How States Collect, Report, and Act on COVID-19 Race and Ethnicity Data

In October 2020, California Department of Public Health (CDPH) released a health equity metric to fight COVID-19 and demonstrate targeted investments to reduce disparities in COVID-19 transmissions. The health equity metric was used to assign risk levels and tier counties, and is used to assess reopening on a county-by-county level.

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

California’s Healthy Places Index (HPI) helps visualize community conditions, like low-income, education completeness, and healthcare access, and 40% of COVID-19 cases and deaths occurred in California’s lowest HPI. The state is distributing 40% of vaccines to this HPI, and as of April 6, 2021, it has distributed more than 4 million vaccination doses through its Vaccine Equity strategy.

The Equity Response Team released its recommendations on June 10, 2020 including equitable testing guidance for COVID-19 testing sites soon after. The group has since sunsetted.

For COVID-19 vaccination distribution, in February 2021, Colorado created a Health Equity Line of Effort, to bring an equity lens to all components of distribution. The governor worked with his health deputies to launch pop-up clinics at churches and clinics in underserved areas to address equity in the vaccine distribution.

The Colorado Office of Health Equity hosts a Health Equity Commission that meets monthly and is helping to implement a state Public Health Improvement Plan; one aim of this plan is to address racism as a public health crisis. The commission also helped advise SB 181 ,”Equity Strategic Plan Address Health Disparities,“ which appropriates $4,892,988 to the health disparities and community grant program to award grants as appropriate and to, on a biannual basis, conduct an assessment and publish a report on health disparities and inequities in Colorado to help reduce the risk of future disease outbreaks. The bill passed during the 2021 legislative session and is awaiting the Governor’s signature..

Connecticut HB 5614, “An Act Establishing a Commission on the Disparate Impact of COVID-19,” directs the legislature to establish a commission with appointees no later than September 1, 2021, that will analyze the disparate impacts on different racial, ethnic, and gender groups in Connecticut, identify causes, assess federal and state responses to the impact, and submit a report by January 1, 2022, with findings.

Governor Carney announced in his January 2021 State of the State address that Delaware is using CARES Act funding to put 3,000 Delaware residents, half of whom are people of color, through a rapid retraining program to re-enter the workforce.

In January 2021, the DC Council passed legislation launching a new office – the Council Office of Racial Equity (CORE). The office will work to ensure all new legislation will be evaluated for its impact on racial equity before passing.

CORE released a report in March 2021 examining racial equity in DC’s vaccination rates and practices.

The DC Council passed the Racial Equity Achieves Results (REACH) Congressional Review Emergency Amendment Act of 2021, which requires, the Office of Racial Equity to establish a Commission on Racial Equity, Social Justice, and Economic Inclusion to advise the Council.

DC Council also confirmed Monica Palacio in May 2021 as the new director of the Office of Human Rights.

Florida Department of Health awarded grant opportunities in March 2021 to several community organizations as part of the state’s Reducing Racial and Ethnic Disparities “Closing the Gap” (CTG) grant awards.

Idaho was awarded $30 million through federally appropriated CDC funds in June 2021 to reduce health disparities related to COVID-19, including testing and contact tracing for at-risk groups.

In June 2020, 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.

In May 2020, the city of Chicago, in partnership with the city’s chief equity officer, created the Racial Equity Rapid Response Team (RERRT) to address the disproportionate effects of the pandemic on communities of color. The city experienced significant improvement in vaccine administration to communities of color by February 2021 as a result of the RERRT’s recommendations.

Illinois HB 3504 requires the Illinois Department of Public Health to conduct an annual “Healthy Illinois” survey with statistically reliable race, ethnicity, gender, age, and other demographic data at the zip code level to help measure public health and health equity needs in Illinois. The department will be required to produce periodic reports relevant to ongoing and emerging health and social issues.

In Nov. 2020, Gov. Eric Holcomb appointed Kerrah A. Herring as Indiana’s first chief equity, inclusion, and opportunity officer. Herring’s job began Feb. 1, 2021 and will advise the governor on systemic change to remove hurdles in the government workplace to achieve equity.

During the pandemic, Indiana integrated the administration of their 211 helpline to the Family and Social Services Administration (FSSA). This integration allowed FSSA to use data collected from the hotline to target interventions, like addressing food insecurity, connecting residents to information about quarantining and isolation if they tested positive, and helping them sign up for vaccines. The hotline is staffed with community navigators and helps address gaps in care and unmet need for vulnerable residents.

In August 2020, 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.

The Maine Department of Health and Human Services announced in April 2021 that will establish the Office of Population Health Equity to address health disparities in communities in Maine.

In January 2020 Maryland Attorney General Brian Frosh created a COVID-19 Access to Justice Task Force to develop strategies and solutions for Marylanders, disproportionately those in low-income areas and communities of color facing civil legal challenges due to COVID-19. The Task Force released their report in January 2021 highlighting findings.

The Maryland Department of Health’s Minority Outreach and Technical Assistance Office revised criteria for its competitive funding to all nonprofits in Maryland. For FY 2021-2022, organizations in jurisdictions with 20,000 individuals of color or fewer were eligible to apply for $25,000 grants and organizations in jurisdictions with over 20,000 individuals of color were eligible to apply for up to $50,000.

