Social Determinants of Health & COVID-19 Podcast Transcript

Transcript

As the pandemic continues, Allina Health Aetna believes we need to find ways to safely co-exist with COVID. I'm Tom Lindquist and today I'm talking to Dr. Luu about social determinants of health and chronic care. First, I'll let you introduce yourself.

Yeah, thanks for having me. I'm Dr. Lan Luu. I am a primary care doctor at Allina East Lake Street Clinic, and I have been with Allina since 2018. I attended the University of Minnesota for my medical and public health degrees. I am an internist and pediatrician which means I am an adult doctor and pediatrician. My areas of interest are in health equity and chronic disease management.

So, some people are delaying medical care because of the Coronavirus pandemic. How can this be putting them more at risk?

Well, I think our fight against COVID-19 must include not losing track of chronic disease management and that people should still get care when they need it. What we know about the Coronavirus is that people with certain chronic medical conditions such as diabetes, severe health disease, or chronic lung disease are at greater risk of developing severe illness from COVID-19. And when these underlying conditions are not well controlled, it makes a person even more susceptible to becoming really sick. Or it can lead to longer-term health consequences. What I have seen in recent months is that some of my patients are now waiting until they are very sick before seeking care, I've sent some patients to the ER immediately for life-threatening concerns after doing a clinic or a telehealth visit.

This situation is not ideal but I'm just glad that patients are reaching out to me, to allow me to help coordinate their care. One of our goals in primary care is to help keep patients out of the hospital and to prevent chronic conditions from progressing. I recommend that people should check-in with their doctors if they have any concerns or fears around COVID-19. 

Yeah, that's, that's really good advice. I, I have family members who have those chronic conditions and they've been incredibly nervous about going in. So, as a healthcare provider, how can the providers ease patient concerns about going in and seeking care?

I think providers really just need to let patients know they are accessible and available to answer any questions or concerns. I think a lot of patients are feeling like they can't seek care because it's not safe to come into the clinic, for fear of catching Coronavirus. At Allina, we have tried our best to communicate with our patients that it is okay to seek care and that we have restructured our clinics in a way to keep patients safe and still to provide quality care. We are also taking a telehealth first approach and only having patients really come into clinic if it is deemed absolutely necessary by their providers. We are always actively weighing the risks versus benefits for our patients during this pandemic, and if patients are not comfortable with coming to the clinic, then providers are always readily available by telehealth. 

Other ways that my clinic has been dealing with this challenge too is that we are trying our best to reach out to patients with certain chronic medical conditions, to say hey, it's okay to seek care. Your providers are here for you and if you have any questions, fears, concerns, is just to reach out to us. We are available. So, I would encourage people to really reach out to their providers to have their fears and concerns heard.

So, let's switch gears and talk about our children. One of the things I've heard from, from parents is that they're willing to wait on vaccinations until they feel like it's safer to go in. So, can you tell us why it's important for children to stay up to date on their vaccinations and check-ups?

I think since this pandemic started, what we've noticed is, you know, even in my clinic and just the recent data that's come out is that childhood immunization rates had significantly dropped. I think this is particularly concerning because the last thing for us as pediatricians, would want to see is for children to be more vulnerable to vaccine-preventable diseases, and for us to see secondary outbreaks such as a measles outbreak on top of an already complex pandemic. Here in Allina, we are now doing routine check-ups for our children of all ages, and besides keeping our children on track with immunizations, pediatricians also play a very important role in making sure kids are meeting their developmental milestones. So, I think all those things are very important and time-sensitive.

Excellent. So, let's switch gears a little bit and talk about social determinants of health and, and the role it plays in healthcare. So, a couple of questions, first, how might people of color be especially impacted, and do you think racial injustice leads to healthcare disparities?

Social determinants of health are the conditions under which we live, learn, and work, that have an impact on our health. My clinic is in a very unique location where I've had the opportunity to serve a very diverse patient population, from different socioeconomic and racial-ethnic backgrounds. This has allowed me to witness how social determinants of health can really impact a person's health. Before COVID-19, we have already seen that there were profound disparities for major chronic conditions such as high blood pressure or diabetes in different racial-ethnic minority populations. Therefore, it's no surprise that we are now seeing data come out that African Americans and people of color are more likely to be hospitalized or die from COVID-19. I really think this unfortunate reality comes from systemic racism that is deep-rooted in our country's history. 

It is a driving force of social determinants of health and has led people of color to live under poor conditions, have less access to quality healthcare, live in food deserts, or work in higher-risk jobs. I see that many of my patients of color are currently serving as essential or frontline workers, that may not have the resources to quarantine at home or able to access healthcare as easily. I think it's time that we start looking beyond why the instance of certain chronic conditions are higher in people of color and ask how we can reform structures that catalyze these health inequities.

I'm so happy to hear you say that. I completely agree and it's incredibly important. So, we know you work at Allina East Lake Street Clinic which was at the heart of the recent civil unrest. I'm interested if you could share what your experience has been like caring for this community?

I think I've been very fortunate to witness one of the largest movements against racial injustices that literally transpired only half a block from my clinic, which is where the Minneapolis Police 3rd Precinct used to sit for some context. Our clinic has definitely felt the community's heartbreak, anger, and sadness, over George Floyd's death, but also heard the loud call for the long-overdue end to systemic racism. I see that my patients are stressed, tired, and traumatized, by the recent civil unrest and COVID-19 pandemic. But also, that they are very resilient. I am humbled by the opportunity to continue to hear patient's stories and to be a part of the East Lake Street community because it has been very moving to see how the community has truly come together to support one another.

I think we need to start acknowledging that systemic racism is a public health crisis and barrier to health equity, and we need to respond to it with urgency as we have with COVID-19. What I think we can do as a health system, is work towards gaining the community's trust, keeping the dialogue open on this topic, and providing support to the community, in its effort to heal, rebuild, and make real systemic changes.

Yeah. Well, I just personally want to say thank you for everything you're doing for our community and all the work that's been happening down there. It's incredibly important and, and your thoughts around this are in sync with what we're hoping to accomplish to reduce healthcare disparities. So, thank you so much. Final question, what is your best advice for co-existing with COVID?

I think this will be our new norm for an unknown period of time, unfortunately. So, I would recommend for people to continue to social distance, practice good hand hygiene, wear a mask in public places, and stay physically active, especially with the warmer weather. Check-in with your doctor if you have any concerns regarding your chronic medical conditions, and call your loved ones and friends. I think it's important for all of us to check in with one another. I also think it's important to find things you enjoy doing and incorporating all these small joys into your daily routine. I think all things could be very beneficial for your overall wellbeing, mental, and physical health.

So, Dr. Luu, thank you so much. That was the last question. I just want to say thank you and I appreciate your insight and your time and sharing all your thoughts around this.

I appreciate you guys having me on today and I really enjoyed our dialogue today.