Commentary: COVID-19 crisis calls for urgent commitment to equity

By Rep. Liana Cassar and Rep. Rebecca Kislak
Posted 5/1/20

COVID-19 is disproportionately striking Latinx and Black communities here in Rhode Island and across the country. As public health and health policy professionals, this does not surprise us. We know …

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Commentary: COVID-19 crisis calls for urgent commitment to equity

Posted

COVID-19 is disproportionately striking Latinx and Black communities here in Rhode Island and across the country. As public health and health policy professionals, this does not surprise us. We know we must do better to reduce racial disparities in immediate health outcomes, and to enact better health and economic policies moving forward.

Early Rhode Island data show that 45 percent of COVID-19 cases are of Latinx people, despite Latinx people accounting for only 15 percent of our residents. Forty percent of Boston’s early COVID-19 cases are African Americans, despite representing about 25 percent of Boston residents. Around the country, we see that Black, Latinx and Native people are getting sick and dying from COVID-19 at disproportionately high levels.

This is not surprising for two reasons. First, Black and Latinx people disproportionately staff low-paying, front line, entry-level jobs – grocery store clerks and stockpeople, aides in nursing homes, cleaning staff in hospitals. For years these workers have been paid stagnating wages, yet now, amidst a pandemic, they are deemed “essential.” These are the jobs where people cannot work from home or practice physical distancing in the recommended ways. Nor do these workers consistently have adequate access to personal protective equipment.

Second, due to a lack of equity in access to basic health care, and poor air quality, residents of many Black and Latinx communities bear a higher burden of underlying conditions such as asthma and diabetes. Even before COVID-19 came on the scene, when workers from these communities fell ill, they were more likely to suffer worse health outcomes.

Many policies that drive these social determinants of health have not focused on the needs of the communities adversely impacted. That lack of an equity lens on policy-making has created populations that are highly vulnerable when a crisis like COVID-19 hits. This is an issue that has long been prioritized by Rhode Island Director of Health, Dr. Nicole Alexander-Scott, a champion for health equity, who frequently states that “environmental, social, and economic factors make certain people more vulnerable. We talk often about how your health should not depend on the ZIP code you are from.”

Rhode Island must take action to address the racial and economic disparities highlighted by this crisis. Those actions include identifying and reversing the outsized burden of COVID-19 on Black and Latinx communities in our state.

Immediately, the state has announced two policies that will help: tracking and reporting case data by race and ethnicity and ensuring that testing is widely available and accessible in all ZIP codes, even to people who might not have access to a car. Once COVID-19 cases are identified, Black and Latinx patients must have access to the quality care they need. Resources must be allocated to ensure that those care decisions do not exacerbate the existing inequities in health outcomes.

In addition, the state and businesses must ensure safe working conditions and fair pay for key infrastructure jobs. This includes immediate hazard pay and a path to a living wage. Some employers may require federal assistance for immediate hazard pay; federal support can help increase payments to nursing homes. Any federal funds to employers must come with the requirement that they be passed through to low-wage employees.

Moving forward, the legislature has tools to address the longer-term legacy of inequity in delivery of and access to health services. Among those tools is funding for community-led and community-focused Health Equity Zones and ensuring that Affordable Care Act is codified for Rhode Islanders. In addition, the General Assembly must pass legislation and fund access to safe, affordable housing and nutritional foods for all communities.

According to Dr. Richard Besser, former acting director of the Centers of Disease Control, “Crises such as...COVID-19 provide a mirror for our society and the actions we take — or fail to take.” While we cannot prevent past injustices, it is up to all of us to support policies that promote equity and justice. As legislators and public health advocates, we aim to do that every opportunity we get.

 

Rep. Liana Cassar (D-Dist. 66, Barrington, East Providence) is a strategy and operations consultant whose career has been centered largely on public health issues. Rep. Rebecca Kislak (D-Dist. 4, Providence) is an attorney who has worked extensively on public health policy, and teaches health policy as an adjunct professor at Rhode Island College.

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