Blood Pressure Screening Services Interrupted at LHDs During the Pandemic
A majority of LHDs reduced BP screening services during the COVID-19 pandemic response. NACCHO’s Forces of Change survey is a periodic survey fielded to a sample of LHDs across the US to assess changes in LHD capacity driven by trends in public health. The 2020 survey focused on impacts to LHD infrastructure in the context of the COVID-19 pandemic.
Hypertension (high blood pressure) is a leading risk factor for cardiovascular disease and a significant contributor to preventable morbidity, mortality, and health care delivery system costs in the United States. Like many other chronic conditions, hypertension-associated morbidity and mortality can be mitigated at multiple levels of prevention. Chronic disease prevention is widely recognized as a foundational public health service informing the activities of local health departments (LHDs). The role of LHDs in chronic disease prevention frequently includes access to secondary prevention via screenings. The National Association of County and City Health Officials (NACCHO) reports that blood pressure (BP) screening is a common LHD function, provided by 54% of LHDs nationwide in 2016 and 59% in 2019.
However, COVID-19 has worsened the already unequal distribution of risk for cardiovascular disease in the United States with significant disparities among geographic regions, racial and ethnic groups, and socioeconomic status levels. Moreover, for most LHDs routine services were interrupted during the initial public health emergency response to the COVID-19 pandemic.
We used NACCHO’s Forces of Change 2020 survey, which focused on LHD practices and infrastructure in the context of the COVID-19 pandemic response, to analyze the impact the pandemic had on screening for cardiovascular disease.
Major Findings:
- More than 2 in 5 LHDs reported reassigning chronic disease staff to perform duties in support to the COVID-19 response.
- Reassignment of chronic disease staff was reported more frequently by LHDs serving large populations than by those serving small or medium.
- Of the LHDs that reported having provided BP screening services at any time during calendar year 2019, more than two-thirds indicated that these services were reduced during the pandemic response.
- Reduction in BP screenings were reported more frequently by LHDs serving large populations than by those serving small or medium populations.
- State-governed LHDs were less likely to report BP screening service reductions than LHDs with shared or local governance structure.
- Only 1 in 5 LHDs reported “clinical care for people with chronic conditions during service disruptions” was a priority.
Why this is important:
Alongside chronic disease staffing reassignment, widespread reduction in BP screening services, and low prioritization of chronic disease clinical care at LHDs, cardiovascular disease risk factors increased. The unequal distribution of risk for cardiovascular disease likely means that populations already suffering health disparities will be further negatively impacted and potentially are at an even greater risk because of the pandemic.
LHDs are uniquely positioned to address chronic disease because of their knowledge of local needs and context; relationships with key health and community partners; and capacity to provide or facilitate access to low-barrier preventive care to the community. We recommend that LHDs use a health-equity approach to address cardiovascular disease risks and outcomes in order to mitigate the existing and potentially increasing health disparities.
Read the article in JPHMP:
Margaret Cunningham, MPH, RN, is a Senior Research and Evaluation Specialist at the National Association for County and City Health Officials. Her research interests include community-based participatory research and the integration of population health and primary care services.
Jordan Royster, MSc, is a Senior Research and Evaluation Specialist at the National Association for County and City Health Officials. Her work concentrates on health equity and evaluation with an interest in practical solutions for public health issues.
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Timothy C. McCall, PhD, is Director of Research at the National Association of County and City Health Officials and Director of Health Sciences Undergraduate Courses in the Department of Clinical Research and Leadership at The George Washington University. His work focuses on the public health and healthcare workforces, well-being, and equity.