Emerging Issues Around COVID-19 and Social Determinants of Health for the Substance Use Prevention, Treatment, and Recovery Workforces
Social Determinants of Health (SDH) are the complex, integrated, and overlapping social structures, policies, and economic systems, including the social and physical environments, health-services structure, and societal factors that are responsible for most health inequities.[i]
Examples of SDH include (but are not limited to) structural racism,[ii] gender inequality, stigma, poverty, citizenship status, education, housing, transportation, health systems and services, social safety network, food insecurity, unemployment/employment and working conditions, public safety, and social exclusion/inclusion.[iii]
To better understand the ways in which SDH create differential impacts in communities of color and/or underserved communities during the current COVID-19 pandemic, the Addiction Technology Transfer Center (ATTC) Network and the Prevention Technology Transfer Center (PTTC) Network facilitated a national SDH series with the substance-use (SU) prevention, treatment, and recovery workforces.
The intent of the series was to engage diverse community voices and create space and structure to hear from these communities about the following issues:
- How has COVID-19 further highlighted racial and ethnic disparities?
- What is the impact on the communities and those with substance-use disorder?
- What is the impact on the SU prevention, treatment, and recovery workforces?
- What strategies and resources are needed to mitigate these impacts?
- What are emerging best practices and tools to support underserved and/or communities of color?
By no means does this series undermine the need for structural changes to address the intersecting and cumulative impacts of Social Determinants of Health.
Rather, the series recognizes that these complex issues require multi-level approaches and that communities are developing culturally responsive strategies and resources to mitigate these impacts.
Key themes emerged that were echoed across communities. These included the need to:
- Address and build trust
- Engage in crucial and uncomfortable conversations around racial bias
- Increase access to resources
- Recognize increasing disparities due to COVID-19
- Address intergenerational trauma
- Build a culturally competent workforce
- Build cultural capacity to support community resilience
- Improve communication and disaggregated data collection to increase visibility of communities of color and/or underserved communities
- Increase community representation on boards and in policymaking
- Link pandemic strategies to the systemic changes needed
Panelists and participants shared a number of key strategies, resources, and tools. Discussions were meaningful and voiced both frustration with the current situation and hope for what can be done to move forward. Select panelist quotes that highlight discussion themes include:
“Systematic racism contributes to health disparities. U.S. society was inequitable prior to this, now those inequities that leaders have tried to sweep under the rug have risen to the surface like a bruise. There was already a lack of technology and running water in many communities – that should never have been acceptable.”
“It is vital that the walls that have been built because of distrust and fear have a door built into them that both lets people in and also lets people out.”
“I think a part of what we can do [is] being genuine, creating safe spaces involves being true and being a real person. Owning biases when we say or speak or have reactions. Trying to be self-aware and educate ourselves so that we can build trust.”
“All that struggle has been paired with a tremendous amount of strength and resilience from all of these groups. We are thriving in some ways - how do we pull from those cultural strengths? Not just advocate but empower to connect with natural sources – traditional healing practices included - bring them to the forefront the strength and resilience that has kept us alive despite all the harshness.”
Topical resources, expanded session notes and reports, and links to all recordings are posted on the ATTC series page and PTTC series page.
Our next SDH series session, on July 16, 2020 will continue the dialogue and focus on racial equity in the substance-use prevention, treatment, and recovery workforce.
[i] Commission on Social Determinants of Health (CSDH) (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva: World Health Organization.
[ii] Structural racism refers to the “Totality of ways in which societies foster racial discrimination through mutually reinforcing systems of housing, education, employment, earnings, benefits, credit, media, health care, and criminal justice.” (Bailey et al. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017; 389:1453-1463).
[iii] Bryant, Toba; Raphael, Dennis; Schrecker, Ted; Labonte, Ronald (2011). “Canada: A land of missed opportunity for addressing the social determinants of health.” Health Policy. 101 (1): 44–58.