Monica Medina McCurdy, PA-C, is vice president of healthcare services at Project HOME and serves on Philadelphia’s COVID-19 Vaccine Advisory Committee.
Significant health disparities due to systemic racism and implicit bias have always plagued our healthcare system. Marginalized groups, particularly people of color with lower incomes, are more likely to suffer from a lack of access to quality care. Nowhere is this more profoundly visible than in individuals experiencing homelessness.
COVID-19 brought these disparities into greater focus. What does a stay-at-home order mean for a person with no home, no regular source for taking care of personal hygiene, and disrupted connections to their usual sources of services?
Project HOME’s healthcare services team saw these challenges first-hand at locations like the Hub of Hope and the Stephen Klein Wellness Center. They brought new urgency to the concept that “housing is healthcare.”
As COVID spread, individuals living in shelters or other congregate sites were often as vulnerable as nursing home populations. Those with underlying medical conditions faced greater risk of severe illness if they contracted the virus. Faced with nowhere to go for recovery, individuals experiencing homelessness who had the infection could put others at risk of contracting the virus by continuing to live on the streets.
With access to housing with supportive services essential to slowing the spread of the virus, the city’s Department of Public Health opened (and still operates) a hotel in Center City for this purpose. It gives infected and high-risk individuals a space to physically isolate themselves while at the same time receiving safe human interaction telephonically to cope with the physical isolation.
What the pandemic made apparent is that when thousands of people lack safe decent housing in Philadelphia, it is a public health crisis.
I hope the health department’s experience of becoming a temporary housing provider during the crisis will highlight the need to remain a key stakeholder in solving homelessness in Philadelphia — even after the COVID emergency has waned.
Even before the pandemic, the connection between housing and improved health was irrefutable.
“Housing is one of the best-researched social determinants of health, and selected housing interventions for low-income people have been found to improve health outcomes and decrease health care costs,” researchers wrote in a 2018 Health Affairs brief. At Project HOME, we see the power of housing in improving health every day. We know meaningful public and private investment in affordable housing can save lives and reduce the strain on our healthcare system.
As the focus of our collective response to COVID-19 shifted from flattening the curve to widespread vaccinations, new challenges in the healthcare system for marginalized groups were brought to the fore.
Generations of paternalistic care from medical professionals have stigmatized groups and denied individuals agency in their own health. Our healthcare services at the Hub of Hope in Suburban Station and our Stephen Klein Wellness Center are structured to overcome this mistrust of anyone in a white coat.
We put a focus on meeting patients where they are and giving them the tools to be advocates for their own health. We’ve conducted vaccine outreach to our high-risk patients and applaud the city’s efforts to close the gap in terms of disparities and vaccine access. It’s clear these challenges around care and access must be addressed throughout the healthcare system — and particularly where marginalized populations are likely to receive services.
The healthcare challenges highlighted by COVID-19 aren’t going away anytime soon. That’s because they’ve existed since long before this virus.
We now have an opportunity, and an obligation, to reflect on the root causes of those disparities and advance meaningful solutions to these systemic challenges — even when there’s not a pandemic going on.
Recognizing housing is healthcare and working to undo paternalism and dismantle racism and implicit bias in healthcare are powerful places to start.