COVID-19 has exposed longstanding systemic inequities in American health care

COVID-19 has exposed longstanding systemic inequities in American health care

There isn’t one part of American life right now that hasn’t been impacted in some way by COVID-19. However, the data available as the pandemic continues shows that communities of color are disproportionately harmed by the pandemic. Recent data from the Center for Disease Control shows that, despite making up 13% of the U.S. population, black people represent 30% of COVID-19 cases. Additionally, according to Indian Health Services, there are more than 3,600 cases of COVID-19 among Native American tribes. As of this weekend, the Navajo nation now has more per capita cases than any state. 

While Nebraska statewide data on cases and deaths does not include a breakdown by race, an article published in the Omaha World-Herald last Thursday stated that 69% of confirmed positive cases of COVID-19 in Douglas County are people of color. We also know that hundreds of workers at Nebraska’s meatpacking plants, many of whom are from immigrant communities, tested positive for COVID-19 in April.

Communities of color are hit harder by COVID-19

There have been numerous articles published looking at the causes for why people of color are being hit harder by COVID-19. The bottom line is that COVID-19 has exposed longstanding systemic inequities in American health care. When looking at the disproportionate impact on black and Latinx Americans, Vox’s Dylan Scott stated

Why is that? Well, there are more acute reasons (black and Latino people are being put at risk more in their day-to-day lives) and then there are the structural reasons (long-standing economic and health disparities between white people and people of color).

The Center for Economic and Policy Research analyzed demographic data of workers in frontline (essential) industries. These are individuals who risk more exposure to COVID-19. The analysis found that people of color and immigrants are overrepresented in frontline industries. Specifically, 41.2% of frontline workers are black, Hispanic, Asian American/Pacific Islander, or another demographic group other than white. Immigrants make up 17.3% of frontline workers.

Long-term, structural inequalities are driving disparities

In addition to what Scott refers to as the “acute reasons,” we must also consider long-term, structural inequities that are driving disparities. One reason for the disproportionate impact on black and Native Americans is the underlying health conditions many experience which can make COVID-19 especially dangerous, such as asthma or diabetes. However, simply pointing to underlying health conditions isn’t a sufficient explanation, as the prevalence of these conditions is rooted in systemic racism and inequality, including higher poverty rates, racism and bias in health care treatment, the physical impacts of discrimination, and discriminatory policies like redlining and housing discrimination that can lead to higher rates of chronic illness. The Indian Health Service, which provides care for millions of Native Americans, is persistently underfunded. 

Disparities also exist in rates of health coverage, which makes getting treatment for COVID-19 more accessible. While the Affordable Care Act led to a reduction in the racial disparities in uninsured rates, an analysis of 2018 data by the Commonwealth Fund found that 46% of black working-age adults live in states that have not expanded Medicaid.

As policymakers respond to COVID-19, we must demand that they keep equity front of mind in order to address disparities and the underlying factors that drive them. 

In a recent video, Dr. Amber Hewitt, Director of Health Equity at Families USA stated

We cannot talk about health disparities without talking about implicit and racial bias in health care, or even policies like redlining, or the realities of voter suppression, mass incarceration, and generational trauma.

Dr. Hewitt noted that this is a critical moment for both responding to the pandemic but also advancing health equity. She further lists specific policy solutions for which we can advocate, including 

  • protections for essential workers, 
  • ensuring equitable access to affordable health insurance coverage, 
  • ensuring health care inclusion for immigrant communities, 
  • language access resources, 
  • ethical allocation for critical care resources, and 
  • analysis and reporting of comprehensive data on race, ethnicity, and primary languages

Each of these items has been part of Appleseed’s advocacy around COVID-19.

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