How States Collect Data, Report, and Act on COVID-19 Racial and Ethnic Disparities

The California Department of Public Health released a health equity metric to fight COVID-19 and demonstrate targeted investments to reduce disparities in COVID-19 transmissions.

CDPH assembled a Health Equity Technical Assistance Team that will partner with key collaboratives and advocacy groups to develop best practices and resources for counties.

The Equity Response Team released their recommendations on June 10, 2020 and released equitable testing guidance for COVID-19 testing sites soon after. The group has sun-setted.

For COVID-19 vaccination distribution, Colorado has created a Health Equity Line of Effort, with the purpose of bringing an equity lens to all components of distribution.

The task force has launched a COVID-19 text messaging system (which includes an option for Spanish-speakers). Illinois residents can opt-in to receive text messages and obtain the most accurate information about coronavirus and how to protect themselves.

The Department of Health and Human Services Office of Minority Health selected Morehouse School of Medicine for a $40 million initiative to fight COVID-19 in racial and ethnic minority, rural and socially vulnerable communities.

Gov. Mills moved $5 million of federal coronavirus relief funds for Maine Housing to double the monthly allotted amount of rental relief as part of Maine’s COVID-19 Rental Relief program.

Maryland Attorney General Brian Frosh has created a COVID-19 Access to Justice Task Force to develop strategies and solutions for Marylanders, disproportionately those in low-income and communities of color, facing civil legal challenges due to COVID-19.

The Department of Public Health’s COVID-19 Health Equity Advisory Group released its recommendations that include:

· Continuing to disaggregate COVID-19 data across populations and sectors, such as transit usage.

· Increasing equitable distribution of personal protective equipment (PPE) for essential workers and residents in professions most at risk.

· Implement policies that increase housing stability for populations disproportionally impacted by COVID-19.

· Prioritizing investment in multilingual outreach to communities to increase access to testing, home and workplace protections, and access to state assistance programs.

· Planning and implementing a strategy for the active engagement and representation of existing community-based organizations in the most impacted communities as part of decision-making processes related to COVID-19 response and recovery.

Policies supported by the Massachusetts Task Force on Coronavirus and Equity can be found here.

The Massachusetts Attorney General’s Office released a new report, Building Towards Racial Justice and Equity in Health: A Call to Action. The report highlights the disproportionate toll the pandemic has taken on communities of color and calls for action in key areas.

· Increase transparency in reporting data regarding the racial and ethnic impact of COVID-19.

· Remove barriers to accessing physical and mental health care.

· Reduce the impact of medical bias in testing and treatment.

· Mitigate environmental and infrastructure factors contributing to increased exposure during pandemics resulting in mortality.

· Develop and improve systems for supporting long-term economic recovery and physical and mental health care following a pandemic.

The task force helped distribute large quantities of masks to the public, launched efforts targeted to communities of color, and collaborated with regional racial disparity task forces and increased access to coronavirus testing in communities of color. The state has seen disparities decrease, possibly as a result of these actions. The task force will remain in effect until 90 days after the public health emergency ends.

Twenty million dollars were made available for the Task Force to respond to community needs associated with the disparate impacts the virus has had on communities of color. Applications for funding through the Rapid Response Initiative closed in August 2020, with funds available for a wide range of needs.

Gov. Whitmer also recently created the Black Leadership Advisory Council, bringing together Black Michiganders to serve in an advisory capacity to the Governor and recommend policies and actions to prevent and eradicate racial inequity in Michigan.

The Minnesota Department of Health (MDH) regularly updates its Health Equity and COVID-19 landing page, and holds regular conference calls with local public health community and faith leaders and other diverse communities across the state where they share COVID-19 updates and answers questions and concerns from partners about their needs and issues and the barriers they face. MDH has also created multilingual COVID-19 resources and provides access to translators on their COVID-19 hotline. The MDH media strategy for providing information about COVID-19 includes contracts with diverse media partners who can better reach residents from communities of color, American Indian residents, LGBTQ residents, and residents with limited English proficiency.

