As more cities and states reopen businesses after COVID-19 shutdowns, public health experts say their recovery efforts could hinge on how leaders address health inequities and the systemic issues that cause them.
Marginalized and underserved communities throughout the country have been greatly impacted by the COVID-19 pandemic. A recent report from the Centers for Disease Control and Prevention tracking COVID-19 activity in 14 states found African Americans made up 33% of hospitalized coronavirus cases despite accounting for only 18% of the total population in those areas.
The disproportionately high share of both COVID-19 cases and deaths among minority groups follows a familiar disparity pattern found for other health conditions. The coronavirus disparities have amplified public health experts' call to address healthcare access and outcomes issues.
"If we want to be able to address these inequities in both the response and recovery, I think we first need to acknowledge that there are underlying structural issues that are driving these differences," said Giridhar Mallya, senior policy officer at the Robert Wood Johnson Foundation.
In terms of a pandemic response, Mallya said states need better data on cases, hospitalizations and deaths based on race, ethnicity, gender and income status to understand where to allocate resources like testing kits and healthcare personnel.
States have ramped up efforts to provide more demographic information on COVID-19 case and death totals. As of April 27, six states do not include race and ethnicity within their case reporting, according to the National Academy for State Health Policy. An analysis conducted by the COVID Tracking Project found that 30 states reported race and ethnicity in their COVID case figures back on April 15.
"A lot of this targeting should have happened from the start, but now we have a chance to do it with the continued response and recovery," Mallya said.
Denise Brooks-Williams, senior vice president and CEO of Henry Ford Health System's North Market, said the system was leveraging many of its existing population health management initiatives to ensure the pandemic response also focused on addressing heath equity.
Last week, Brooks-Williams was appointed to Michigan Gov. Gretchen Whitmer's Task Force on Racial Disparities in COVID-19, which was created to address the state's high prevalence of cases and deaths among African American residents. Black residents of Michigan make up more than 13% of the population yet account for 40% of COVID-19 related deaths, according to data from the state's health department.
A key objective of both the task force and Henry Ford is to target and provide primary-care access to areas in need of such services.
Brooks-Williams said the group has begun work on creating a database to locate areas that lack primary-care services and developing lists of available providers to strengthen clinical connections for residents.
"If we have a second wave (of COVID-19), the chronic conditions that are in the community will be better managed and will hopefully mean people will have better outcomes if in fact they were to be infected," Brooks-Williams said.
As focus on the pandemic shifts from response to recovery efforts, Allison Hoffman, a professor at the University of Pennsylvania Carey Law School, said there needs to be a discussion on how providers and regulators can make more structural changes to the health system to shore up the medical and social safety net.
Lawmakers and leaders must also address expanding healthcare coverage, which was problematic even before the pandemic with 30 million uninsured. Hoffman said that should be a priority for the 15 states that haven't expanded Medicaid to all adults earning up to 138% of the federal poverty level. She recommended the federal government could also make it easier for people to sign up for coverage through the health insurance exchange.
"If you think about the health insurance part, there's a lot of different policies that would need to happen to make sure people have access to the medical care they need," Hoffman said.
But a larger issue is addressing the social factors that are often associated to poorer health outcomes among more economically vulnerable communities.
"Our failure to create things like housing security and food security and economic security for people makes them vulnerable in all kinds of situations," Hoffman said. "I'm hopeful we'll see even more interest in weaving in the health implications of social policies across the board going forward."