As COVID-19 continues to wreak havoc across the country and daily case counts exceed 150,000, many states are working to confront long-standing racial and ethnic disparities that the pandemic is laying bare.
While states are taking immediate action to address the health and economic consequences of the pandemic and preparing to distribute vaccines, their new approaches to health equity are critical first steps toward identifying and addressing systemic issues of discrimination, structural racism, and health care under-service that have led to COVID-19 disparities, and developing informed policies that advance equitable solutions.
States recognize that immediate action is needed to ensure that new strategies will reduce – rather than unintentionally exacerbate – the disparities among populations with disproportionate risk. Disparities will not be addressed without investing time and effort into learning from data and evidence, listening to the voices of populations most affected, and developing culturally competent responses.
State justice and equity task forces are being tasked to provide inclusive and transparent approaches to address persistent and historic circumstances that put some racial and ethnic minority populations at higher risk. Reducing health disparities and improving health equity in the face of COVID-19 is complex work that requires states to:
- Use data-driven approaches;
- Meaningfully engage communities of color directly impacted by COVID-19; and
- Develop culturally responsive policies and interventions to address the root causes of inequities.
The latest update to the National Academy for State Health Policy’s (NASHP) interactive map, How States Collect Data, Report, and Act on COVID-19 Racial and Ethnic Disparities, shows more states are developing strategies and infrastructure to address these health equity issues. NASHP’s map shows 18 states that created task forces to address the high rates of COVID-19 cases and deaths in communities of color are continuing to enhance data-gathering and elevate issues by establishing new agencies and making high-level appointments. They are building strategies and infrastructure to address the issues of equity through meaningful action today and after the pandemic.
As a first step, many states have enhanced tracking and analysis of racial data to improve the identification of COVID-19 disparities, increase transparency, and inform their interventions. Examples include:
- The Louisiana COVID-19 Health Equity Task force plans to create a health equity dashboard to measure progress in ensuring testing is available for all communities and providing the medical community with best practices.
- Massachusetts’ Task Force on Coronavirus and Equity compiled a repository of policies they support, including ensuring housing security and safety, securing worker rights, and implementing data collection and action planning for equity.
- New Jersey’s Department of Health improved its COVID-19 data tracking and added cases defined by race/ethnicity to the state dashboard.
- Tennessee’s Department of Health and Office of Minority Health’s Health Disparity Task Force recommended creating surveillance dashboards for special populations to inform responsive solutions and policies to reduce disparities. The task force implemented three COVID-19 surveillance dashboards that track pregnancies, disparities, and cases among school-aged children.
Two state’s attorneys general have taken actions to address racial equity through the justice system:
- Maryland Attorney General Brian Frosh created a COVID-19 Access to Justice Task Force to develop strategies and solutions for low-income Marylanders and communities of color who are disproportionately facing civil legal challenges due to COVID-19.
- The Massachusetts Office of the Attorney General released a report, Building Towards Racial Justice and Equity in Health: A Call to Action, that highlights the disproportionate toll the pandemic has taken on communities of color. The report calls for action in key areas:
- Collecting data for identifying and addressing health disparities;
- Equitable distribution of health care resources;
- Using telehealth as a tool for expanding equitable access to care;
- Health care workforce diversity; and
- Identification of social determinants of health and root causes of health inequities.
Other governors have worked to address racial disparities and create sustainable change:
- Michigan Gov. Gretchen Whitmer recently created the Black Leadership Advisory Council. This council is designed to bring 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.
- Ohio Gov. Mike DeWine created the Ohio Governor’s Equity Advisory Board. This will be a permanent board that will guide leaders to address underlying conditions that contribute to outcomes disparities.
In addition to these strategies, COVID-19 vaccine distribution plans will provide another opportunity for states to address COVID-19 racial disparities. Mitigating health inequities and promoting justice are two of the four ethical principles that the nation’s Advisory Committee on Immunization Practices (ACIP) has established to guide its decision-making process if vaccine supply is limited. With the anticipated arrival of the COVID-19 vaccine, states are following suit with their vaccine distribution plan, focusing on an equitable distribution by identifying critical populations at high risk of infection.
The continued disparities underscore the urgency of immediate state responses to address issues of equity that the COVID-19 pandemic has laid bare, but without continued and focused investments, these important issues will not be solved. Strategies to track and respond to COVID-19 racial and ethnic disparities in case counts and deaths have catalyzed state actions that can continue beyond the pandemic. Indeed, states can set the stage for sustainable change as they:
- Improve data tracking, analysis, and transparency;
- Develop strategies to address racial equity through the health, human services, and justice systems; and
- Identify ways to meaningfully engage people of color in developing culturally responsive policies and interventions.
NASHP will continues to track and monitor COVID-19 response and engage with states to identify and spread promising practices to advance health equity.