Why we need to be talking about health equity during the coronavirus pandemic

Although the continued spread of COVID-19 is inevitable, worsening structural inequities and health disparities in its aftermath are not.

The global COVID-19 pandemic has laid bare striking deficiencies in our nation’s health care systems. As we develop statewide COVID-19 responses, we need to ask ourselves who is being left behind and how this pandemic might alter economic, health, and social outcomes down the road.

While measures taken to control the pandemic impact us all, they take a particular toll among Connecticut’s underserved populations — groups experiencing longstanding health disparities and structural inequities. These social, economic, and health disparities translate to an increased risk of both contracting COVID-19 and experiencing worse outcomes.

For example, people of color in Connecticut are more likely to live in densely populated areas and to work in jobs that cannot be done from home and are deemed “essential” — such as service industry jobs or gig economy employment. Access to paid sick time and appropriate protections against the virus at work are limited. In other words, it is likely that many black and brown workers across the country and in Connecticut are exposing themselves to COVID-19 for a paycheck.

It is also likely that the economic fallout will have a greater impact on people who were already struggling to make ends meet on hourly wages and who are now more likely to lose wages due to both the closure of businesses and the need to take unpaid sick or family leave. The burden will be even higher among undocumented families.

As a result of injustices that led to people of color being more likely to lack health insurance, and distrust health systems, people of color also experience a higher burden of chronic disease such as heart disease, asthma, and diabetes. Given well-documented racial disparities and implicit bias in health care, people of color are likely experiencing significant barriers to accessing COVID-19 testing. These barriers are also more likely to affect uninsured, low income, and formerly incarcerated citizens.

To shift this tide of inequity now and in the future, we need data to show who is receiving testing and who is not. We need to know the racial and ethnic demographics of tests administered to those who seek medical care for suspected COVID-19 infection. Given Connecticut’s dramatic disparities in health care access and outcomes, it is especially critical that we center people of color and other medically vulnerable populations in the state’s response strategy.

In Connecticut, we have ripe opportunities right now to develop equity-centered responses to COVID-19. But doing so requires us to harness data that clarifies who in our state has the greatest unmet need. Limited race and ethnicity data on COVID-19 cases and deaths have been made public, but the data are not uniform or comprehensive. Additional data on COVID-19 testing and hospitalizations are needed as well as data quantifying access to social and economic supports — such as Medicaid, SNAP, unemployment, and loans. Increased transparency is also needed regarding data collection and decision-making around COVID-19 screening, testing, and diagnoses, especially in light of the structural racism embedded in our health, economic, and social support systems.

Race, ethnicity and language data are critical to understand which communities are disproportionately affected by COVID-19 and its economic, social, and health implications. This knowledge can drive necessary systems change. Congressional and state General Assembly leaders are already calling for collecting and reporting these data, and we join them in the call for data-driven policy-making that employs disaggregated data by race, ethnicity, and language preference for COVID-19. What gets measured gets done.

Without these data, we can not thoughtfully design policy to prevent inequities or evaluate how COVID-19 is affecting people of color and progress in our efforts focused on these communities. When we design pandemic responses that meet the needs of the most vulnerable among us, we all benefit. Eliminating disparities and advancing health equity among people of color in Connecticut requires changes in the policies we design, health care we deliver, and research infrastructures we build.

Working for social, economic and health equity means a healthier Connecticut, now and in the future.

Dr. Wizdom Powell is the director of the UConn Health Disparities Institute. Dr. Tekisha Dwan Everette is the executive director of Health Equity Solutions.