In North Carolina, Ohio and Virginia, state officials have appointed groups specifically tasked with reducing racial disparities as they emerge from the first phase of the coronavirus pandemic. Rhode Island and Washington have incorporated equity metrics in their reopening plans.
And in Chicago, the city has committed $56 million to help community-based organizations develop localized contact tracing programs. The city also partnered with hospitals on a ZIP code-driven health initiative to mitigate the impact of COVID-19 on black and Hispanic communities.
These efforts — flagged in new research from Princeton University’s State Health and Value Strategies program and by other experts — are among the ways public officials nationwide are working to address the outsize toll the novel coronavirus has taken on communities of color, a dynamic caused by limited access to care, greater exposure risk, a higher rate of underlying health conditions and systemic racism that causes or exacerbates these factors.
“We can’t just shrug our shoulders and wring our hands and say, ‘Oh, what a shame,’” said Michellene Davis, an executive vice president and chief corporate affairs officer at RWJBarnabas, one of New Jersey’s largest health care systems. “We can’t unsee what we have seen. But we can take action.”
Experts agree there is no one-size-fits-all approach to improving equity, but they insist public leaders must take concrete steps to prioritize black and brown populations in their coronavirus response.
Important demographic data
In New Jersey, Gov. Phil Murphy expanded the collection and publication of racial and other demographic data related to the pandemic and the state started to break this down by ZIP code for more populated areas. But targeted efforts to test for COVID-19, trace its spread, and support communities of color have largely been left to local governments and grassroots groups. And it is not clear what new steps New Jersey’s state government is taking to reduce racial inequalities as the public emerges from months under a stay-at-home order designed to reduce the virus’ spread.
Addressing equity is particularly important now, as New Jersey reopens its economy, Davis said. In May the state began to expand access to nonessential retail and outdoor public spaces and, on Monday, it entered Phase Two of Murphy’s re-entry plan, which allows for outdoor restaurant service. Davis said patrons at these establishments — especially those who choose not to wear a mask, even when such actions may be required — put the employees at risk for contracting the virus.
“Those who are on the receiving end of this have no choice. They have to feed their families,” said Davis, a national leader on health equity. “The good news is, there’s real opportunity here to apply a racial equity lens to every single decision we make” about reopening, she added.
Murphy has made a point of highlighting the racial disparities related to COVID-19 during his daily press briefings and pledged to use the state’s reopening process to address some of the longstanding gaps in care. “COVID-19 did not create the inequalities in our society, but it laid them bare. So, this is also our opportunity to help close those gaps,” Murphy said when he outlined his “Road Back” recovery plan in late April.
How exactly New Jersey will go about closing those gaps is unclear. When asked for an update Monday, Murphy said, “There’s a whole lot going on through a whole variety of lenses,” and he pointed to long-standing efforts to address health care gaps in minority communities, like First Lady Tammy Murphy’s Nurture NJ campaign, which seeks to reduce the state’s high maternal mortality rates among black women, who are 3.6 times more likely to die in childbirth than white mothers.
Equity in work and education
Murphy said his administration is also focused on workplace equity and improving educational opportunities for minority residents, noting that those deemed “essential workers” during the pandemic are predominantly from black and brown communities. “So it’s a whole range and I would say it’s overwhelmingly a work in progress. I don’t have a — I wish I had a simple magic wand, magic-bullet answer,” he said Monday.
The state has beefed up its demographic data collection related to COVID-19, which is now included in its online dashboard, and more recently added some ZIP-code data as well, while excluding figures for less populated areas out of concerns for privacy. In late April Murphy signed legislation, championed by Sen. Ron Rice (D-Essex) and Sen. Nia Gill (D-Essex), both members of the Legislature’s black caucus, which required hospitals to collect and report to the state certain demographics related to COVID-19 patients.
More than 168,000 New Jerseyans have now been diagnosed with COVID-19, including 12,800 who have died. White residents, who comprise 67% of the population, account for 35.5% of the cases and nearly 54% of the deaths. Blacks, who make up 14% of the population, account for more than 17% of the cases and 18.5% of the deaths. (That’s down from early April, when black residents accounted for 26% of the COVID-19 diagnoses and 22% of the deaths.) Hispanics are counted differently when it comes to population, but the group comprises 30.4% of cases and 20.4% of the fatalities.
Experts agree that ZIP-code data is critical to enable government to better target its COVID response to where it is needed most. New Jersey is now one of 15 states that report cases by ZIP code and one of five to break down deaths in this way, according to researchers at the Princeton health and value program, which is part of the Woodrow Wilson School for Public and International Affairs. The group also identified key strategies to reduce racial and other gaps — like using targeted data, empowering community health workers and local groups, and appointing individual or team equity leaders to oversee the process — and reviewed how state and city leaders have put these into practice.
Heather Howard, a former state health commissioner who leads the Princeton program, praised New Jersey’s efforts to track and use demographic data and urged other states to carefully consider how to improve equity as they reopen society. “New Jersey is a leader state now in how they are reporting data and thinking about equity in their response to COVID-19,” she said.
It’s not enough to collect data
Davis, with RWJBarnabas, stressed that data collection alone was just the start. To make real, lasting change, she said work must be done to dismantle the structural racism and inequality that impact social determinants of health — factors like education, income and access to quality food, housing and medical care that greatly influence health and wellness. Doing this right requires input from those who experience these challenges firsthand, she added.
“As we are reopening, we need to make sure we don’t just have individuals who have studied poverty” leading the discussions and decisions, Davis said. “That lived experience is worth a Ph.D.”
RWJBarnabas has taken multiple steps to address these underlying social determinants, creating an urban greenhouse and associated programs in Newark and enlisting ride-sharing services to help patients lacking transportation get to appointments. It has also partnered with Horizon Blue Cross Blue Shield, the state’s largest health insurance provider, on Neighbors In Health, a program that deploys community health workers to help targeted individuals in select ZIP codes access medical and social services.
In the public sector, experts said advancing equity requires identifying and prioritizing communities of color and other at-risk groups for COVID-19 testing, ensuring they can obtain affordable treatment if needed, and potentially providing income, housing, food and other essentials as individuals who test positive need to quarantine. In addition to being more at risk for contracting the virus than white residents at work, black and brown individuals are also more likely to live in multi-generational housing, in more crowded communities, and rely on mass transit — all of which increase the risk for the virus to spread.
Social services, better internet, more sick leave
Addressing social determinants is also a priority for the NAACP, which has called for maintaining or better yet expanding social service programs, which benefit a high number of minority residents. The national advocacy organization also has flagged the need for universal access to free broadband internet service, making it easier for people to obtain information about their health and employment benefits and to participate in online education programs; expanded sick-leave protections; and emergency child care options to reduce the pressure on multi-generational households. The group also has underscored the need for wider health insurance coverage and additional resources for community health clinics.
But these larger steps have been discussed for years and all involve significant investment, at a time when the state is already facing a revenue shortfall that, by Murphy’s calculation, could reach $10 billion. (The governor has pledged to use federal funding to pay for some of the state’s coronavirus response.)
“I don’t want to underestimate that things will happen overnight” when it comes to improving equity, said Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute, a collaborative focused on improving care and controlling costs. “I think it’s going to take a complete re-upending of our social-economic system. Which is very difficult,” she said. “Hopefully people will start to see, we’re not healthy unless everyone is healthy.”