Preserving Priorities Amidst a Global Pandemic: ADFM’S Commitment to Health Equity

This time last year, as our 2020 Annual Conference wrapped up in New Orleans, Louisiana, we had no clue how drastically the months ahead would change the course of the world at large; the COVID-19 pandemic brought forth radical change to institutions and systems. One of the largest changes for ADFM was the switch from our traditionally in-person Annual Conference to a virtual event. Despite its virtual nature, our speakers, panelists, and attendees cultivated robust conversations about COVID-19 impacts and steps to improve and continue best practices toward health equity.

Exploring the avenues of political and social determinants of health within the pandemic was this year’s keynote speaker, Daniel Dawes, JD. Dawes is the director of the Satcher Health Leadership Institute at Morehouse School of Medicine in Atlanta, Georgia and a professor of health law, policy, and management. He expounded on ways to repair the political past that has created inequities in health care, currently exacerbated by the COVID-19 pandemic. He elaborated on the way both social and political constructs work in tandem to produce greater social inequities that must be addressed. Political and social determinants long predate COVID-19, so it is of no surprise that the impact of a pandemic (especially a highly politicized one) aggravated inequity. Dawes eloquently stated, “many [medical] issues can be firmly linked to political action or inaction. By understanding the political determinants of health, their origins, their impact, and their interconnection with the other determinants of health, we will be better equipped to develop and implement actionable solutions to close the health gap.”

The speech concluded with actions to increase healthy equity: (1) engage in the tough conversations around race, place, and class; (2) work upstream to understand the social and political determinants; (3) research the history of our communities to understand policies that exacerbated exclusion; (4) strengthen networks and engagement with allies; and (5) realize that health equity both begins and ends with political determinants of health.

Many other panels focused on addressing health inequities, including:

• “Learning & Unlearning: Addressing Structural Barriers to URM Faculty Achievement” led by STFM President, Tricia Elliot. The discussion on underrepresented minorities was presented by personal stories from the panel through an examination of how structural racism is at play across the medical education pipeline, including its impact on diverse representation in academic family medicine.

• The ADFM Education Transformation Committee led a panel titled “Moving the Needle on Racial Justice in Medical Education,” with a strong focus on action plans to make notable steps toward being anti-racist. Recommendations of action plans highlighted were (1) implementing audacious statements from leadership; (2) engaging diverse teams; (3) addressing cultural and practical barriers; and (4) tracking progress.

• The ADFM Diversity, Health Equity, and Inclusion Committee led an interactive session on a 3-pillar framework for creating an anti-racism plan within your family medicine department. This framework highlighted concepts of diversity, equity, and inclusion within the departmental pillars of care delivery, health workforce recruitment & retention, and learner recruitment & training.

The theme of dedication and commitment to equity and diversity did not waver while also observing COVID-19; instead, COVID-19 became a highlighter of disparities. Rebecca Etz, PhD, Co-Director of the Larry A. Green Center, began the evaluation of COVID-19’s impacts by presenting results of an ongoing survey of primary care providers and patients. The survey was built to be responsive to the pandemic practice and to date, has found major impacts on equitable primary care.

Among primary care providers:

• Nearly 60% report they have furloughed staff

• 25% of clinician salaries skipped

• 22% thinking of leaving primary care

• 48% burnout is at an all-time high

• 65% report family well-being suffers

• 45% decrease in psychological well-being

The survey also found that patients themselves have experienced major impacts.

• Inequities grew substantially: nearly 60% reported financial struggle, 40% substance abuse, 37% housing insecurity, 35% food insecurity, 15% domestic violence increase.

• A staggering 85% reported mental health decreased(ing), and physical health (58%) and chronic conditions worsening (38%) was also reported.

So, where do we go from here? An important and valuable reminder in the survey is that patients reported highly valuing the relationship with their care provider. Primary care must continue to pivot in the face of adversity and maintain the relationship—a message that was both validating and re-energizing for conference attendees.

The conference wrapped with 2 final, stellar sessions. First, “A Look into the Life of a Dean,” shared by a panel of Deans who were formerly chair of Family Medicine departments. And a final note on a systems-approach to well-being, highlighting specific examples of methods to care for one’s self and one’s team during the chaotic time in which we find ourselves. This year’s 2021 conference bore the weight of a pandemic and exacerbated racial, economic, and political divisions and disparity. In spite of all the turmoil, the focus on well-being and the positive impacts of family medicine revealed that this passion managed to bring us together while we sat hundreds of miles apart. This year was one for the records; now we look onward towards vaccinations, improving our systems, our practices, and aim to connect next year in Denver, Colorado.

• © 2021 Annals of Family Medicine, Inc.