COVID-19 has illuminated racial and ethnic disparities across the country and simultaneously created new momentum for state leaders to address the root causes of racial inequity. COVID-19 case data has made the disparities — driven by systemic racism and inequitable economic and social conditions — increasingly blatant. In response to the dual crises of racism and COVID-19, many state leaders are working to address the inequities leading to disproportionate outcomes for communities of color.
A new section of 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, highlights how states are approaching this issue. Eighteen states have activated task forces to address the high rates of COVID-19 cases and deaths in communities of color and their recommendations include:
- Additional protections and compensation for employees who are put at increased risk of COVID-19 due to the nature of their jobs;
- Additional collection, analysis, and transparent release of COVID-19 demographic data;
- Targeted distribution of personal protective equipment (PPE), testing, and treatment resources to communities most impacted by COVID-19;
- Formal methods for the incorporation of community-based organizations and community voices into state and local decision-making processes;
- Increased efforts to make COVID-19 informational materials multi-lingual and accessible;
- Increased focus on affordable and stable housing for those most impacted by COVID-19; and
- Increased public health funding and the continuation of services that support and prioritize communities of color.
NASHP will continue to monitor state task forces to identify recommendations that are incorporated into state policy. States are also using new funding streams, implementing innovative technology solutions, and targeting resources to where they are most needed:
- North Carolina: The North Carolina Department of Health and Human Services (NCDHHS) awarded grants to five local organizations to help address the disparate impact that COVID-19 is having among the state’s Latinx communities. Additionally, Gov. Roy Cooper issued an executive order to address the disproportionate impact of COVID-19 on communities of color. The order:
- Tasks the North Carolina Pandemic Recovery Office with ensuring the equitable distribution of pandemic relief funds;
- Prioritizes historically underutilized businesses for state contracts and resources for recovery;
- Directs NCDHHS to ensure all communities have access to COVID-19 testing and related health care; and
- 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, and the North Carolina National Guard to assist with mass testing of food processing and migrant farm workers.
- Virginia: Gov. Ralph Northam announced a pilot program in Richmond to increase access to PPE in underserved communities . The new Health Equity Leadership Task Force is leveraging data to prioritize areas experiencing disproportionate impacts of COVID-19 and working with the City of Richmond to establish policies and programs that include an equity lens.
- Ohio: A new position will be created within the Ohio Department of Health dedicated to social determinants of health and opportunity. This position will build on existing efforts and work directly with local communities on their specific long-term health needs and Ohio’s response to COVID-19. This position will also collect data to inform best practices and assist in implementation of the Minority Health Strike Force’s recommendations.
- Illinois: The Illinois Department of Public Health created a multi-departmental COVID-19 equity team to address health disparities. The equity team 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 the coronavirus and how to protect themselves.
- Louisiana: Gov. John Bel Edwards announced he is making $500,000 from the Governor’s COVID-19 Response Fund available to the Louisiana COVID-19 Health Equity Task Force to examine the causes and possible solutions to the high rate of deaths within Louisiana’s African American community and other impacted populations.
- Massachusetts: Gov. Charlie Baker signed a bill into law that requires the collection of vital public health data — information that would provide additional detail about the impact of COVID-19 on minority communities — and establishes a COVID-19 Equity Task Force.
- Washington, DC: The Equity, Disparity Reduction, and Vulnerable Populations Committee is part of Reopen DC’s advisory group. The committee assembled a set of recommendations describing how to ensure equity during reopening.
- West Virginia: Gov. Jim Justice and the Department of Health and Human Resources also announced a plan to increase COVID-19 testing opportunities for minority populations and other vulnerable populations in counties that have both a large minority population and evidence of COVID-19 transmission.
The disproportionate impact of COVID-19 makes it more clear than ever that racism is a public health issue with implications for state health policy. As states continue to grapple with COVID-19, many, like those in the examples above, are focusing on how to address immediate disparities related to the pandemic.
