Earlier this month, public health departments around the country began releasing data showing the disproportionate impact of COVID-19 on communities of color. In particular, we learned that Black Americans were dying from the disease at rates that far exceeded those of white non-Hispanic individuals. Here in New York State, COVID-19 has shown to be twice as deadly for Black and Latinx populations. In New York City, Latinx people make up 29 percent of the population, yet they represent 34 percent of COVID-19 related deaths. In cities like Chicago and Milwaukee and states like Louisiana, Black Americans represent over 70 percent of COVID-19 deaths.
There is a clear story behind this racial disparity in infections and fatalities. Black and Latinx Americans make up a large percentage of the “essential,” low-wage workforce in major urban communities; this exempts them from the privilege of social distancing and working from home, greatly increasing their risk of exposure. Many must simultaneously scramble to provide childcare for their kids who are home from school. Another major factor is the prevalence of chronic health conditions within communities of color, including diabetes, heart disease, and obesity. These conditions put those who become infected at greater risk of complications and negative outcomes.
While many of these health-related risk factors exist at higher rates in communities of color, these disparities are not a result of biological predisposition, nor are they a result of personal choices. Rather, they are the result of deeply-entrenched social and economic inequities that have been exposed and exacerbated — not caused — by the virus. They are the legacies of decades-long policies and living conditions that have limited many non-white communities’ access to reliable healthcare options, green spaces, food and community security, and opportunities that lend themselves economic stability and growth. Data showing the distribution of COVID-19 testing sites and resources continue to offer a somber reflection of these persistent disparities in access to medical care.
Immediate response efforts must continue to support frontline workers providing critical care and provide relief to the communities hit hardest by the fallout. While the crisis is already lodging devastating blows to social and economic systems in this country and around the world, communities of color in the U.S. are experiencing a disproportionate share of this disruption. We must act with a sense of urgency about the long-term impact of this crisis, and how health systems and policies can reduce health disparities and promote health equity by engaging these communities in the immediacy of the pandemic, as well as its aftermath.
Here are several examples of what these considerations might look like:
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Prioritize data. To understand racial injustices and community vulnerabilities tied to the health impacts of COVID-19, laboratories and the country’s public health infrastructure at the local, state, and federal level must prioritize the collection and dissemination of race and ethnicity data. This includes the number and location of testing centers, testing outcomes, hospitalizations, morbidity, and mortality rates. Once a vaccine is developed, its administration should be prioritized in the most at-risk communities and appropriate surveillance systems put in place to help monitor progress. Without standard protocols for tracking this data, it will be impossible to reduce existing racial health gaps specific to COVID-19 and to ensure equitable access to appropriate healthcare and resource distribution.
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Address social determinants of health. Policymakers and practitioners need to engage in strategic cross- and multi-sector partnerships to remediate the ongoing impacts of entrenched structural racism and promote health equity. Doing so means working to address “social determinants of health” — defined by the WHO as the “conditions in which people are born, grow, work, live, and age and the wider set of forces and systems shaping the conditions of daily life.” Health status is a social construct, and it is important to consider the range of personal, social, economic, and environmental factors that influence it. With this in mind, stakeholders can better understand the impact of affordable housing, education, accessible transit, food security, and economic opportunity and help prevent and mitigate health issues that disproportionately affect communities of color.
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Expand community health worker (CHW) programs. Community health workers are invaluable in connecting community residents to health and social services. This is particularly important in areas where public health and healthcare resources are limited, and where trust in healthcare systems is low. Community health workers are also critical to educating community members about public health safety precautions, including preventative measures for self-protection and for curbing the spread of the virus. Practically, CHW’s can help reduce the burden on healthcare providers by engaging communities in preventive practices that may reduce the number of people in emergency departments. Not only can the mobilization of trained community health workers ensure the medical and social support of at-risk populations, it also provides jobs for many of those facing significant hardship due to the economic downturn. There are many examples where CHW’s have been effective in increasing cancer screening, improving testing for HIV and other STI’s, reducing obesity, and increasing the use of primary care that reduces the risk for chronic health conditions.
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Invest in or create community programs that support the most vulnerable workers and populations. Such place-based investments by corporate and civic leaders with economic and health equity goals should be prioritized. Making equity a guiding principle of the country’s recovery strategy by engaging communities of color, supporting minority-owned initiatives, and developing employment-protection programs will be critical. Revisiting existing DEI policies and commitments and corporate social responsibility efforts, and modifying those initiatives as indicated will also be important. Also, ensure that the decision-making bodies and care providers within institutions and communities are composed of a diverse group that represents the populations who will be most impacted.
As a certified Minority-Owned Business, Ichor and our expert team has decades of healthcare experience in the public, social, and private sectors as well as deep relationships in urban communities throughout the U.S. Our diverse background allows us to provide focused and proactive counsel to those in the healthcare industry, and to guide the development of community-first business strategies to better serve consumers, governments, and communities while improving health outcomes and reducing equity-related health disparities.
The COVID-19 pandemic has made it impossible to look away from the history of systemic biases that have made access to positive health status an uneven pursuit in this country. This crisis is “a moment of ethical reckoning,” as one physician has recently noted. In the immediate term, it is imperative that testing, treatment, and quality care are available in underserved neighborhoods and communities of color. But as we face the long road to recovery, this crisis also affords us a unique opportunity to address long-standing structural injustices.
