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COVID-19, other health issues influenced by where you live, experts say

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When Marion County Health Commissioner Dr. Virginia Caine fell down a flight of stairs recently, a pill to treat her arthritis became a way to cope with the pain.

But she forgot her insurance card on a trip to the pharmacy, and the out-of-pocket price of her prescription — $230 — gave Caine sticker shock. 

It’s the same sort of shock her uninsured patients often experience, she said. And that sort of financial pressure is magnified during the COVID-19 crisis.

“If I had to decide between ‘Am I going to keep my lights on’ or ‘I got to pay my rent,’ medical care may be the least of my priorities related to those former two issues,” she said.

Caine and other experts recently spoke to WFYI and the Indianapolis Recorder about how poverty and other living conditions affect health. These factors — known as social determinants of health — can explain why pockets of African Americans and Latino Hoosiers experience more COVID-19 cases than any other group. 

Indiana’s health department is hoping to change that trend. Last week, it announced a partnership with local health departments a to add nearly 100 testing sites for COVID-19.

In Marion County, for example, most low-paying jobs are held by members of the Black and Latinx communities. That means they face a greater risk of exposure to COVID-19. 

Experts say these are just the latest indicators of disparities that leave minority groups on the losing end. 

Dr. Broderick Rhyant, chief physician with Eskenazi Health Center Forest Manor, said environmental factors are mostly to blame. 

“Social determinants of health cannot be ignored,” he said in discussion with WFYI and the Recorder.

Black Hoosiers also are more likely to live with relatives in densely populated, impoverished areas, Caine said. Lack of reliable transportation, affordable housing and fresh food can plague these areas.

“You may have this intergenerational family of people living in an apartment compared to their white counterparts, which increases risk of for COVID-19, but probably also access to primary care,” Caine said. “[Someone says,] ‘I’ve got symptoms and I want to know whether I’m infected or not.’ Testing may not be available for them in the areas and the places where they reside …” 

A state health department spokesperson says half of its drive-thru testing sites since the beginning of the pandemic have been directed to minority and vulnerable residents. The agency says more than 56% of those tested are members of minority groups. 

“We want every Hoosier to be able to find testing when they need it so that we can reduce the spread of COVID in our communities,” State Health Commissioner Dr. Kris Box said. 

State officials said three dozen local testing sites opened this month, with nearly 60 others scheduled to open by Oct. 1. 

Caine says improved health also can come from more doctors being culturally competent — and identifying with the challenges their patients face.

“Black babies are less likely to die if they are treated by Black physicians,” she said. “That’s really controversial and that’s hard to hear, but we’re speaking to cultural competency and understanding shared experiences.”

Better, more equitable care is what Indiana University Health hopes to provide with a new $500,000 grant program. The program aims to address social and environmental determinants of health.

Organizers at Shepherd Community Center, which serves much of Indianapolis’ east side, said their grant will be effective because workers are familiar with the issues neighbors face.

“We know poverty really impacts all areas of someone’s life,” said Andrew Green, assistant executive director at Shepherd. “We take a relational approach and create long-term relationships.”

Noting that hunger can impact proper health care, he said some of the IU Health grant will help take care of families’ basic needs. 

“A lot of times, if you haven’t experienced it, you might think of third-world poverty, but I think what [poverty] really looks like in our neighborhoods here in Indy is more of an access issue,” he said. 

Since the pandemic began, Shepherd has added a weekly food distribution to help families who live in food deserts. With the grant money, they’ll start organizing daily home deliveries of food boxes to neighbors who struggle to get access to fresh food. 

They’ll also fund telehealth follow-up appointments from a local paramedic.

Jamal Smith, director of government affairs and strategic partnerships at IU Health, said it was critical to talk with community leaders and evaluate neighborhood quality of life surveys when considering grant money.

And he said coronavirus highlights social impediments that have been longstanding.

“The need to invest in our communities before our community members come inside of our hospital is critical.”

To find a testing site, visit www.coronavirus.in.gov and click on the COVID-19 testing information link.

This story was reported as part of a partnership between WFYI, Side Effects Public Media and the Indianapolis Recorder.

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