· The collection and ongoing release of demographic data;

· Conducting a thorough analysis of all available data using a cross-cultural research method to examine the social, cultural, and systemic factors contributing to differences and disparities in COVID-19 related outcomes;

· Identifying and recommending specific resources that could be allocated to address these disparities; and

· Within 30 days (as of May 28), identifying and recommending achievable steps for the state and other stakeholders to consider undertaking to remedy the disparate impact of COVID-19, which is likely to be a public health concern for months, if not years to come.

The Response Team released their initial Report and Recommendations in July, 2020, which includes recommendations across several topics including the following examples:

· COVID-19 Specific Recommendations

· Permanence of Equity Response Team

· Equitable Data Practices

· Equitable Resource Allocation

· Community Engagement

· Policy

At a press conference in October, Governor Sununu announced that the Governor’s Office for Emergency Relief and Recovery is working with the COVID-19 Equity Response Team to ensure equal access to the new $100 million in “Main Street Relief Funds.”

The state legislature introduced a bill to establish the Racial Equity Rapid Response team. It was referred to the Assembly Community Development and Affairs Committee in June of 2020.

· Establishes the Andrea Harris Social, Economic, Environmental, and Health Equity Task Force to focus on economic stability, health disparities, and environmental justice in North Carolina;

· Tasks the North Carolina Pandemic Recovery Office to ensure the equitable distribution of pandemic relief funds;

·  Directs the Historically Underutilized Business Office to provide small historically underutilized businesses with access to opportunities, tools, and resources that promote equitable economic recovery and procurement of state contracts;

· Directs the North Carolina Department of Health and Human Services to ensure all communities have access to COVID-19 testing and related health care;

· Tasks the Office of Public Engagement to increase awareness about COVID-19, COVID-19 relief services and resources, and provide education on eliminating disparities;

· Directs the Division of Emergency Management to continue coordinating efforts to protect the food supply chain and support feeding operations at food banks and school systems;

· Directs the North Carolina National Guard to provide planning and logistical support and personnel where feasible to support mass testing of food processing plant workers in impacted communities and migrant farm workers; and

· Tasks the Department of Environmental Quality to create a common discourse on environmental justice and coordinate with state executive agencies on the integration of environmental justice considerations into current and future policies, programs, and procedures.

Gov. Cooper followed that executive order with another that established a task force for addressing racial inequity in the state criminal justice system.

The North Carolina Department of Health and Human Services (NCDHHS) also awarded grants to five local North Carolina organizations to help address the disparate impact that COVID-19 is having among the state’s Latinx communities. NCDHHS partnered with Livingston College, a historically Black College, to execute a community-based program to help address food insecurity in vulnerable communities.

· Establishing culturally appropriate and accessible COVID-19 exposure notification services for communities of color

· Acknowledge racism as a public health crisis and commitment to swift action to dismantle racism, which is a driving force of the social determinants of health

· Using data to prioritize resources in the communities that have the highest need

· Develop community understanding, health literacy, and trust

· Consider the implementation of one or more of the poverty-reduction strategies from the 2020-2022 State Health Improvement Plan (SHIP)

· Enhance job connections and workplace protections for essential workers by linking people of color to job training and other employment supports.

· Collect and report consistent, disaggregated police and court data.

· Explore options to expand broadband funding to ensure that Ohioans of color have sufficient internet access and bandwidth for education and telehealth activities.

· Strengthen cross-agency implementation of SHIP and monitor success.

In response to the Strike Force’s recommendations, Gov. DeWine released a Plan of Action to Advance Equity. He previously had announced other activities that the state has undertaken to address disparities:

· A $1 million federal grant will be used to address mental health issues among difficult-to-reach population especially among people of color

· A new “Stay in the Fight” messaging campaign aims to keep minority communities informed, involved and inspired in the effort to combat COVID-19

· A new position will be created within the Ohio Department of Health dedicated to social determinants of health and opportunity

· The governor announced the creation of the Ohio Governor’s Equity Advisory Board, which will be permanent and ongoing to guide leaders to address underlying conditions that contribute to disparities in Ohio.

· Use inclusive communications, including translated materials that are accessible, timely, trauma-informed, shared by trusted messengers, and involve the intended community.

· Form community-informed policy and partnerships. Work with community leaders who are an essential part of the decision-making process.

