Let’s talk about “a crisis within a crisis” that too few policy makers and leaders have been raising. The issue of health inequities during this pandemic. You see, underlining the larger movement in this country to increase access to health services, and improve the quality of care and treatments, has been another movement to advance health equity for all groups. COVID-19 does NOT discriminate, but our current economic and social policies do.
Historical Context Matters
Coronavirus, much like many past pandemics, negatively impacts and further disadvantages communities of color the worst. A review of studies have shown, in this country, when pandemics, natural disasters, wars and other crises are reviewed post-event, these disparate groups are impacted more than other population groups. Our history has shown some success, however, in times of crises in bringing about a sea change when it comes to crafting more effective, more equitable and inclusive health policies. Interestingly, when it comes to pandemics, we have not been successful in advancing equitable policies during those times, but we can take lessons from the success we realized in other crises to advance more equitable policies today.
Federalism and Con-federalism still an issue today. Weakening federalism and equity-focused policies at the federal level.
Today we see a regression in terms of leadership and governmental responsibility over pandemic responses and best practices. Initially, state and local governments were charged with handling this, but the burden was too much to bear and these governments realized a hodge-podge approach was not effective in the late 1800s to the early 1900s. So they deferred to the federal government to tackle these issues and codified that authority into law. Now we see a regression of sorts happening between fed and state governments and state and local governments, where the larger governments have been punting their long-established authority of managing pandemics to the smaller government, which is resulting in a very unfortunate blame game. Equally concerning, however, is the regression of health equity-focused policies at the federal level, which will likely intensify the disparities experienced by people of color.
Need a 360 approach to policies, which take into consideration the social and political determinants of health.
We know that the underlying factors, such as asthma, heart diseases, hypertension, lung disease, cancer, HIV/AIDS, diabetes and obesity, strike disproportionately within communities of color. As a result, they are at greater risk for complications from COVID-19. The inequities that pre-date COVID-19 did not suddenly become inapplicable, which could result in the U.S. ending up with major disparities in who dies from the coronavirus. Minorities and other vulnerable communities still contend with neighborhoods that are largely devoid of necessary resources, and they still contend with the political determinants or drivers that created, perpetuated and exacerbated these health inequities. The lower a person’s socioeconomic status, the more limited their resources and ability to access essential goods and services, and the greater their chance of suffering from premature death. As local and state governments implement restrictions on personal liberty in some of the hardest hit areas by COVID-19, the potential for discriminatory enforcement and police escalation may endanger the safety and civil rights of at-risk and traditionally marginalized populations. The social determinants of health play an outsized role in these human-made pre-existing inequities, but underlying each one is a political determinant. Unless we recognize the connection between our life expectancy/quality of life and the political determinants, and actually engage and leverage the political levers that dictate our circumstances, we will never move the needle toward health equity in America. Even more concerning, unless we address the political determinants of health now, our community will have more difficulty weathering this pandemic.
The importance of data especially now – arguably one of the most significant political determinants.
Unconscious biases comes into play especially during shortages. When you compound systemic racism that has been in our health care system and the extreme shortage of life-saving resources (PPEs, ICU beds, ventilators), who do you think is on the downside of advantage and or opportunities? Who do you think is going to go without when there is a shortage of life-saving resources? History has already shown us who will go without. Perhaps this time around we can change that outlook. The data that is being collected and reported out, simply is not being prioritized and disaggregated by race/ethnicity, socioeconomic status, insurance status, and other important demographic data. We know what this means: NO DATA, NO PROBLEM! NO PROBLEM, NO FUNDING! NO FUNDING, NO National Attention!
When we get through this and we will, once we look back and crunch the numbers, the disparities will be appalling, like they have been every time there has been a crisis. They always are. Again, we have an opportunity to change the outlook. At the Satcher Health Leadership Institute at Morehouse School of Medicine, as we have conducted our own examination of all state health departments and major municipalities with large minority populations, we found no states that reported income/socioeconomic data or insurance status, and only three states (SC, VA and MI) include race and ethnicity data in their daily reporting measures. Majority of states include age and gender in their daily reporting measures (only 26% of states do not report cases relative to age and gender). We must do better if we are to stem the tide of this pandemic and its disproportionate impact on communities of color.
In my book, The Political Determinants of Health, I explore many of the things that contribute to health and survival in this country for our most vulnerable populations. Our history has shown some success, in times of crises in bringing about a sea change when it comes to crafting more effective, more equitable and inclusive health policies.Interestingly, when it comes to pandemics, we have not been successful in advancing equitable policies during those times. But we can take lessons from the success we realized in other crises to advance more equitable policies today. The recent stimulus bills offer a temporary solution for a long-term systemic problem. The most important thing our lawmakers can do is to take a 360 approach to this issue – any legislation that’s passed needs to employ an equity lens and really take into account social and political determinants of health in order to have meaningful impact and save lives. As the House moves forward with crafting the fourth stimulus package, now is the time to work on including robust health equity provisions and address the social determinants of health. Once these policies are implemented, we need to monitor the data to ensure they are equally and fairly applied to all groups. The biggest opportunity right now is to shift to addressing the upstream factors because what’s happening upstream is eventually going to come downstream, and will be sitting promptly at our feet. These decisions or these effects are not felt in a vacuum. Inform yourself, arm yourself with the knowledge, and engage in tackling and addressing the political determinants of health.
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