COVID-19 has made it abundantly clear what happens when we don’t plan for the future and fail to put equity at the center of everything we do. Moving forward, we have a duty: We must anticipate the future to create a more equitable and just health system.
The novel coronavirus has laid bare the health disparities and disproportionate impact on communities and People of Color in the Granite State just as it has across the nation. A recent report issued by the New Hampshire Fiscal Policy Institute underscored this. While non-Hispanic white residents make up 90 percent of the New Hampshire population, they constituted only 74 percent of COVID-19 infections. More than one in five people hospitalized with COVID identified as a Person of Color. That is a stark example of disproportionate impact right here at home.
Add to this another public health issue: the centuries-old virus of racism. Right now, in this perfect storm of flashpoints — a pandemic and protests — our journey feels uncomfortable and disruptive. But with disruption comes innovation and new beginnings.
Wrestling with new opportunities and challenges
Take telehealth as an example. Before the pandemic, we were very resistant to telehealth and there were many barriers to its adoption. Federal reimbursements for New Hampshire’s safety-net care providers have always been exclusively linked to in-person patient visits. But the sudden necessity of telehealth forced health insurance companies to adjust reimbursement models. Remote services are now much more feasible and treatment and prevention services have become more accessible to Granite Staters. This rapid change would not have happened without COVID-19.
But even with these new possibilities, relying on telehealth brings new challenges for delivering care equitably. New Hampshire has two groups of people who often lack high-speed internet connectivity: (1) New Americans living in urban areas and (2) people living in rural areas, often older folks who are dealing with complicated health challenges and disabilities. We’re seeing some ingenious solutions like “bus hotspots,” where the city of Manchester drives school buses outfitted with high-speed wi-fi and meals into neighborhoods so young people can connect and get healthy food.
But these solutions are a patch; they won’t work in the long run. New Hampshire needs to envision a future where internet connectivity is a full utility and take action to make it so. We are catching a glimpse of this reality now as we have all been deprived of physical interaction and forced to connect online.
Marnita’s Digital Table
I recently witnessed another example of innovation in action during virtual events hosted by Marnita’s Table, part of a national conversation that envisions health in 30 years. Like many foundations around the country, the Endowment for Health partnered with the FORESIGHT initiative and Marnita’s Table to invite households in communities around our state to a series of feasts and conversations. Together, we explored the future we want to see for the health and well-being of ourselves, our families, and our community in a post-COVID-19 world.
Before the pandemic, these conversations were envisioned as in-person events. But the organizers did a remarkable job converting them to an online platform which enabled us to bring together people from all over the state, not just a particular city or region. The Marnita’s Table team found a way to deliver delicious food to every participating household and ensure everyone had access to technology and translation assistance where needed. In the course of three separate digital events this summer, space was made to ensure that everyone had a voice, regardless of age, language, or background.
The conversations were remarkable and challenging. It was amazing to gather as a community and ask tough questions like: What has been happening for the past several months? And how do we envision the future? But it is very difficult to think about health and well-being 30 years from now when the present is dominated by a global pandemic and racial reckoning. Most participants in the Marnita’s Table events were eager for change right now.
We did not get to 30 years from now but we did achieve a real sense of bonding as a community and held deep discussions about health and well-being. We got one big step closer to reimagining how we live together and support each other. We all received gifts from each other and everyone had a voice in the conversation. That felt like a great start.
Next FORESIGHT will take the insights gained from New Hampshire and compile them with perspectives from people across the country. All of these insights will seed a vision for the future of health that communities can start to make a reality in the coming months and years.
Anticipating the future for health
The Endowment for Health is also embracing innovation and positive disruption. Long before COVID, the Endowment recognized that we were not doing enough to integrate the future into present-day efforts to improve our state’s approaches to early childhood development, child behavioral health, maintaining wellness with aging, and health equity. We know we can reach out to new communities and ensure that they help inform what we fund and support.
As a partner of FORESIGHT, we supported development of a futures scanning report that uncovered dozens of forces that could drive change in the coming decades. These were distilled down to nine “Game Changer” themes including big shifts like climate change, gig and other new economies, and breakthrough technologies like AI and gene editing that could dramatically improve our lives — or deepen disparities. The Endowment will now use these Game Changers to imagine how our state can define, experience, and access health. This is about changing our culture — and the culture of New Hampshire’s system for health — to ensure that we are always looking to the future in thinking about the present.
We know that health and well-being will be different for people in New Hampshire in five, ten, and 30 years but we do not know how. Will we access our healthcare remotely in our homes or still travel on antiquated roadways to doctors’ offices and hospitals? Will everyone have universal health coverage or will there be no Medicaid? Will the growing gig economy allow people more flexibility in work and life or deprive them of health and economic benefits?
These are big questions but we need to ask them and play out different scenarios. Like our friends at Marnita’s Table, we need to keep bringing people together in community to have difficult and invigorating discussions about health and well-being. The stakes are high. We must change the way we think to shape the future — before it shapes us.
Yvonne Goldsberry is president of the Endowment for Health, a nonprofit foundation dedicated to improving the health of New Hampshire’s people, especially those who are vulnerable and underserved.