· Ensure safety for our communities. Protect civil rights for all Oregonians and take active measures against discrimination, racism, xenophobia, stigmatization, violence, and hate crimes.

· Collect, analyze, and report data in culturally and linguistically responsive communications. Allot resources for the most-impacted communities across the state and collect qualitative data to provide context to quantitative data.

· Ensure a safe, inclusive, and accessible workplace for all. Recruit, hire, retain, and promote diverse staff, create leadership pipeline opportunities, and ensure every level of state government’s workforce reflects the population of Oregon.

· Make investments in community resilience. Target investments to historically and currently marginalized populations and organizations that serve them, to improve economic welfare.

· Ensure contract equity. Provide state economic opportunities for all Oregon businesses, in particular those who are owned by people who are minorities, women, disabled, and/or veterans.

· Ask – and answer – the tough questions. The Equity Framework outlines more than a dozen guiding questions to ensure you are applying equity.

Gov. Kate Brown created the Racial Justice Council to address systemic racism. The Council will have five subgroups; criminal justice reform and police accountability, health equity, economic opportunity, housing and homelessness, and environmental justice/natural resources. The council will provide recommendations for the 2021-2023 Governor’s budget.

Office of Health Equity has a Covid-19 Health Equity Response Team with six core strategies:

· Clinical Care Considerations for Vulnerable Populations at Risk for COVID-19;

· Predictive Modeling;

· Strategic Communications;

· Coordination of Strategic Partnerships;

· Mass Fatality Management; and

· Economic Stability and Revitalization.

· Community Support;

· Health and Safety Needs;

· Culturally Competent Communications;

· Testing Accessibility; and

· Contact Tracing and Data Strategies.

The Tennessee Department of Health has created surveillance dashboards for special populations, including a COVID pregnancy dashboard, a COVID Disparities Dashboard, and COVID cases among school-aged children.

Texas state senators are proposing bills to re-allocate funding for the Office of Minority Statistics and Engagement to understand the disproportionate impact of COVID-19 on communities of color in Texas.

· Evaluate structures of support for racially diverse populations, including a focus on the racial disparities in health outcomes highlighted by COVID-19;

· Review current state and federal law on hate speech and freedom of speech, and consider changes to state law to clarify the path for prosecuting harassment, hate speech, and other bias-motivated crimes; and

· Study and present options to encourage Vermonters from diverse, marginalized, or underrepresented racial and ethnic groups to run and serve in public office at all levels.

· The task force is using a data-driven approach with a health equity lens to inform the COVID-19 command on at-risk populations and geographic areas of increased risk.

· Gov. Ralph Northam announced a pilot program in Richmond to increase equitable access to personal protective equipment (PPE) in underserved communities that may be more adversely impacted by the virus. The task force is leveraging data to prioritize areas experiencing disproportionate impacts and working with the City of Richmond to establish policies and programs that include an equity lens.

· Adequately fund the Office of Equity and statutory commissions to conduct community outreach and engagement.

· Provide opportunities for communities to take the lead in creating information about and for themselves, including through contracts and grants.

· In partnership with the statutory commissions, build connectivity with communities that are isolated (socially, technologically, geographically, linguistically).

· Prioritize issues that are most important to communities and work with them on emerging issues.

Lessons from the COVID-19 pandemic and response.

· The impacts of COVID-19 highlight systemic barriers and institutional oppression. There is disproportionate burden on communities of color, immigrant communities, low-income communities, the LGBTQ community, the disability community, and vulnerable labor forces.

· ‘Hitting pause’ on services is not neutral — it is harmful. Agencies must be prepared to continue serving all populations (e.g., students with disabilities, isolated communities).

· Do not revert to inequitable systems and behaviors; do not replicate and reinforce inequities.

· What will be different this time? We have the responsibility to ensure communities are not left behind, and a unique opportunity to rebuild systems to be more just and equitable.

· The door is open even wider than before for an Office of Equity — it is needed now more than ever.

If approved, these lessons would supplant the current Office of Equity Task Force Preliminary Report (2019)

Since May, the task force has met weekly to review COVID-19 data on racial and ethnic disparities.