Health Equity During COVID-19: Top Strategies for an Equity-Focused Recovery Strategy

May 21, 2020 | Anna Bartels

The COVID-19 pandemic has exposed the depth of health inequities in our country. Low-income and marginalized communities are experiencing a disproportionate burden in terms of both health outcomes and economic impact. At the same time, COVID-19 has reinforced the message that disease impacts entire communities and that we are all interdependent on one another. The pandemic has generated awareness of the importance of building community resiliency and brought about an influx of federal funding, which offers an opportunity to advance equity in prevention, social determinants of health, and healthcare.

On May 19, ASTHO, in partnership with the National Association of State Offices of Minority Health (NASOMH), Big Cities Health Coalition, and NACCHO, hosted a tele-town hall on COVID-19 recovery and resilience. The event was moderated by Gail Christopher, executive director of the National Collaborative for Health Equity and featured Gerd Clabaugh, Director, Iowa Department of Public Health; Brenda Jagede, Office of Equity and Minority Health Manager, Michigan Department of Health and Human Services; Angelina Esparza, COVID-19 Senior Regional Advisory, CDC Foundation; and Antoinette Holt, Director, Office of Minority Health, Indiana State Department of Health and Past President, NASOMH. Based on their conversation, here are the key considerations to develop an equity-focused recovery strategy:

Bring in the community’s voices from the very beginning

Health is local. Communities should be empowered and involved in the recovery process from the very beginning, not as an afterthought. Michigan’s governor, for example, issued an executive order to establish the Michigan Coronavirus Task Force on Racial Disparities, which was tasked with performing outreach to all stakeholders including to community leaders. Michigan’s Department of Health and Human Services also recognized that not everyone has access to online resources, so communications materials are provided in a variety of formats—including print and radio—and languages.

As part of community engagement, state and territorial health agencies (S/THAs) should also consider who their “messengers” are and bring in people with lived experience. Community health workers (CHWs) are an existing frontline workforce, who can enhance the public health response. As members of the community they serve, CHWs can share valuable perspective on communities’ needs and offer input on how to adapt policies and services to be most meaningful.

Understand the data first, then plan ahead

Local data—even neighborhood and street-level data—is an important asset in creating tailored interventions to address COVID-19. States and localities are using tools, including CDC’s social vulnerability index, to layer COVID-19 cases against data on poverty, access to transportation, housing, race/ethnicity, language, and socioeconomic status. This type of analysis can identify communities that need higher levels of funding and targeted resources both during and after COVID-19. For example, Angela Esparza highlighted how Houston officials found that their COVID-19 cases match closely with zip codes with poor social determinants of health. Data of this sort can identify community-level barriers to health before a crisis even occurs, and it can now help public health leaders monitor whether those barriers are addressed or become heightened over the course of the response.

Remember we can go further if we go together

COVID-19 makes communication challenging but critical. Partners can help state and territorial health agencies more effectively tailor their messaging or open doors to reach marginalized communities. For example, Gerd Clabaugh highlighted how the Iowa Department of Public Health has partnered with the business and manufacturing sector, especially within the meat packing sector which employs many individuals who are not English-speaking. Iowa has also initiated partnerships with other state agencies, including the Department of Human Rights and Homeland Security and Emergency Management, to assist with communication efforts. Other states are also reaching out to community-based organizations and ethnic media outlets to build trust and ensure their messaging is reaching those most impacted.

Antoinette Holt also shared how the partnership between the Indiana Minority Health Coalition, Interagency Council on Black and Minority Health, and State Department of Health’s Office of Minority of Health allows them to each contribute unique resources to address common priorities, including testing, contact tracing, and behavioral health. Some partners have the flexibility and resources to conduct activities that state public health cannot, such as offering direct services or providing testimony on key issues to the state legislature. As Clabaugh said, “it’s not possible for us to address health equity challenges without the partnership and resources of the other agencies coming to bear, too.”

We need transformative change to build a better, more equitable system

Now is the time to strategize about how to work across sectors, address the long-term health and social needs of a community, and remove structural barriers to health for socially vulnerable populations. For instance, states and localities have widely prohibited evictions during the COVID-19 response, but housing insecurity and homelessness are likely to emerge as a major issue once restrictions are lifted and will need to be addressed in a coordinated fashion. States may also experience pent up or increased demand for physical and mental healthcare services, requiring attention on improving access to care. Public health agencies also identified a key area of improvement as building capacity to reach individuals who are undocumented and connect them to support and care.

Public health leaders—equipped with community input, data, and cross-sector partnerships—are well positioned to think about what is needed to address health equity issues beyond this immediate crisis to build a transformed society. COVID-19, despite its immense challenges, presents that critical window of opportunity. Gail Christopher shared a proverb to stress this point: “To stumble is not to fall but to move forward faster.”