Abstract
This paper is aimed to criticize the article “Health Disparities and Equity in the Era of COVID-19,” written by Nana-Sinkam et al. (2021). The report focuses on the impact of clinical and translational initiatives on understanding health disparities and inequities. The paper will examine the limitations and strengths of the article and suggest how it can be improved. It will discuss the following issues: overuse of health care, the role of Community Health Workers, the National COVID Cohort Collaborative (N3C) initiative, and the trustworthiness of the research. Finally, the paper will evaluate the article and offer further research ideas.
Keywords: health disparities, equity, inequality, initiatives, COVID-19, Community Health Workers.
Introduction
In the United States, the problem of health disparities is interrelated and interdependent with the socio-economic status of the population. The COVID-19 pandemic aggravated the issues of health disparity and equity, disproportionately affecting Black, Indigenous, and Latinx communities. In their article “Health Disparities and Equity in the Era of COVID-19,” Nana-Sinkam et al. (2021) examine the impact of the pandemic on health care inequity and propose instruction on how to integrate academic research into the comprehension of such inequality. The authors focus on the main causes of health disparities in the COVID-19 era, arguing that racism and structural inequities “have contributed to increased morbidity and mortality from coronavirus infection due to limited access to care” (Nana-Sinkam et al., 2021, p. 1). They also discuss the role of Community Health Workers, National COVID Cohort Collaborative (N3C), and other NIH (National Institutes of Health) initiatives in dealing with disparities and inequities.
Although the researchers provide a detailed analysis of the initiatives mentioned above, they do not offer clear instructions on how to reduce disproportions with the help of clinical and translational research. First, the authors ignore the problem of health care overuse, which is important to understand the reasons for disparities. Second, the role of Community Health Workers is also underestimated and not fully revealed. Moreover, Nana-Sinkam et al. (2021) do not explain on what principles the N3C is built. Instead, they claim that there is a lack of information from small community health centers. At the same time, the researchers clearly identify one of the main obstacles to scientific research – misinformation. This piece of writing will examine these and other aspects, criticizing the analyzed article and providing scientific evidence to support this critique.
Critique
The main strengths of the article are its believability and robustness. The article is written in a concise, grammatically correct manner and does not contain jargon. The abstract suggests a clear overview of the content and informs the readers about the authors’ main focus. Most of the sources used to support the authors’ claims are relevant and recently written. The researchers focus on the most popular and widely-established initiatives that have a great impact on health disparity and equity. Nana-Sinkam et al. (2021) often emphasize what is important to do next and how clinical communities can impact future research, thus appealing to pathos. Moreover, they appeal to ethos, citing credible sources to support their claims. Finally, they build up logical arguments, stimulating the audience to think and draw some conclusions. One can see that the appeals to ethos, pathos, and logos are used successfully in the article.
At the same time, the article has several limitations, such as the lack of clarity and specific instructions for integrating clinical and translational research in the understanding of health disparities. Some sources are outdated since they were written more than ten years ago. Moreover, the authors omit some important aspects, such as health care overuse, the role of Community Health Workers, and the principles of the N3C initiative. These and other issues might have made the article more specific and clearer.
Understanding how health care is delivered to minorities is important to addressing inequities and disparities. At the beginning of the article, Nana-Sinkam et al. (2021) claim that different discriminatory practices and policies have contributed to the creation of communities and neighborhoods with limited access to health care (p. 2). However, they ignore the subject of overuse, which is also crucial to understanding the US health care system. According to Wassermann et al. (2019), “studying overuse may provide insight to underuse,” which is associated with the failure to deliver high-quality health care (p. 65). Overuse is the provision of care where the harm potential is higher than the benefit potential (Oakes et al., 2019, p. 1). Overuse can be identified with misuse and waste of resources, which is often physically and morally harmful to the clients (p. 1). The more commercially insured population overuses or misuses healthcare services, the less access minority populations will have to these services. Thus, studying the overuse of health care is crucial to understanding the reasons why Indigenous, Black, and Latinx communities have limited health care opportunities.
The function of Community Health Workers (CHWs) is also important to comprehending health disparities and inequities. Nana-Sinkam et al. (2021) argue that CHWs have experienced difficulties with telehealth and videoconferencing technology needed to reach their clients in the era of COVID-19 (p. 2). For this reason, they cannot fully address the problem of health disparities among the minority population. Even though this statement is true, the authors do not explain how CHWs can address this issue and do not offer other ways to influence the situation.
For example, CHWs can use their collective voice to push for change and address the challenges they experience with health care resources and technology. Schaaf et al. (2018) write that the Massachusetts Organization of CHWs “has on two occasions drafted legislation and found a sponsor to introduce it into the House of Representatives” (p. 3). It means that CHWs are not powerless, and they can unite and initiate changes. If Nana-Sinkam et al. (2021) were more specific about the potential of CHWs “as a bridge from public health initiatives to communities,” their research would be more valuable and informative (p. 2). At the same time, the authors emphasize the importance of CHWs to understanding health disparities, which is relevant to their research.
