A question to the RGV candidates: What about the social determinants of health?
I am a family, sports and pain physician from the Rio Grande Valley (RGV) and I have a question for the many candidates in the Valley.
The RGV has some of the worst health outcomes in the country. COVID has exacerbated this situation. Many people in the community have unaddressed underlying health conditions that have been exacerbated by COVID. My question is, how do the candidates plan on addressing the social determinants of health which play an important role in health outcomes?
According to the U.S Department of Health, social determinants of health (SDOH) are defined as “conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” They can be assessed using 5 factors namely: economic stability, quality and access to education and healthcare, neighborhood quality and community environment.
Many residents of the RGV have such factors that affect their health negatively. For example, 30% of the RGV population lives below the federal poverty level and 33% do not have a ninth-grade education. This has been a recipe for disaster, forcing people to endure abysmal conditions in poverty-stricken areas termed ‘colonias’ which suffer from poor water quality, lack of electricity, heating and air-conditioning.
Oftentimes many of these individuals are fighting to survive so when they arrive at my office with debilitating conditions like severe diabetes causing them neuropathic pain, or kidney disease, or heart disease, they are looking for a quick fix. It is hard to impress upon them the severity of their medical conditions and the need for expensive, essential medication as they tend to focus on their more pressing, immediate concerns such as staying employed, paying rent, and providing for their families. They tend to put other healthcare concerns on the backburner until it is too late to ignore. This is a common occurrence seen repeatedly by physicians in the RGV that makes it very difficult to provide quality care for patients who are struggling everyday for survival.
One of the other major reasons the RGV suffers from poor health outcomes is that 30-40% of patients are uninsured. While our politicians talk about Medicaid expansion, which would vastly alleviate this issue, there has been no follow up or implementation. Lack of Medicaid coverage undermines public health outcomes in many ways.
Without Medicaid coverage, hospitals across Texas, particularly those in rural Texas, cannot afford to provide medical services to patients and subsequently close down. Texas now leads the nation in rural hospital closures. A ramification of this is loss of healthcare access, loss of jobs and a further decline in health outcomes.
Since the RGV has so many uninsured patients, communities must instead rely on the 1115 waiver, which is a temporary agreement to reimburse hospitals for uncompensated health care costs, and the Delivery System Reform Incentive Payment Program (DSRIP), which provides funding for innovative healthcare initiatives. However, patients would be better benefited if they were provided some sort of health coverage instead. It makes little sense to allow people to be uninsured and then to reimburse hospitals for caring for them. This only leads to unnecessary complexity in the system of care.
This system is also expensive to maintain. The treatment costs are astronomical compared to the cost of preventative care. With better insurance coverage, doctors could instead focus on prevention, education, and management of chronic conditions.
Chronic conditions coupled with poor SDOH are a big reason why this community has been particularly susceptible to the disastrous effects of COVID-19. These health and economic disparities have been particularly exacerbated during COVID-19 as the largest occupations in the RGV are typically low-wage jobs in grocery, fast food, retail, and domestic work, which are often insufficient to cover basic housing, childcare, food, transportation, and medical costs.
To pay their bills and feed their families, many employees continued working through the pandemic. Since their jobs cannot be done remotely, essential workers face an increased risk of contracting COVID-19 and suffering consequences of COVID. Additionally, many of these people have several underlying conditions that predispose them to higher risk of contracting COVID.
Those who have contracted and survived COVID may additionally have to deal with the consequences of long-COVID, which are still being studied but may include fatigue, shortness of breath, anxiety, and depression to name a few. The consequence of COVID in children is still being studied but reports suggest they could include an increased risk for developing diabetes, HTN, ADHD, anxiety, and depression.
Clinicians are already facing challenges dealing with such secondary side-effects of COVID in well-funded urban hospitals to say nothing of the rural, underfunded hospitals with large populations of uninsured patients at the RGV. It will be an impossibility to tackle consider many of the patients in the RGV have more pressing concerns to attend to related to their social and economic circumstance before they address their healthcare concerns.
Until these concerns are addressed, it is very difficult to improve the long-term healthcare quality in the RGV. Insurance coverage, while important, is not alone enough to ensure health outcomes. Rather we need plans and policies to improve the SDOH.
All policies made by elected officials will have a direct impact on the health outcomes of the citizens of the RGV. Therefore, to the many candidates running in the RGV, I ask what their plans are to improve the SDOH in the RGV. To the people of the RGV, as you prepare to vote, I encourage you to educate yourself on the candidates and the issues as their decisions will directly impact your lives.
Editor’s Note: The above guest column was penned by Dr. Sujan Gogu, a triple-board certified physician in family medicine, sports medicine, and pain medicine who is currently working in the Rio Grande Valley at South Texas Health System Clinics. His clinical focus is in an underserved community. Dr. Gogu is a graduate from Edward Via College of Osteopathic Medicine in Blacksburg, VA. He completed his family medicine residency at The University of Texas Health Science Center in San Antonio, followed by a sports medicine fellowship at Texas A&M University in Bryan and a pain medicine fellowship at Texas Pain Institute in Fort Worth. Dr. Gogu serves on many boards and is active in many physician and patient advocacy groups, including being co-founder of Doctors in Politics. Originally from San Antonio, Texas, Dr. Gogu now lives in the Rio Grande Valley, with his wife. He can be reached by email via: [email protected]
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