States are beginning the process of setting in place strategies to address the preexisting racial and ethnic disparities that worsen outcomes for people of color. New positions dedicated to addressing social determinants of health and opportunity; multi-departmental equity teams; enhanced collection and reporting of data; and public health services that support and prioritize communities of color are key strategies to ensure equity issues remain part of states’ agendas. NASHP will continue to track how states approach this work and how they measure change and success over time.
Support for this work was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the foundation. Thanks to NASHP’s Population Health Team for their contributions to this analysis.
The brutal deaths of Breonna Taylor, Ahmaud Arbery, George Floyd, and countless people of color before them, and the shocking disparities in death rates from the coronavirus, are tragic examples of the still pervasive racism in America. For organizations like NASHP, it is not enough to speak out – we need to redouble our efforts, along with our state partners, to combat racism and ensure health equity. NASHP pledges to more intently listen to Black voices, to work harder to frame policies rooted in the experiences of communities that have been disenfranchised for far too long and, most importantly, to make way for, seek out, and support Black leadership in state health policy. We won’t achieve the change we need until we first change ourselves.
Health Equity Resources
COVID-19 and Health Equity
American Medical Association: Why African American Communities Are Being Hit Hard by COVID-19, May 13, 2020. Join a virtual town hall hosted by the AMA and the National Association of Black Journalists exploring COVID-19 and the black community, moderated by NABJ President Dorothy Tucker, an investigative reporter for CBS 2 Chicago (WBBM-TV).
Journal of the American Medical Association: COVID-19 and Health Equity — A New Kind of “Herd Immunity,” May 11, 2020. Segregation of health care also contributes to racial disparities in health care. COVID-19 testing centers are more likely to be in well-off suburbs of predominantly white residents than in low-income neighborhoods that are predominantly Black. The advice to obtain testing through a primary care clinician limits access to testing for people who lack one. Improving access to care for all and ensuring high-quality care, with greater focus on under-resourced settings and vulnerable groups, is an important “treatment” for racial disparities in health.
American Medical Association FAQs: Health Equity in a Pandemic, April 2020. Marginalized and minoritized patients have and will suffer disproportionally during the COVID-19 crisis. The AMA is answering frequently asked questions on health equity in the pandemic response to equip physicians with the consciousness, tools and resources to confront inequities.
American Medical Association You Tube Health Equity Discussion: Physicians Detail COVID-19’s Impact in Latinx Communities, May 21 2020. More than 28 percent of people diagnosed with COVID-19 are Latinx. Aletha Maybank, MD, MPH, chief health equity officer and group vice president of the AMA, joins four Latinx physicians to discuss how the coronavirus has impacted their communities.
Police Violence Impact on Community Health
UNC Center for Health Equity Research: Health Equity Implications of Police Violence, August 2017. As of August 2017, the US is on track to approach 1,000 deaths of civilians at the hands of police for at least the third year in a row. This brief provides an overview of existing evidence documenting police-related killings of civilians, and suggests key strategies to mitigate the disparate health impacts resultant from those acts of violence.
The Lancet: Police Killings and their Spillover Effects on the Mental Health of Black Americans: A Population-Based, Quasi-Experimental Study, July 28, 2018. Police kill more than 300 Black Americans — at least a quarter of them unarmed — each year in the United States. These events might have spillover effects on the mental health of people not directly affected.
American Psychological Association PsycNet: Black and Blue: Exploring Racial Bias and Law Enforcement in the Killings of Unarmed Black Male Civilians, April 2016. The report attempts to disentangle racial bias from common characteristics of law enforcement agents (e.g., social dominance orientation), while also addressing the interaction between racial bias and policing to more effectively identify and develop solutions to eradicate excessive use of force during interactions between “Black” (unarmed Black male civilians) and “Blue” (law enforcement).
American Journal of Public Health: Unequal Burdens of Loss: Examining the Frequency and Timing of Homicide Deaths Experienced by Young Black Men Across the Life Course, July 2015. A study of the frequency and developmental timing of traumatic loss resulting from the health disparity of homicide among young black men in Baltimore.