The part about the N3C is clearly written and provides useful information about new research initiatives addressing health disparities. Nana-Sinkam et al. (2021) support their arguments with evidence, providing quantitative data about the demographic distribution of COVID-19. Moreover, they discuss the limitations of the N3C initiative, making their research more objective and unbiased. For instance, the authors claim that most of the participants are academic medical centers, and the database lacks data from small community health centers (Nana-Sinkam et al., 2021, p. 3). This information may be useful to further research on disparities because the minority population is more likely to attend community health centers than huge medical centers.
Nevertheless, it would be valuable to explain what the N3C is and on what principles it is built. According to Haendel et al. (2021), N3C is based on the principles of “partnership, inclusivity, transparency, reciprocity, accountability, and security” (p. 429). It means that the Collaborative is open to any US organization that wants to share data and any registered researcher who wishes to access this data. Thus, the limitation mentioned by Nana-Sinkam et al. (2021) may be addressed straightforwardly, which means that it is not a limitation but a deficiency that can be solved. The authors should have mentioned that the reason for the lack of information from small community health centers was not the lack of access to N3C but some other reason.
The part about the trustworthiness of the research enterprise is extremely important because mis- and disinformation are at their peak in the era of COVID-19. Such social networking websites as Twitter, Facebook, or Instagram, as well as YouTube channels, often spread medical mis/disinformation and rumors among millions of people (Cacciatore, 2021, p. 5). Therefore, instead of working on health disparities and equality, American scientists must combat misinformation, mixed messages, and mistrust toward scientific communities (Nana-Sinkam et al., 2021, p. 4). One can see that this part of the analyzed article is essential to further research since it explains the obstacles clinical and scientific communities may face while dealing with disproportions.
Conclusion
Having analyzed the article by Nana-Sinkam et al. (2021), one can conclude that it has both strengths and limitations. The authors successfully appeal to ethos, pathos, and logos and use credible and relevant sources to support their arguments. They discuss the most popular and important clinical and translational initiatives that may affect the understanding of health care disparities and equity. At the same time, the researchers omit such aspects as the overuse of health care and the potential of CHWs to influence governmental decisions. The authors do not provide step-by-step instructions on how to use clinical research to reduce or comprehend health disparities. Despite these limitations, the article is written in a concise manner and can be used as an introduction to further research in this field. To conclude, Nana-Sinkam et al. (2021) make a powerful appeal to all scientific communities and emphasize the importance of clinical and translational initiatives to health disparities in the era of COVID-19.
References
Cacciatore, M.A. (2021). Misinformation and public opinion of science and health: Approaches, findings, and future directions. PNAS, 118(15), 1-8. Web.
Haendel, M. A., Chute, C. G., Bennett, T. D., Eichmann, D. A., Guinney, J., Kibbe, W. A., Payne, P. R. O., Pfaff, E. R., Robinson, P. N., Saltz, J. H., Spratt, H., Suver, C., Wilbanks, J., Wilcox, A. B., Williams, A. E., Wu, C., Blacketer, C., Bradford, R. L., Cimino, J. J., … Gersing, K. R. (2021). The National COVID Cohort Collaborative (N3C): Rationale, design, infrastructure, and deployment. Journal of the American Medical Informatics Association, 28(3), 427-443. Web.
Nana-Sinkam, P., Kraschnewski, J., Sacco, R., Chavez, J., Fouad, M., Gal, T., AuYoung, M., Namoos, A., Winn, R., Sheppard, V., Corbie-Smith, G., & Behar-Zusman, V. (2021). Health disparities and equity in the era of COVID-19. Journal of Clinical and Translational Science, 5(1), 1-8. Web.
Oakes, A. H., Chang, H.-Y., & Segal, J. B. (2019). Systemic overuse of health care in a commercially insured US population, 2010-2015. BMC Health Services Research, 19(280), 1-9. Web.
Schaaf, M., Fox, J., Topp, S. M., Warthin, C., Freedman, L. P., Robinson, R. S., Thiagarajan, S., Scott, K., Maboe, T., Zanchetta, M., Ruano, A. L., Kok, M., & Closser, S. (2018). Community health workers and accountability: Reflections from an international “think-in.” International Journal for Equity in Health, 17(66), 1-5. Web.
Wassermann, J., Palmer, R. C., Gomez, M. M., Berzon, R., Ibrahim, S. A., & Ayanian, J. Z. (2019). Advancing health services research to eliminate health care disparities. American Journal of Public Health, 109(1), 64-69. Web.