We must consider this coronavirus crisis as a wake-up call to prioritize equity and challenge ourselves to consider how to better serve historically underserved communities, says a public health expert at Washington University in St. Louis.
“In the middle of a pandemic, it is easy to overlook health equity,” said Darrell Hudson, associate professor at the Brown School.
Health equity, Hudson said, means that everyone — regardless of their identity, including race/ethnicity, gender and social class — has the opportunity to reach their optimal level of health.
Health equity for many was problematic before the pandemic.
“Health does not simply mean that people are not sick or have a disease. Health is comprehensive and encompasses so much,” Hudson said. “In fact, many patients seeking care do not actually care much about health. How can they when their bandwidths are exhausted? Most people are consumed with day-to-day functioning.
“They care about their jobs, providing for their families, paying bills, and other social and economic concerns. This is even more problematic right now for families that are struggling with sudden, drastic changes in employment and financial strain.”
What effect will the pandemic have on such families?
“There is often a misalignment between the messages that public health and medical professionals seek to deliver to the public, especially people who have been historically marginalized and who are most vulnerable,” Hudson said. “Presently, the public health message being disseminated across the country is to observe social distancing guidelines — to stay home and avoid contact with large groups of people. How does this messaging affect citizens who do not have adequate resources to purchase additional food and supplies, especially if they have growing children at home for three meals a day?
“Simultaneously, these families may have jobs in industries that are not shuttered or operating at barebones capacity to observe the social distancing guidelines. How will these families get the resources they need if they cannot work?”
Health inequity already has taken a toll, Hudson said.
“Racial and socioeconomic inequity in the social and built environment has already affected the health and well-being of marginalized communities,” he said. “For example, the risk factors associated with illness due to coronavirus include obesity ─ a whopping 76% of black Americans are overweight or obese. Another risk factor is chronic disease. Over 60% of black Americans age 50 and older have high blood pressure and 23% have diabetes.
“Black Americans experience chronic disease at earlier ages and are more likely to die prematurely compared to whites. Scholars have found that black Americans experience greater stress and trauma across the life course, compared to whites. Therefore, their immune systems may be functioning less effectively due to chronic stress, making them more susceptible to chronic disease as well as infections.
“The confluence of these factors is placing a tremendous burden on communities of color and people with low socioeconomic status. We have already failed these communities before COVID-19. What will happen if the highly contagious COVID-19 is widely transmitted in communities that do not have equitable access to healthcare services much less the social and economic resources that could help mitigate the spread of the virus in the first place?”
This outbreak, among other changes, may provide the “wake-up call” that there is a health gap based on income and privilege as well, Hudson noted.
“Dr. Martin Luther King Jr. once stated that it seems like a cruel jest to tell a bootless man to pull himself up by his bootstraps. We must be mindful of our public health and medical messaging and whether people can comply with what we are asking,” he said. “And if they are not able to adhere to guidelines, we should interpret that as a societal failure to ensure that everyone has equitable opportunities to achieve their highest level of health.
“To be frank, we are a long way off from health equity in our society, much less our region. And we have yet to see what the effects of COVID-19 transmission could be on historically marginalized communities. We must consider this crisis as a wake-up call to privilege equity and challenge ourselves to consider how to better serve historically underserved communities.”
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