Inequity and the path to change

We knew that we had issues with racism and health inequity long before the events of spring 2020. The long-standing issues of police misconduct and health inequity born of racism in America have a more than 400-year history. The savage beating of Rodney King 29 years ago and the failure to hold police accountable should have changed our conversations about race.

W.E.B. DuBois sounded that alarm back in 1906 and noted the role of what we now term the social determinants of health:
With improved sanitary conditions,
improved education, and better economic
opportunities, the mortality of the race may
and probably will steadily decrease
until it becomes normal.
Social determinants of health, the conditions in which people are born, live, work and play, explain 60–80% of health disparities.

COVID-19 exposes the inequities born of an inability to sustain collective action focused on addressing systemic racism. It is, unfortunately, not a shock that as of Aug. 5, African Americans accounted for approximately 25% of COVID-19 deaths but are only 13% of the U.S. population.

Also, it is not surprising that a recent analysis by “ABC News” and FiveThirtyEight indicated that individuals in predominantly Black and Latinx communities experienced longer wait times for testing than those in wealthy, predominantly white neighborhoods. Although not surprising, these statistics seem to be motivating communities to action.

The work of the Institute for Public Health

Every member of every community has a role to play in addressing the racism that contributes to disparities in disease, including COVID-19. The Center for Community Health, Partnership and Research (CCHPR), part of the university’s Institute for Public Health (IPH), works to reduce disparities and improve health and wellness in the region by supporting collaborations among institutions and organizations. As co-director of CCHPR, I am able to see diverse communities coming together to accept that responsibility.

Community engagement promotes research, programs and policies that drive improvement through mobilization and organization of resources. The partnership approach to change suggested by community-engaged scholars improves community acceptance and implementation of behaviors that can mitigate the spread of COVID-19. To accomplish this level of community engagement and participation, the IPH has increased its efforts to work with diverse institutions and organizations in the St. Louis region and its focus on research to address the disparities faced by communities of color.

When the pandemic started, faculty with infectious disease expertise, as well as faculty and staff from the Dissemination and Implementation Center and from the Public Health Data and Training Center, extended their partnerships with local health and public-health institutions to support planning efforts and data monitoring and management.

Recognizing that health inequity is socially determined, the IPH funded seven research projects aimed at social and policy countermeasures in health to mitigate the spread and negative impact of COVID-19. These projects focus on communities disproportionately affected by the virus, particularly racial and ethnic communities. Several of these projects receive direct support from CCHPR and Public Health Data and Training Center faculty and staff. In addition, CCHPR has supported efforts to ensure that COVID-19 information is available in a variety of languages and routinely shares relevant information with its partners. Partnership and sustained community effort are key components for our path forward.

The path forward

We are acting in ways that address the crises of race and COVID-19. We know that we see inequity in the distribution of key social determinants — such as education, employment and wealth accumulation — just as we see disparities in the health outcomes that they drive. The research, services and support that we have provided are much-needed interventions to address the consequences of centuries of racism. However, addressing the social determinants themselves moves us further along the path to equity. To achieve equity, we must be willing to intervene directly on the social determinants and the practices and policies that sustain the system of inequity. Unaddressed, the systems that drive inequity will recreate disparities each time we have a need to tackle a disease or crisis. Are we willing to commit to a sustained effort to dismantle these practices and policies, in addition to providing redress?

— Vetta Thompson serves as co-director of the Center for Community Health, Partnership and Research in the Institute for Public Health.

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