Dr Marcella Nunez-Smith: Accurate Data Are Needed to Improve Health Disparities

In a keynote address at the 2021 AcademyHealth National Health Policy Conference, Marcella Nunez-Smith, MD, MHS, stressed the important role that accurate data play in the effort to prioritize health equity during the coronavirus disease 2019 (COVID-19) pandemic.

Nunez-Smith was appointed by President Joe Biden as chair of the COVID-19 Health Equity Task Force at HHS in January.

“Over the past year, our country has collectively witnessed the social and structural problems that drive disparities in both health and health care,” Nunez-Smith said. In addition to the disproportionate impact the pandemic has wrought on communities of color, underserved populations like incarcerated or homeless individuals in addition to citizens living in rural parts of the nation have also faced substantial economic, physical, and mental health challenges.

But statistics can be insufficient. “While we have filled in some of the data gaps related to race and ethnicity, in particular, over the course of the pandemic, those data are inconsistent and incomplete,” Nunez-Smith said. Additional marginalized populations “are still largely unrepresented in our data and in our research.”

Of the 19% of Americans who live in rural areas, 80% are designated as medically underserved, and rural populations are more likely to be struggling economically. Furthermore, “undocumented immigrants, also often excluded from the social safety net, are largely unseen in our data and more likely to be in high-risk positions.” These individuals are overrepresented in essential roles, as “they make up 9% of food preparation workers, 19% of hand packers and packagers, up to 30% of agricultural workers, and around 10% of freight material movers, equipment operators, and other production workers,” Nunez-Smith said.

Piecemeal data collection is not enough and reflects a lack of contextual data needed to target resources, she argued. Better data on geographic location, environmental pollution, nutrition, housing, security, and basic needs can all aid in the effort to “disrupt the predictability of health inequities.”

“The reality is that clinical care delivery and research cannot continue to operate in a silo apart from these drivers,” Nunez-Smith said. “We need to develop practices for integrating the living conditions of our patients into the care that they receive.”

In addition to structural changes at the care delivery level, Nunez-Smith elaborated on how the Biden administration is working to combat the inequity seen in pandemic outcomes. These actions include the creation of the COVID-19 Health Equity Task Force, a call to bolster data systems and transparency during the vaccine rollout, and posting demographic data related to vaccinations on the CDC website. “We need real-time information about the progress of the national plan,” Nunez-Smith said.

In the long term, more accurate data can help ensure proper personal protection equipment (PPE) and quarantine support gets to those populations with the greatest need, and they can address gaps in health care that will remain prominent after the pandemic is over.

“It is simply unacceptable that so many individuals go without the care they need and deserve…The continued surge of COVID-19 is just accentuating the dire outcomes of a system in which many people still lack access to affordable and high-quality care,” Nunez-Smith said.

Not only can reliable data help expedite vaccine rollout and target mitigation efforts in vulnerable communities, but data transparency and scientific honesty are key ingredients to rebuilding trust in communities of color that may resist federal pandemic interventions, Nunez-Smith explained. Culturally responsive messaging will be vital to the vaccination campaign. “We have work to do to rebuild trust.”

Despite the urgent challenges brought to light by the pandemic, the crisis also allows for opportunities to adopt existing frameworks and innovate new models to address these hurdles. “Employing best data collection and sharing practices ensures we are accurately capturing what is actually happening in our communities,” Nunez-Smith concluded.