How to Address COVID-19 in Communities of Color

June 03, 2020 | ASTHO Staff

The statistics of who is dying from COVID-19 paint a glaring picture and highlight the ever-growing health disparities that exist in communities of color. The mortality rate for African Americans is 2.4 times higher than whites and 2.2 times higher for Asians and Latinos. In addition, although African Americans represent 13 percent of the U.S. population, they represent 25 percent of the deaths. This health disparity is also becoming more prevalent among Latinos, particularly in states and localities where a predominant number of "essential workers" are Latino. As it pertains to the Native American population, the effect on those communities is also troubling because local tribes suspended the services—like casinos and other private enterprises—that often fund vital community programs.

These health disparities have become a focus area for Congress during COVID-19 response activities. In May, the House Ways and Means Committee held a hearing to examine “The Disproportionate Impact of COVID-19 on Communities of Color.” In addition to being the first virtual committee hearing of the U.S. House of Representatives, the full committee hearing spoke about the history and experiences of communities of color, with respect to the coronavirus.

In this hearing, Ibram X. Kendi, the founding director of The Antiracist Research & Policy Center at American University provided a history of racism and racial disparities. He argued that the prevalence of racist policies have led to the health disparities in COVID-19 deaths. He challenged policy makers to advance policies that push non-racist policies, with the goal of liberating people of color from infection and death.

Similarly, James Hildreth, the president and CEO of Meharry Medical College, presented a plan to utilize professionals from four Historically Black College and University (HBCU) medical schools to provide expanded testing, contact tracing, surveillance, training of front-line health workers, and research/drug development to address to address the needs of communities of color. By utilizing professionals from HBCUs like Meharry Medical College, Howard University College of Medicine, Morehouse School of Medicine, and Charles R. Drew Medical School, they can provide culturally competent care—which has been proven to result in better health outcomes.

Minority populations are also more likely to be considered "essential workers," which contributes to the disproportionate impact on minority populations. Raynald Samoa, an endocrinologist with City of Hope in Los Angeles, testified about the number of Pacific Islanders who work in "essential" jobs, which directly places them at higher risk. He proposed the following three steps: provide funding for evidence-based initiatives to fight the coronavirus in Pacific Islander communities, fix legislative oversights that have led to inequities, and restore Medicaid Compact of Free Association Communities.

Alicia Fernandez, a professor of medicine at the University of California San Francisco, described the impact of the coronavirus on the Latino population and implored members of the committee to protect industries/small businesses by mandating self-distancing and use of appropriate PPE at employment, require comprehensive data on testing, extend provisions in the CARES Act related to wage replacement, ensure that information collected during contact tracing is safe and not used for the prosecution of those that may be living in the United States illegally, and support efforts to expand culturally competent community health workers.

Finally, Thomas Dean Sequist, Chief Patient Experience and Equity Officer at Mass General Brigham and Professor of Medicine and Health Care Policy and Harvard Medical School, compared his experience working in the Navajo Nation and Chelsea, Massachusetts. Overall, residents in both communities are fighting for their lives and dignity. He cites racism, the lack of access to grocery stores, individuals suffering from health conditions at home without care, and crowded living as the major problems. He recommended funding public health programs within these communities, increasing funding for the Indian Health Service, as well as infrastructure in both native and non-native communities, and supporting programs that increase healthcare provider supply in diverse communities.

A few themes that emerged during the question and answer portion of the hearing included the importance of addressing barriers (language, immigration, financial, etc.) that prevent people of color from seeking healthcare, scaling up testing and contact tracing efforts to better understand the scope of deaths and confirmed cases, and considerations for providing telehealth services. Other members were interested in strategies to reopen the economy, improve the cultural competencies of medical professionals and providers, and how to address other disparities in communities such as lack of access to safe drinking water and broadband internet.

There is still much we can learn about coronavirus in communities of color. The CDC recently provided $10.25 billion to state, territories, and local jurisdictions that will likely help in better identifying the extent of the coronavirus across the country. There is also activity happening within state and territorial health departments to enhance data dashboards used to inform decisions on the re-opening of communities. The seriousness of this matter requires a "whole of government" approach to ensure that racial and health disparities within communities of color are addressed not only considering the current pandemic, but with other chronic diseases and conditions.