It is said that coronavirus doesn鈥檛 discriminate 鈥� across race, income, or geography. Yet, as the pandemic progresses, it has further exposed and aggravated many of the pre-existing inequities that exist in our society. In the U.S., for COVID-19 infections and deaths, and profoundly impacts the social determinants of health 鈥� e.g., employment, housing, incarceration, income, and education, among others 鈥� by disproportionately burdening systemically disadvantaged communities including communities of color.
We are living in a moment when people increasingly recognize the value of public health. There is a growing awareness that equitable social policies 鈥� like paid sick leave, affordable and stable housing, fair economic policies, access to educational resources, and universal health care 鈥� strengthen the health of everyone. How can we use this moment to spotlight pervasive inequities, offer solutions, and envision a better way forward?
网爆吃瓜 is committed to dismantling racism and advancing healthy equity through our conversations, our work, and our partnerships with communities. On this page, we offer curated evidence and resources to evaluate the crisis through a health and racial equity lens. We also highlight exemplary leadership addressing these inequities and invite you to take action. Each day, there are new data and stories of how COVID-19 is revealing societal inequities, so we hope this is the start, and for many, the continuation of much needed collective conversations and action 鈥� as we work together to protect the public鈥檚 health and advance equity.
Testing, treatment, and health outcomes
There is mounting evidence that communities of color are COVID-19. Data show that the virus is as well as Latinx and immigrant communities in the US. These inequities are attributed to the disproportionate presence of pre-existing chronic conditions facilitated by 鈥渆nvironmental, economic, and political factors [that] have compounded for generations,鈥� combined with lower . A key problem is a lack of access to translation and interpreter services. Non-English-speaking patients already have worse health outcomes for many routine procedures due to a lack of professional interpreter services, a problem further . In addition, now that visitors are prohibited and in-person interpreters are limited, patients are left without advocates.
In Massachusetts, the City of with the highest COVID-19 incidence rate. This community, with many Latinx working families and immigrants, many of whom are undocumented, is experiencing a high burden of illness.
Exemplary Leadership and Action Steps
Massachusetts Governor Charlie Baker recently announced a new initiative, in collaboration with Boston-based global health nonprofit Partners In Health (PIH), to accelerate the state鈥檚 efforts to contain the spread of COVID-19, by dramatically scaling up capacity for contact tracing. The new COVID-19 Community Tracing Collaborative (CTC) is designed to not just flatten the curve but bend it downward by rapidly reducing the number of cases in the state. PIH is coordinating with the MA COVID-19 Command Center, Commonwealth Health Insurance Connector Authority, and the Massachusetts Department of Public Health on this initiative.
Partnerships and collaborations among public health departments, community health workers (CHWs), health care institutions, schools of public health, and community-based organizations are critical to contain the virus鈥� spread. We also must expand the public health workforce focused on COVID-19, and we encourage leaders and lawmakers to mobilize existing trained workforces like the Medical Reserve Core, Americorp, social workers, and CHWs as part of their pandemic response plans. There are nearly 3,000 CHWs throughout Massachusetts. They are experienced in working in their communities, skilled in patient navigation and care coordination, and fluent in the languages and norms of the most affected people, including those with limited English proficiency and undocumented immigrants. They are trusted members of their communities who can collect the right data and match people with the resources that they need. Denise Octavia Smith, Executive Director for the National Association of Community Health Workers (), recently co-authored an opinion piece in Health Affairs calling for community leaders to leverage the strengths of the CHW workforce.
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Lack of racial/ethnic test data
Racial and ethnic data are essential to understand which communities experience the greatest burdens of illness and death. While data from cities like illustrate clear disparities in COVID-19 infections and deaths, in Massachusetts, racial and ethnic data were available for of COVID-19 deaths and positive tests. The absence of the collection and public reporting of racial and ethnic data will continue to perpetuate implicit biases and structural inequities. Encouragingly, Representatives Ayanna Pressley (MA) and Robin Kelly (IL)Senators Elizabeth Warren (MA), Kamala Harris (CA), and Cory Booker (NJ) have called on the U.S. Department of Health and Human Services to .
Exemplary Leadership and Action Steps
In Chicago, Mayor Lori Lightfoot has to address the inequitable impact of COVID-19. In Milwaukee, where county leaders had declared racism a public health issue in 2019, 听data collection on coronavirus cases and deaths included from the beginning of the pandemic, making it one of the few places in the US with more complete racial data.
Massachusetts is making strides in the right direction. On April 8, 2020, Governor Baker and Commissioner Bharel signed an that health care providers should make every reasonable effort to collect race and ethnicity data for confirmed or suspected cases of COVID-19, and laboratories conducting tests for COVID-19 should report these data. As of April 26, 2020, the City of Boston is reporting race and ethnicity for about two-thirds of cases, but Massachusetts continues to report these data for less than half of cases. The Massachusetts Public Health Association鈥檚 (MPHA) COVID-19 Task Force鈥檚 has implored the Governor to improve data collection practices, provide greater transparency through disaggregated data, and monitor racial inequities in enforcement of public health orders. Presently, legislators are to address COVID-19 data collection and treatment disparities that specifies data to be collected and how these data must be publicly reported. The MPHA COVID-19 Task Force sent comments on the bill to MA Senate President Karen Spilka on April 27th.
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Ability to 鈥渟ocially distance鈥�
Stay-at-home orders have been an essential response to the COVID-19 pandemic. While many are now experiencing the challenges of working remotely, some workers don鈥檛 have that option. Dubbed a 鈥�,鈥� the ability to stay at home highlights inequities in employment and access to childcare, technology, living space, education, and healthcare. Data show that unavailable to many low-income workers and workers of color who tend to have less job security and fewer benefits, and therefore greater susceptibility to getting sick.
