Health Equity & Access Weekly Roundup: January 18, 2024

Economic Data Show Cost-Effectiveness of Statin, Antihypertensive Polypill for CVD in Low-Income Populations

New research demonstrates that a cardiovascular polypill—combining a statin with 3 half-dose antihypertensive medications—offers a cost-effective solution for managing cardiovascular disease (CVD) in majority Black and low-income populations, addressing significant health disparities. Using a computer simulation model, researchers analyzed the polypill’s impact on health care costs, quality-adjusted life-years (QALYs), and cost-effectiveness, finding it a high-value intervention at $8560 per QALY gained and potentially cost-saving if priced at $443 annually. The simplified regimen could improve medication adherence and reduce income- and race-related disparities in CVD outcomes, especially for populations facing systemic and economic barriers to care. While the polypill comprises generic components, no pharmaceutical company has pursued FDA approval, and its generic status excludes it from Medicare price negotiations under current policies.

Nearly One-Third of Americans Face Unregulated Contaminants in Water

Findings from the Silent Spring Institute reveal that nearly one-third of Americans have been exposed to unregulated contaminants in drinking water, with significant racial disparities disproportionately affecting Hispanic and Black communities. The study analyzed EPA data from 2013 to 2015 and found detectable levels of harmful chemicals—including PFAS, 1,4-dioxane, and other toxins—in 27% of public water systems serving 97 million people. These communities are more likely to live near pollution sources like industrial sites and wastewater plants, with systemic issues such as racism and historical redlining contributing to the disparities. The findings underscore the need for stronger federal regulations to address widespread water contamination, as current standards fail to account for thousands of potentially harmful chemicals.

Building Trust Through Community Engagement in Cancer Care

In part 2 of an interview from an Institute for Value-Based Medicine® event, Karen Winkfield, MD, PhD, emphasized the need for health care systems to move beyond a one-size-fits-all approach and ensure meaningful accessibility for underserved communities. As executive director of the Meharry-Vanderbilt Alliance, Winkfield highlighted systemic barriers faced by marginalized groups, including socioeconomic challenges and language barriers, which hinder access to care. She called for cultural humility, relationship-building, and community engagement among health professionals to establish trust and address disparities. Winkfield also urged researchers to communicate the relevance of their work in ways that resonate with the public, particularly as taxpayer funding supports these efforts. She stressed the importance of representing institutions as trusted partners through education and outreach, ensuring innovations in health care benefit all populations equitably.

Increased Interest in Advance Provision and Over-the-Counter Medication Abortion

The growing interest and support for advance provision (AP) and over-the-counter (OTC) medication abortion as viable options for abortion care was observed in a recent evaluation of trends following the Dobbs decision. The research found increased public interest in these models, especially among marginalized groups in states with restrictive abortion laws, rural areas, and those facing barriers to care. AP allows patients to receive abortion medication in advance for future use, while OTC enables individuals to obtain the medications without a prescription, offering privacy, convenience, and earlier access to care. However, concerns remain about misuse, lack of guidance, and coercion. Researchers call for further policy support, insurance coverage, and product approval to ensure equitable access to these care models.

Disparities in Telehealth Access Undermine Adoption Among Patients With Schizophrenia

The rapid adoption of telemental health care during the COVID-19 pandemic was significant, but among New York State Medicaid beneficiaries with schizophrenia, racial and ethnic disparities in access were identified. While 95% of mental health agencies quickly integrated telemental health services, minority groups, including Black, Asian, and Latinx individuals, experienced slower access to initial visits compared with White beneficiaries. These disparities narrowed during periods of heightened pandemic severity but persisted overall, with state-operated agencies leading adoption due to better resources. Experts noted that telemental health care, though widely used, is not universally ideal due to barriers like housing instability and technology access. The study calls for states to monitor and address inequities, prioritize vulnerable populations, and consider financial incentives to improve adoption among underperforming agencies.