By Stephanie Miceli

The novel coronavirus has been called “the great equalizer,” when in reality, it has only exacerbated health inequities that racial and ethnic minorities have experienced for decades, according to panelists who participated in two recent webinars.

During two recent webinars, experts outlined why the fight against COVID-19 should be concentrated in cities with populations that are majority black and other underserved groups.

Early data has showed black and Latino populations make up the majority of coronavirus-related deaths in cities including New York City, Chicago, and New Orleans. Often, they are already entering the health care system at a disadvantage — whether because of underlying chronic conditions, or due to fear that wearing a mask will incite racial profiling, said Stephen Thomas, director of Maryland’s Center for Health Equity. Some chronic conditions that increase one’s risk for COVID-19 complications — such as diabetes, obesity, and asthma — stem from a long legacy of housing segregation, which has placed black and brown communities in the midst of food deserts and poor air quality.  

“COVID-19 provides an opportunity for us to address deferred [action] on issues of race,” said Thomas. “We need to ensure that where we go next is not where we’ve been.”

‘Racial Equity Is Spatial Equity’

Health equity means everyone has a fair and just opportunity to be as healthy as possible, but “if you put COVID-19 testing sites in the wealthiest communities, don’t call that health equity,” said Thomas.

Rebekah Gee, CEO, Louisiana State University Healthcare Services, was reminded of a woman in her 90s who walked more than a mile in the New Orleans heat to reach a testing site — only to find the line wrapped around the block.

There should be intensified mobilization in testing and contact tracing in the neighborhoods where it’s needed most, said Gee. “We also need to ask ourselves, if a vaccine became available tomorrow, who would be able to get it?”

Testing affects treatment, said Lawrence Brown, director of county health rankings and roadmaps at the University of Wisconsin Population Health Institute. “It not only makes sense to break testing data out by race and ethnicity, but [also] by neighborhood. Instead of just talking about populations, we need to talk about the spaces and places in which people live.”

Collecting racial and ethnic data on COVID-19 cases and deaths will continue to be critical, said Gee. “But that shouldn’t be counted for the sake of counting. We’re counting to take action,” she said.

Incorporating ‘Health-in-All-Policies’

Webinar panelists also discussed the telework disparity in the U.S. Among the American workforce, just 16.2 percent of Hispanic workers and 19.7 percent of black Americans are able to work from home, while about 30 percent of whites and 37 percent of Asian Americans can, according to the Economic Policy Institute.

“The data says it all — staying home is a luxury,” said Winston Wong, medical and community benefit director of Kaiser Permanente’s disparities improvement and quality initiatives.

Webinar Panelists

Pursuing Data on COVID-19: The Health Inequity Multiplier

Winston Wong (moderator), medical and community benefit director of disparities improvement and quality initiatives, Kaiser Permanente

Lawrence Brown, director of county health rankings and roadmaps, University of Wisconsin School of Medicine and Public Health

Rebekah Gee, CEO, Louisiana State University Healthcare Services

Stephen B. Thomas, director, Maryland Center for Health Equity

COVID-19 and Health Equity — Exploring Disparities and Long-Term Health Impacts

Debra Pérez (moderator), senior vice president of organizational culture, inclusion and equity, Simmons University

Jeanette Kowalik, Milwaukee Commissioner of Health

Sandra Quinn, senior associate director, Maryland Center for Health Equity

Umair Shah, executive director, Harris County Public Health (Texas)

Mail carriers, public transit drivers, child and elder care providers, grocery store cashiers, and other essential workers are faced with a hard choice. Perform physically taxing but essential work while risking infection — or stay home and don’t get paid.

“Longer term, we need to talk about systemic change and compensation for the essential workers,” said Milwaukee Commissioner of Health Jeanette Kowalik. “You shouldn’t have to work three jobs to make what a white man makes.”

Sandra Quinn, senior associate director of the Maryland Center for Health Equity, said the biggest lesson she has learned from COVID-19 is that it’s not enough to have a pandemic plan. “We need to have a pandemic plan that’s developed with a health equity and health-in-all-policies lens,” she said.

A health-in-all-policies approach integrates health considerations into the pandemic response across sectors such as housing and education. For example, that could mean prohibiting evictions and rent increases, and making sure local and state funds still enable schools to provide meals to those on the free lunch program.

At college campuses, “we have to think about everything from LGBTQ students who are returning to home environments that are hostile, to first-generation students who support family and are finding themselves jobless,” said Debra Pérez, senior vice president of organizational culture, inclusion, and equity at Simmons University in Boston.

Investing in Health Workers and Epidemiologists

Thomas said, “I’m thrilled to see the diversity of our health workforce.” However, he is concerned about the many psychological burdens facing health workers — including not being able to go home to their families to prevent exposure.

This challenge is compounded for health workers of color, he noted, who often face a duality of treating patients who are victims of discrimination, while facing it in the workplace themselves.

We also shouldn’t lose sight of the xenophobia against Asian Americans, said Umair Shah, executive director of Harris County Public Health, which includes the city of Houston. Coronavirus rumors led to a 60 percent drop in revenue in Houston’s Chinatown; and some forms of harassment have been directed specifically at Asian health workers.

Like people in many cities, Houstonians have taken to applauding health care workers every night from their balconies.

“I absolutely agree with this concept of ‘health care heroes’,” said Shah. “But we also have to remember there are epidemiologists working until 2 a.m. who get flack — when there was a lack of investment in them. Years ago, it was hard for people to envision that investing in public health preparedness would be worth it. Now we have to look in the mirror as a society and ask, ‘what do we value?’”

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