Maryland Legislature passed HB 463 and HB 78, two bills in the 2021 legislative session related to improving health equity as a result of the disparities the COVID-19 pandemic exacerbated. HB 463 establishes a “Pathways to Health Equity Program in the Community Health Resources Commission.” Among other activities, the bill requires the Commission to designate areas in Maryland as Health Equity Resource Communities and direct resources to reduce health disparities. HB 78 establishes the Maryland Commission on Health Equity to employ a health equity framework to improve health outcomes and reduce disparities.

Maryland also established a state Food System Resiliency Council, to be created by November 2021, that will work to address the food insecurity crisis that resulted from the pandemic, with an emphasis on addressing and eliminating racial inequities in the food system. addressing and eliminating racial inequities in the food system. addressing and eliminating racial inequities in the food system. addressing and eliminating racial inequities in the food system.

The Department of Public Health’s COVID-19 Health Equity Advisory Group released recommendations in June 2020 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.

The Massachusetts Legislature has a Health Equity Task Force that makes recommendations to the legislature. Since August 2020, the task force has received weekly presentations from stakeholders engaged in health equity efforts. The task force is currently working on a final report.

Massachusetts is spending $1 million on a grant program to support vaccination efforts in historically underserved communities through the Massachusetts League of Community Health Centers. Health centers can apply for up to $25,000 to educate community members about the vaccine. The Massachusetts Department of Public Health is being deployed to 20 cities and towns that have been disproportionately affected by the pandemic to help reduce barriers to being vaccinated.

Massachusetts’ COVID Vaccine Equity Initiative publishes weekly highlights of its initiatives to reach the 20 hardest hit cities and towns in Massachusetts.

·       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 and meets bi-weekly.

The Racial Disparity Task Force released a report on Jan. 22, 2021 highlighting research and strategies with the goal to get 70% of Michiganders 16 and older by December 31, 2021.

The state made $20 million available to 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. To date, 33 organizations received a total of $17.6 million dollars.

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.

As part of the Whitmer Administration’s commitment to improving equity, highlighting the need demonstrated during the pandemic, they  announced a new implicit bias training required for new licensed health care workers in the state, to go into effect on June 1, 2022.

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 officials 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 its 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, Native American residents, LGBTQ residents, and residents with limited English proficiency.

In February 2021 the University of Minnesota launched a Center for Antiracism Research for Health Equity through a gift from Blue Cross Blue Shield of Minnesota. Rachel Hardeman, MPH, PhD, will lead the center.

In March 2021, Gov. Walz announced a partnership between the state and the Minnesota Electronic Health Record Consortium to publish vaccination data on the state’s COVID-19 Vaccine Data Dashboard. The dashboard “will inform additional, targeted strategies to ensure the equitable distribution of vaccine to Minnesotans of all races and ethnicities, including communities disproportionately impacted by COVID-19 as a result of systemic inequities.” Minnesota had targeted its initial equitable vaccine distribution strategy on zip codes with high social vulnerability index (SVI), and is moving towards a more general equity-focused approach as the rates of vaccination in these vulnerable areas more closely match the general rates.

·       Tribal governments

·       Long-term care facilities

·       Correctional facilities

·       Rural health

·       Pharmacies

·       Homeless shelters

The coordination team will ensure that its partners and communities receive current information about the vaccine, provide training to providers, and make outreach to critical at-risk populations.

The governor’s initiative will include a partnership with Clark County Emergency Management and Southern Nevada Health District for equitable vaccine distribution.

Nebraska’s Department of Health and Human Services’ Office of Health Disparities and Health Equity hosted an inaugural Conference on Health Equity in April 2021.

·       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 its 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

In late February 2021, the New Mexico Department of Health announced a vaccine equity plan. The plan includes equitable allocation, distribution, and access, a communications plan, and effective community engagement, monitoring, and evaluation.

·       NYC Department of Health and Mental Hygiene;

·       NYC health agencies and hospitals;

·       Office of the Mayor;

·       NYC Test and Trace Corps;

·       NYC Department of Education;

·       Community and faith-based organizations;

·       Clinical and non-clinical businesses; and

·       Community boards and other local elected officials

The initiative seeks to expand to other NYC neighborhoods that are disproportionately impacted by COVID-19.

In December 2020, Gov. Cuomo launched New York’s Vaccine Equity Task Force to assist him on equitable distribution of the COVID-19 vaccine.

·       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.

NCDHHS created a tool that maps social vulnerability and vaccination rates by census tract. The tool encourages providers and partners to focus their outreach efforts. Healthier Together: Health Equity Action Network, is a private-public partnership that uses the tool to increase the number of Black, Indigenous and People of Color (BIPOC) and other historically marginalized populations receiving the COVID-19 vaccine. The initiative also provides grants to community-based organizations and regional health equity teams. The program is funded by federal COVID-19 dollars.

·       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 In August 2020. 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.

In November 2020, Gov. Mike DeWine appointed Jamie Carmichael as the Chief Health Opportunity Advisor. The position will support the findings of the Minority Health Strike Force.

