4 Things 2020 Revealed About Healthcare Today

Health disparities, mental health and more

Mother and baby health care

By Meredith Foxx, MSN, MBA, APRN, NEA-BC, Executive Chief Nursing Officer

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In just one year, the world of healthcare changed significantly.

What did 2020 teach nurses and other healthcare professionals? A lot. From discovering new care delivery innovations to devising needed changes in operational and practice processes to adapting to new care and communication avenues through virtual healthcare technology and more, 2020 had many positive teaching moments.

Now that the dust is starting to settle, healthcare professionals are seeing more clearly some of the large-scale issues 2020 also brought to the forefront. Those include challenges associated with:

  • Public health
  • Mental health
  • Maternal/child health
  • Health disparities

By the numbers

For example, because of the COVID-19 pandemic, the largest portion of healthcare dollars in the U.S. in 2020 was spent on illness rather than prevention. As published in an article by KFF, the Center for Disease Control’s data on age-appropriate cervical cancer screening among women insured through Kaiser Permanente Southern California shows that use of preventive services was considerably below pre-pandemic levels. The data reported 78% (women aged 21-29) and 82% (women aged 30-65) drops in cervical cancer screenings from mid-March to mid-June compared to the same time period in 2019.

Further, according to an analysis of electronic health records by Epic Health Research Network, average weekly cancer screenings dropped 94% (breast), 86% (colon) and 94% (cervical) from mid-January to mid-April compared to prior averages. Additionally, an IQVIA analysis found that while oncology visits for newly diagnosed cancer patients started increasing in summer, by October they still hadn’t reached baseline. Similar patterns can be seen for other serious and chronic diseases.

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Regarding mental health, the number of people looking for help with anxiety and depression dramatically increased. Data from Mental Health America (MHA) showed that from January to September, 315,220 people took MHA’s anxiety screen, which was a 93% increase over the total number of anxiety screens in 2019. Depression screens totaled 534,784 – a 62% increase from 2019. The number of people screening with moderate to severe symptoms of depression and anxiety also increased. Per MHA, these screenings peaked in September, when more than 8 in 10 people who took an anxiety or depression screen scored with moderate to severe symptoms.

Another key MHA finding was that more people reported frequent thoughts of suicide and self-harm in 2020 than MHA had previously recorded in its screening program, which launched in 2014. Since March, more than 178,000 people reported frequent suicidal ideation and 37% reported having thoughts of suicide more than half or nearly every day in September.

Life expectancy in the U.S. also dropped by one year in 2020, to an average of 79.1 years. In 2019, the U.S. ranked 35 in life expectancy; today, it ranks 46. There are a number of public health factors that affect life expectancy, such as access to healthcare, family and community, and having a sense of purpose. These social determinants of health, and others, play a vital role in determining length and quality of life.

Research indicates that only 20% of a population’s health is determined by the healthcare it receives. The remaining 80% is determined by:

  • Physical environment, including built environment (buildings, roads, parks, restaurants, grocery stores) and environmental factors (clean air, water) – 10%

  • Health behaviors (smoking, diet, exercise, alcohol use) – 30%

  • Social and economic factors (education, employment, income, family, social support, community safety) – 40%

There are also issues with maternal and child health. Women and children in the U.S. already experience higher rates of morbidity and mortality than those in nearly all other industrialized countries, with marked racial and ethnic disparities. According to Health Affairs, the unfolding effects of the pandemic have heightened these disparities, specifically in disease burden and mortality, for an even more pressing need to optimize health and wellbeing for women and children in the U.S. This includes ensuring access to care and addressing social and environmental determinants.

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Recent studies also show the pandemic has increased stress and mental health issues in children. And, with fewer in-person medical visits in 2020, rates of critical childhood immunizations decreased. The disruption in traditional education will likely have long-term consequences as well, and young families – especially among communities of color – continue to experience vulnerabilities and economic losses as a result of the pandemic and the associated effects on housing, nutrition and parental wellbeing. 

Looking ahead

As healthcare professionals look ahead, those in the nursing profession should set their sights on recalibrating after the pandemic. This will likely include focusing on the safety of all caregivers, patients and visitors, new engagement strategies for nurses and patients, and emotional and financial recovery, as well as outlining changes in staffing for much needed stabilization of the nursing workforce.

While preparing for a post-pandemic healthcare world may pose new challenges, hope is on the horizon as, together, we slowly begin to emerge on the other side of this pandemic.