By Maridith Yahl
NKyTribune reporter
The Foundation for a Healthy Kentucky advocates for health equity in Kentucky. One way they do this is by education, including webinars. Covid-19 and Health Equity in Kentucky: Beyond this Pandemic is one that provided information about our status on health inequity and the questions to ask to transform healthcare.
Dr. Anita Fernander, associate professor of Behavioral Science in the College of Medicine at the University of Kentucky, discussed “the health disparities through the lens of Covid-19,” presenting a social justice approach to health.
“From the time COVID-19 became apparent in the U.S., it became evident that communities of color were disproportionately burdened by the virus. Almost every state where racial data is available, African Americans have higher cases of exposure, infection, hospitalizations, and deaths from Covid-19,” said Dr. Fernander.
Anita fernander
Dr. Fernander says there have been ongoing systemic inequalities to not only healthcare but all aspects that govern life. Understanding and recognizing what enables these inequities is what is needed to make the appropriate change.
People living with chronic conditions such as diabetes, hypertension, COPD, and cardiovascular disease are more susceptible and have more severe cases of COVID-19. African Americans have these chronic conditions at much higher rates.
“While it may be expedient to point to genetic differences, individual behaviors, or other racialized myths as the cause of pre-existing, chronic conditions, and COVID-19’s accessibility among African Americans, it must be emphasized that these pre-existing, chronic illnesses are not accounted for by inherent biological predispositions due to race,” she said.
What causes this, is systemic, in-place structures called social determinants. Social determinants account for 80% of health risks, include economic stability, educational opportunities, employment, neighborhood, and physical environment, community & social contexts, and health care, says Dr. Fernander.
The lack of financial stability is a main risk factor for health, especially when it comes to COVID-19. One good indicator is homeownership. Shockingly, 73% of white Americans own homes versus 41% of African Americans. Sadly, “the rate of homeownership among African Americans is the same as in 1968,” Dr. Fernander says.
African Americans have a much higher rate of jobs in the service industry, are twice as likely to not be in an early childhood education program, have an incarceration rate six times higher of white Americans, and are grossly underrepresented in civic engagement.
Dr. Fernander says that “zip code matters more than your genetic code.” Referencing environmental conditions such as air pollution, water quality, green space, and distance to health options (hospital and other providers). Distance, plus lack of medical insurance means African Americans are less likely to seek medical care. With regards to COVID-19, early reports indicate testing and treatment have not been equal among races.
“The top 10 counties with the highest food insecurity rates are all at least 60% African American. African Americans of all socioeconomic levels are exposed to higher levels of air pollution and live in close proximity to toxic waste sites,” says Dr. Fernander.
Heather Howard
African Americans make up 40% of the homeless population. Shelters, which were relied on for simple hand washing, showering, and meals, have not been able to fully function and/or operate since the Covid-19 outbreak. The Emergency Shelter of Northern Kentucky had to close doors briefly to set-up a temporary location at the Northern Kentucky Convention Center.
Heather Howard, JD, Program Director at State Health & Value Strategies (SHVS) at Princeton University, says there are five key questions the state should ask to develop strategies to transform the current healthcare system into more equitable and affordable.
The questions need to be asked right now for recovery efforts to advance.
Question one to ask is, “Have we identified a person or team of people to apply an equity lens to all of our COVID-19 response and recovery efforts?” Establish a Minority Strike Force, as Ohio did, to make recommendations. Including, expanding access to testing in African American communities.
“Have we identified at-risk populations and targeted resources specifically to those populations, employing national cultural and linguistically appropriate standards (CLAS),” is the second question to ask, says Howard. North Carolina is utilizing a Department of Commerce program to advocate for minority-owned businesses and ensuring equal distribution of relief funds.
Question three, “Have we issued any guidelines that foster health inequity?” In Alabama, officials released guidelines that excluded people with intellectual disabilities. With an outcry from citizens, the policy was changed.
The fourth question, “Are we collecting, analyzing, reporting, and using demographic data for COVID-19 testing, hospitalization, and deaths?” Is the data from Covid-19 being reported so that our responses are equitable? To ensure this, the more data that is reported by race, ethnicity, and geographically, the better it supports policy interventions, says Howard.
“Have we collaborated with community organizations and members of heavily impacted neighborhoods to address gaps in outreach and build trust” is the fifth question of this series. Ohio’s Minority Strikeforce encouraged a partnership to increase testing in high-risk and African American communities and employ health workers who mirror the community, says Howard.
Consider both economic and public health concerns as we shift from response to reopening and recovery.
“Any steps – no matter how small – constitute a good beginning in the long journey of advancing health equity,” Howard says.
Howard says Kentucky is doing well with data and policy response, but it’s about integrating data to your response and holding policymakers accountable.
“You’ve got some great initiatives going on, the Governor just this week announced an expansion to health insurance, but you need data to ground good policy, to drive the best way to address inequities, and especially its resource allocation,” says Howard.