Exemplary Leadership and Action Steps
网爆吃瓜 has signed onto Trust for America鈥檚 Health (TFAH) action letter . We also support the work of MPHA and the Raise Up Mass Coalition to advocate for paid sick leave time for all front line and essential workers, positions disproportionately held by women, people of color, and immigrants. MA legislators are currently .
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Safe and healthy housing
The ability to stay safe at home requires safe and stable shelter, and access to safe, stable, and affordable housing is vital to prevent the spread of the virus. Yet, our nation鈥檚 history of systemic discrimination in housing policy has created persistent inequities in homeownership, wealth, and racial segregation; these policies have facilitated the conditions for black residents and residents of color to be at greatest risk for being cost-burdened by housing, and having less stable and of poorer quality housing. Therefore, housing policy responses must consider these long-standing inequities that black and other communities of color face.
Exemplary Leadership and Action Steps
On April 20, 2020, Governor Baker signed into law a housing security bill that put a moratorium on evictions and foreclosures as a result of strong advocacy from communities and the MPHA COVID-19 Task Force. Advocates in Massachusetts asked legislators to put a moratorium on all evictions and foreclosures including renters/owners who live in state- or federally-subsidized homes and homeowners who have federally-backed mortgages. This legislation also extends to ensuring access to safe quarantine for those experiencing homelessness (including ) and other congregate facilities. These two items are a part of the from the MPHA鈥檚 Health Equity and COVID-19 .
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Access to economic stimulus
The federal government鈥檚 attempts to provide relief to the nation’s many affected small businesses has drawn immense criticism. The first-come-first-serve approach and broad definition of what is considered a 鈥渟mall business鈥� allowed large corporations to swiftly empty the fund鈥檚 coffers, leaving little if any for minority-owned businesses that are often the cornerstones of their communities. 鈥淩elief was not being equitably felt,鈥� said Representative Ayanna Pressley in a recent interview. Recent articles in the Boston Globe highlight the shortcomings of the federal efforts and the implications for racial inequity, specifically the Paycheck Protection Program (PPP), and .
Exemplary Leadership and Action Steps
Congress is currently working to release an additional $350 billion in aid, and many are responding to the emerging needs in the community. The Boston Foundation (TBF) is offering workshops to help non-profits pursue these resources through the Small Business Administration. The United Way is听 supporting organizations seeking federal relief under the CARES Act by who can provide guidance and help them apply for the PPP and Economic Injury Disaster Loan program. Meanwhile, of Massachusetts-based partners is supporting MA black and Latinx businesses by providing emergency funds.
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The following organizations are providing technical assistance for the PPP program:
Racist narratives, stigma, and bias
Throughout history, epidemics and pandemics that promote fear-mongering, othering, stigma, and anti-immigrant discrimination. COVID-19 is no exception. In the US, the xenophobic description of COVID-19 as a 鈥淐hinese virus鈥� or the 鈥淲uhan virus鈥� has elevated deeply held racist tropes and stereotypes about people of Asian descent. This has led to an increase in .
In addition, as we think about enforcement of shelter in place and social distancing guidance, we must consider how the increased powers of law enforcement might impact communities of color and exacerbate racial biases. With the recent CDC guidance to wear masks in public, increased incidents of racial profiling and police harassment against black men wearing protective face coverings have been documented.
Exemplary Leadership and Action Steps
Asian Pacific Policy & Planning Council (A3PCON) and Chinese for Affirmative Action (CAA) launched reporting center to document incidents of coronavirus discrimination among Asian Americans nationally. The incident report form is available in 12 languages. After a month of reporting, almost 1,500 reports have been made, with almost 10% being AAPI seniors and nearly half of all incidents taking place at private businesses, reflecting both workplace discrimination and being barred from businesses. A3PCON and CAA are fostering public, private, and community-based collaborations to provide resources for impacted individuals and to advocate for policies and programs that curtail racial profiling.
Senators Kamala Harris, Cory Booker, Richard Durbin, Edward Markey, Mazie Hirono, and Benjamin Cardin sent a letter to the Department of Justice and the Federal Bureau of Investigation demanding anti-bias training for law enforcement officials amidst COVID-19 response.
Calls to Action
The COVID-19 pandemic will affect all of our lives. But because of pre-existing inequities caused by structural racism, some communities will be hurt more. Let us work to call out racism as the underlying cause of these inequities and join together to identify, develop, and promote equitable policies and approaches that dismantle racism and address the social determinants of health.
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our COVID-19 Services and Resources page for more information about what we are doing to support COVID-19 response and planning efforts.
References
Articles
- (NPR, 3/4/20)
- (The New Yorker, 3/17/20)
- (New York Times, 3/27/20)
- (ProPublica, 4/3/20)
- (Kaiser Health News, 4/6/20)
- (Podcast, 3/26/20)
- (ProPublica, 3/31/20)
- (NYT, 4/3/20)
- (CommonWealth Mag, 4/4/20)
- (NBC News, 4/5/20)
- (PBS, 4/6/20)
- (Boston Globe, 4/7/20)
- (Boston Globe, 4/8/20)
- (The Globe and Mail, 4/8/20)
- (Boston Globe, 4/10/20)
- (Boston Globe, 4/20/20)
- (Boston Globe, 4/21/20)
- (Vox.com, 4/22/20)
Web Resources
- (Trust for America鈥檚 Health)
- supporting black and Latinx businesses in Massachusetts
PPP Technical Assistance
Legislation
Letters
Artists
Introduction