 million people incarcerated, largely Black and brown people, who are imprisoned at seven or eight times the rate of Whites. About 70 percent of incarcerated Americans have substance abuse or mental health disorders. Why is this related to despair? Because the antidote to despair in part is self-efficacy. If we in health care can work with others to improve the conditions in our communities, I believe this will be energizing. And right now, many people who are incarcerated face a near impossibility of social distancing to reduce the spread of COVID-19 in crowded — often overcrowded — conditions.
The coronavirus has brought to people in health care challenges at work unlike anything most of us have ever seen before. During these extraordinary times, we need to think in perhaps unconventional ways. Supporting the health and well-being of all health care professionals means making structural changes in social conditions in the US and other countries to support real safety and opportunity for everyone. On this, health care should lead.
Donald M. Berwick, MD, MPP, FRCP, is President Emeritus
and Senior Fellow, Institute for Healthcare Improvement.
You may also be interested in:
Conversation and Action Guide to Support Staff Wellbeing and Joy in Work During and After the COVID-19 Pandemic
Our Oaths and Our Actions Can Dismantle Racism