The Vulnerable Populations Data Project provides local health departments data to assist providers identify communicates with high social vulnerability. Vaccine providers are encouraged to focus on these areas for their outreach.

·       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. The council began meeting in December 2020 and Gov. Brown announced over $280 million in investments prioritized by the council in her 2021 State of the State address. This funding will support access to affordable childcare, expansion of behavioral health services to Oregonians regardless of immigration status, $20 million in housing initiatives, and economic justice.

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.

The Pennsylvania Department of Human Services (DHS) released a Racial Equity Report at the beginning of 2021 that identified ongoing work and next steps in the areas of diversity, inclusion and equity initiatives, health equity, economic justice, early childhood education child welfare, and juvenile justice within the department and for individuals served by DHS.

·       Community support;

·       Health and safety needs;

·       Culturally competent communications;

·       Testing accessibility; and

·       Contact tracing and data strategies.

• Identify gaps in vaccine allocation and utilization and make recommendations for deploying resources to fill those gaps;
• Offer recommendations on how to best engage underserved communities; and
• Assist in connecting community groups and leaders with vaccine providers.

The Tennessee Department of Health has created surveillance dashboards for special populations, including a COVID-19 pregnancy dashboard, a COVID Disparities Dashboard, and tracking COVID-19 cases in school-aged children.

The Texas Department of State Health Services is using $45 million in federal funding to create the Office of Health Equity Policy and Performance. The office will work across agencies and focus on vulnerable populations.

In December 2020, Gov. Gary Herbert and racial equity leaders launched the Utah Compact on Racial Equity, Diversity and Inclusion. The compact includes anti-racist principles and actions to create equal opportunity. Current Gov. Spencer Cox also signed the compact.

Gov. Cox’s One Utah Roadmap released in January 2021:

·       Identifies and invests in priority services and infrastructure needs that impact social determinants of health;

·       Develops a statewide health equity plan charged to evaluate systemic changes that address health disparities; and

·       Expands opportunity and improves life outcomes for people with historically and systemically less access to opportunity, including women, people of color, and LGBTQIA+ individuals.

Utah published a report, Striving Towards Equity: Utah’s COVID-19 Vaccine Distribution Roadmap in March 2021. The roadmap is intended for providers, local officials, and community groups to equitably distribute the vaccine.

·       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 released reports in September 2020 and January 2021. The first report outlined recommendations for housing, language access, public health, emergency response, broadband internet, employment law, and school discipline. The second report identifies structures to support racially diverse populations, current laws regarding hate speech, and makes recommendations to encourage Vermonters from diverse backgrounds to run for public office.

In May 2021, Gov. Scott signed legislation that:

–           Establishes an Office of Health Equity and Health Equity Advisory Committee;

–           Issues grants to promote health equity;

–           Improves data collection to understand health disparities; and

–           Requires cultural competency training in medical education.

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.

Gov. Northam and Janice Underwood, PhD, Virginia’s Chief Diversity Officer released the One Virginia Plan, a strategic plan to “advance visible diversity, equity and inclusion across state government.” The plan includes supporting state agencies in understanding the role of systemic inequity, increasing diversity at all levels of government and promoting community engagement.

During the 2021 session, the Virginia General Assembly passed HB 1993 to require state agencies to develop diversity, equity and inclusion plans in coordination with the chief diversity officer. The Virginia General Assembly also passed HB 1990 to allow committee members to request racial and ethnic impact statements from the Joint Legislative Audit and Review Commission for criminal justice legislation. Gov. Northam’s budget includes additional funding for historically black colleges and universities, Virginia State University and Norfolk State University.

Virginia’s Health Equity Leadership Taskforce created two dashboards to advance health equity. The Equity in Action dashboard describes how the state is prioritizing equity in COVID-19 response and recovery and the Equity-at-a-Glance dashboard is an assessment of six social determinants of health at the state and local level. The dashboard shows data on income and poverty, educational attainment, food access, unemployment, broadband access, and housing insecurity.

·       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)

HB 1783 created the Office of Equity within Inslee’s administration. Gov. Inslee’s 2021 budget proposal includes $365 million for equity initiatives, including the Equity Office which will include eight staff members to “develop and implement a five-year equity plan for the state and assist agencies in developing their own diversity, equity and inclusion plans.” Other initiatives include establishing Juneteenth as a legal holiday, mandating independent investigations of police use-of force, funding the Immigrant Relief Fund, banning insurance decisions based on credit scores, and investments in communities of color.

In May 2021, Gov. Inslee signed legislation to create Health Equity Zones, community coalitions to address health disparities guided by data. The state will provide technical assistance and funding, if available, to community leaders to develop effective programs toa ddress health inequity. The program is based on Rhode Island’s model.

Since May 2020, the task force has met weekly to review COVID-19 data on racial and ethnic disparities.

Gov. Tony Evers appointed 30 nonprofit, tribal, religious, community organization, and governmental members to his Advisory Council on Equity and Inclusion in February 2021. He is also proposing legalizing marijuana and investing the $80 million in annual tax revenue into underserved communities and school districts through a Community Reinvestment Fund.