The Historic Opportunity COVID-19 Presents to Address Health Equity

November 24, 2021 | Marcus Plescia

Manhattan skyline at night, from the water

I recently attended the premiere of The First Wave, a documentary about the COVID-19 outbreak in New York City from April to June of 2020. It was a harrowing account of the pandemic’s impact on health care workers, as well as its disproportionate impact on people of color and those with limited social and financial resources.

The disparities experienced during the COVID-19 pandemic have brought a national focus to health equity. The attention and resources currently being provided to help address health inequities provide an opportunity that I have never witnessed in my public health career. Last summer, CDC provided $2.25 billion in grants to all states and territories to build and expand capacity and services to improve health equity. Major investments for CDC and national organizations, including ASTHO, will provide the continued support and technical assistance for this work.

In response to these investments ASTHO will review state and territorial workplans, support state technical assistance requests and engage consultants with specialized expertise. ASTHO has also developed a technical package to support state and territorial health equity initiatives. The purpose of the technical package is to take a more proactive approach to our technical assistance role. The technical package is based on an assessment of evidence-based interventions, expert recommendations and a review of current state activities to address health equity. Based on this assessment ASTHO has prioritized specific areas of work outlined below that we will focus on with all states.

Our efforts will focus on improving our collection of accurate race and ethnicity data. Public health cannot address inequities in access to services, quality of care and health outcomes without these basic demographic data. The completeness of many COVID-19-related datasets have improved substantially during the pandemic through mandates and data modernization efforts. But it will require clear directives, ongoing prioritization and insistence from state public health leaders to achieve comprehensive race and ethnicity data across all states and extend these practices to other datasets and conditions beyond COVID-19.

We will also work with states, NACCHO, and the newly formed National Association of Community Health Workers (NACHW) to expand and support the community health worker (CHW) workforce in state and local public health departments. CHWs are one of the few interventions shown to both improve outcomes and reduce disparities, and at least two thirds of states have indicated they will expand this work force in their workplans. ASTHO will work with health officials and our human resource leader peer group to identify standardized job descriptions, hiring practices and career ladders, and to develop and structure contractual services to engage CHWs through community-based organizations. We will support NACHWs efforts to develop and serve its membership and create CHW registries in states. We will also work with states to expand CHW interventions beyond COVID-19 to address behavioral health, maternal mortality, child well-being, and chronic disease risk factors.

Finally, we will engage with state leaders to address social determinants of health. We will focus these efforts on policy interventions to promote economic mobility and health through expanded access to paid family and sick leave. Our emerging policy statement on family and sick leave will define this approach, and we will work with states to expand and support these benefits, track related policy interventions and advocate to policymakers.

The current federal resources are a historic opportunity to build the capacity of state and territorial health agencies to focus specifically on health equity. The resources are still comparatively modest, the timeline is limited, and we are distracted by the ongoing pandemic. But we have an opportunity to build momentum for the first time in decades if we can focus on implementing evidence-based strategies, demonstrating change and documenting our progress.