Health Equity: What did we learn from COVID-19 and what is next?

COVID-19 Hospitalization & Death Rate Ratios: The Centers for Disease Control and Prevention, Risk for COVID-19 Infection, Hospitalization, and Death By Race/Ethnicity, updated May 26, 2021

American Indians

• Navajo Nation unemployment: Talha Burki, COVID-19 among American Indians and Alaska Natives, The Lancet Infectious Diseases, Volume 21, Issue 3, 2021.

• Median household income: Talha Burki, COVID-19 among American Indians and Alaska Natives, The Lancet Infectious Diseases, Volume 21, Issue 3, 2021.

• Casino shutdown impact: Meister Economic Consulting, LLC, Coronavirus Impact on Tribal Gaming

• Doctrine of Discovery: Presentation by Stacy Bohlen, CEO of the National Indian Health Board, during a NIHCM webinar, “Achieving Health Equity: What’s Next?”

• Navajo Nation, electricity and water access: Talha Burki, COVID-19 among American Indians and Alaska Natives, The Lancet Infectious Diseases, Volume 21, Issue 3, 2021.

• Broadband: Talha Burki, COVID-19 among American Indians and Alaska Natives, The Lancet Infectious Diseases, Volume 21, Issue 3, 2021.

• Higher rates of diabetes, obesity and heart disease: Talha Burki, COVID-19 among American Indians and Alaska Natives, The Lancet Infectious Diseases, Volume 21, Issue 3, 2021.

• Smoking statistics: Talha Burki, COVID-19 among American Indians and Alaska Natives, The Lancet Infectious Diseases, Volume 21, Issue 3, 2021.

• Tribal lands & access to health care facility: Talha Burki, COVID-19 among American Indians and Alaska Natives, The Lancet Infectious Diseases, Volume 21, Issue 3, 2021.

• Unrecognized tribes & COVID-19 aid: NPR, Unrecognized Tribes Struggle Without Federal Aid During Pandemic

Black Americans

• Unemployment rate: U.S. Bureau of Labor Statistics, “The Employment Situation — January 2021,” Press release, February 5, 2021

• Over-Representation in Frontline and Essential Worker Roles: Associated Press

• Federal Paycheck Protection Program: Laura C. Morel, Mohamed Al Elew, Emily Harris, Alejandra Reyes-Velarde, “Businesses in majority-white communities received PPP loans at higher rates, analysis shows,” Los Angeles Times & Reveal

• Hypersegregated Housing: COVID-19 in context: Racism, Segregation, and Racial Inequities in Philadelphia, Drexel University, Urban Health Collaborative

• Air pollution & redlining:

  • Wu, X., Nethery, R. C., Sabath, M. B., Braun, D. and Dominici, F., 2020. Air pollution and COVID-19 mortality in the United States: Strengths and limitations of an ecological regression analysis. Science advances, 6(45), p.eabd4049

  • Brad Plumer, Nadja Popovich, “How Decades of Racist Housing Policy Left Neighborhoods Sweltering,” The New York Times, August 24, 2020

• Pre-existing conditions: CDC, analysis and infographic on risk factors

• Barriers to early vaccine access:

  • “The Wealthy Are Getting More Vaccinations, Even in Poorer Neighborhoods,” The New York Times

  • “Older Adults Without Family or Friends Lag in Race to Get Vaccines,” Kaiser Health News

• Discriminated against by health care provider: Urban Insitute, Perceptions of Discrimination and Unfair Judgment While Seeking Health Care

Hispanic & Latino Americans

• Essential workforce: NPR, Why COVID-19 Disproportionately Impacts Latino Communities

• Agricultural workforce: New American Economy, Hispanic Americans in Healthcare and in Essential Roles

• Pandemic job loss: Center for American Progress, Latinos Face Disproportionate Health and Economic Impacts From COVID-19

• Federal Paycheck Protection Program: Laura C. Morel, Mohamed Al Elew, Emily Harris, Alejandra Reyes-Velarde, “Businesses in majority-white communities received PPP loans at higher rates, analysis shows,” Los Angeles Times & Reveal

• Multigenerational households: Pew Research Center, A record 64 million Americans live in multigenerational households

• Language barriers & Boston hospital study:

• Less likely to have health insurance: KFF, Changes in Health Coverage by Race and Ethnicity since the ACA, 2010-2018

• Immigration status & access to care: STAT, Fearing deportation, many immigrants at higher risk of COVID-19 are afraid to seek testing or care

Solutions for Health Equity:

• Education and anti-racism training in academia and medical school

• Address racial biases in algorithms and other tools: Obermeyer Z, Powers B, Vogeli C and Mullainathan S. “Dissecting Racial Bias in an Algorithm Used to Manage the Health of Populations.” Science, 36(6464):447-53, October 25, 2019

• Incorporate incentives for improving health outcomes: Chin MH. Creating the Business Case for Achieving Health Equity. J Gen Intern Med. 2016;31(7):792-796. doi:10.1007/s11606-016-3604-7

• Consider accountability standards for unmet metrics: A Practitioner's Guide for Advancing Health Equity - Community Strategies for Preventing Chronic Disease, National Center for Chronic Disease Prevention and Health Promotion, The Centers for Disease Control and Prevention

• Invest in community health workers and centers: Presentation by Denise Octavia Smith, Founding Executive Director of the National Association of Community Health Workers, during NIHCM webinar, Community Health Workers & Pharmacists: Their Frontline Role in the Response to COVID-19

• Build and maintain trust by working within the community: Mother Jones, There’s Never Been a More Urgent Moment to Build Black Americans’ Trust in the Medical System, May 8, 2020

• Address social determinants of health, including food and housing security: Kaiser Family Foundation, Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity, May 10, 2018

• Address equitable access to clean air, water and land: Aspen Institute, Driving Equitable Access to Water and Public Lands

• Establish initiatives & policies that prioritize equitable access to resources: Promoting Health Equity, A Resource to Help Communities Address Social Determinants of Health, Centers for Disease Control and Prevention

• Build capacity for equitable public health emergency preparedness: American Medical Association, 4 ways to integrate equity into public health emergency response

• Increase broadband access: Brookings Institute, Digital prosperity: How broadband can deliver health and equity to all communities

• Expand tribal public health services: National Indian Health Board, Strengthening Tribal Public Health Systems (Formally Tribal ASI)

• Improve transportation options to increase accessibility: US Department of Transportation, Health and Equity