For decades, the varying health outcomes of different racial and ethnic populations in Santa Clara County flew under most people’s radar. The absence of useful and specific data conspired to conceal this fact.
During the COVID-19 pandemic, however, these race and ethnic health disparities became tragically apparent. Compared to the white community, people of color proved less protected from transmission, had less immediate access to vaccination sites and experienced barriers to basic care. In 2020, age-adjusted COVID death rates were 2-3 times higher for Blacks and Latinos than for whites.
What all this revealed could no longer be ignored.
In response, six community-based organizations — Working Partnerships USA, The Health Trust, Santa Clara Family Health Plan (SCFHP), Community Health Partnership, Behavioral Health Contractors Association and Black Leadership Kitchen Cabinet — along with the county’s public health department, mobilized together. We formed the Health Equity Agenda (HEA), a countywide effort to inform the public about health disparities, develop recommendations and strategizes to eliminate them, and establish key metrics to track our progress.
For example, diabetes is a chronic illness that can damage the heart and kidneys, require frequent hospitalizations and lead to death. Latino and Pacific Islander residents with diabetes are less likely to have their blood sugar at healthy levels, leading to poorer health outcomes and expensive hospitalization. That’s why the HEA has prioritized development of a comprehensive plan for diabetes, including a multiyear strategy for prediabetes screening, care management and expansion of existing diabetes management programs and services.
Many of our fellow community members have trouble getting treatment for mental health or alcohol and other drug-related problems. In fact, only 44% of Santa Clara County residents with such needs report being able to access behavioral health services when they need them. There simply are not enough behavioral health providers to support the level of need. So the HEA has initiated the launch of new behavioral health training programs at local community colleges.
Even when services are available, many feel they receive unfair treatment based on their race or ethnicity. The share of Latino residents who report never having experienced unfair treatment when seeking health care lags 13 to 18 percentage points behind all other groups, except American Indians and Alaska Natives. People who experience discrimination or culturally unresponsive medical care are less likely to finish a course of treatment, return for a follow-up visit and improve their health. This is why the HEA proposes to establish a community worker coordinating council, tasked with increasing the use of community health workers to improve the cultural competence of service delivery.
We stand at a critical juncture in the history of our health system. This community rightly prides itself on its historic programs to achieve universal coverage. We now must deliver on the promise of what such programs are intended to achieve — the ability of any resident of our community to live a healthy life, regardless of their race or ethnicity.
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To do so will require acknowledging the race-based disparities demonstrated by existing data. It will require thinking creatively about how to reduce them. It will require collaborative planning among a range of health care providers and community-based organizations. And it will require strategic investments of public and private resources.
Chances are, you have either a stake in this work, a role to play, or both. We encourage you to ask your health care providers and government leaders how they are helping eliminate health disparities in our community.
Christine Tomcala is CEO of Santa Clara Family Health Plan. Yvonne Maxwell is a member of the Black Leadership Kitchen Cabinet of Silicon Valley. Dolores Alvarado is CEO of Community Health Partnership.
