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Population Health Lessons of the COVID-19 Pandemic

Why It Matters

"To prepare for the next public health crisis, we need to start with equity in mind."


As a physician and population health expert with experience in government, public policy, and research, Kara Odom Walker, MD, MPH, MSHS, has had a unique perspective on COVID-19. In the early days of the pandemic, she was Secretary of the Delaware Department of Health and Social Services. She later joined the Nemours Children’s Health System as Executive Vice President and Chief Population Health Officer. Walker, who is a new Institute for Healthcare Improvement (IHI) board member, talked in a recent interview about what she hopes health and health care leaders learn now to ensure a stronger and more equitable response to future public health crises.

In the early days of the pandemic, you were the Secretary of the Delaware Department of Health and Human Services. Later in 2020, you became a health system executive. Would you describe your experiences of the COVID-19 pandemic from those perspectives?

Addressing the underlying issues around community trust was essential in both roles. When the pandemic initially hit, I was serving as Secretary of Health and Social Services in the state of Delaware. We saw firsthand the government’s opportunity to work collaboratively with health systems and to determine how we would keep the public safe and healthy to the best extent possible.

I also saw health equity issues emerge very quickly. We saw that the health precautions asking people to stay home and isolate themselves were not going to work among communities of color at large because economics played a huge role in who was able to do that and who couldn’t.

In September of 2020, I transitioned into my current role as a health executive. As Chief Population Health Officer [at Nemours Children’s Health System in Washington, DC] one of my roles is to see the intersection between how we serve our patients and families and how we engage communities. Around the time we started to see vaccines becoming available, we quickly pivoted from supporting state efforts to make testing available to thinking about how to equitably distribute vaccines. This has required a lot of community engagement around schools and employers and communities in a unique way. I was honored to serve the state and still honored to serve in a role that requires paying attention to the intersection of economics and social determinants and how we maintain health for the larger population.

What are some of the population health lessons of the pandemic so far?

Population health is all about providing the right service, at the right time, and the right way to communities, and I’ve seen firsthand the need to focus on population health in the context of the pandemic. Trying to keep the community safe has required us to think about social factors like where you live, what kind of work you do, where you go for educational resources, how we support families and children, and how we think about the intersection of education and mental health.

We’ve learned a lot about how social networks play into how we handle COVID-19. In some ways, the close-knit nature of immigrant communities and communities of color lent themselves to higher risks of spread because people typically take care of each other and rely on each other for shared and informal caregiving of elders and young ones. Unfortunately, that put those same individuals at risk of being exposed [to the coronavirus].

We’ve also seen that if you don’t have trusted voices in and from communities, poor information leads to poor health. We had a lot of myth-busting to do. Poor information was being spread very rapidly. We had to reorient to use those close-knit social networks to spread the right information. We did things like send a pop-up tent to a community hub where many people are located and had someone there that people in the community know and trust enough to ask questions. You can’t just send in flyers. You need people on the ground.

Early in the pandemic, we were trying to keep people safe in the Delaware poultry industry. Good information wasn’t getting to people because they were often from marginalized communities with fewer resources available in their native language.

We saw a massive outbreak happening in the region. At first it was a few patients showing up in the ER who were incredibly sick and ill. Then we saw that many of those people were linked to the poultry industry. They either worked in the industry or they had a family member who was an employee. It showed that we needed to deploy a distinct strategy to make sure we were getting culturally appropriate and thoughtful messages out in Spanish and Haitian Creole. We had to make sure we were providing not just health care resources around testing and what to do once you’re sick. We also had to help people think about where they could stay to keep their family safe and how to keep grandma and auntie and the kids fed when the only employed person in the family is sick.

I hope the population health lessons we’ve been learning from the pandemic carry forward [beyond COVID-19]. For example, we realized we needed community health workers, and to make those who work in and from the community part of the health care team. Church leaders and community organizations have been more important than ever to get information out about food options, rental assistance, or legal aid to avoid evictions. Making sure we’ve had a robust pandemic response has not just been about health and health care.

How should we prepare for the inevitable next public health crisis?

To prepare for the next public health crisis, we need to start with equity in mind. Part of that is addressing structural racism. Housing and transportation policies, for example, have contributed to longstanding poverty and all of it contributes to poor health.

Instead of just asking how to raise all boats, we need to make sure we’re providing targeted efforts to create an even playing field. We should invest in communities where we know there are longstanding inequities. We need to build equity it into our everyday work. Efforts like the US Office of Management and Budget request for information on how we advance equity in our governmental funding and programs is an important step in this process. It’s not just on the health systems to address equity. We all need to do our part to promote good health and for preparedness in general.

IHI is celebrating our 30th anniversary this year. What would you like to see IHI do in our next 30 years?

I would like to see IHI take on the big issues facing health care. How far does health care go in investing in social determinants of health? How do we tackle issues like housing and violence and guns in our communities? These issues are challenging for health care leaders and clinicians who haven’t necessarily been trained to take on issues beyond the medical paradigm. I think that that’s where we need to go, and I hope IHI will guide all of us to improve the world around us.

Editor’s note: This interview has been edited for length and clarity.