Image: Health care workers cheer marching Black Lives Matter supporters.
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It’s an ongoing national tragedy that communities of color remain at increased risk for a wide range of adverse health outcomes related to social and economic determinants of health, and COVID-19 is no exception.”--Dr. Jeff Duchin, Health Officer for Public Health – Seattle & King County.
As of May 15 in King County, COVID-19 infection rate for Blacks was nearly 4 times that of Whites, and for Hispanics it was 9-fold that of Whites. Hispanics had nearly 6 times the COVID deaths as Whites, after adjusting for age differences in the populations. These inequities are also apparent in COVID hospitalizations in King County:
Across the country, as states have begun to report race and ethnicity data, the same patterns are emerging. COVID is disproportionately affecting Black, Indigenous and Hispanic people.
Our current market-based health system not only values profits over patients, but also fails to achieve or even aspire to achieve equitable health for all. The healthcare system must value health care as a human right and be designed to achieve equitable health care access, affordability, and outcomes. This cannot be achieved with a model rooted primarily in employer-sponsored insurance for the majority of the working-age population and a financing model which favors excess profits for insurers, providers and pharma over equitable, affordable care for patients.
We Pay the Most for Healthcare and Get the Least Equitable Health Outcomes
It is often noted that the US spends the highest percentage of its GDP on healthcare, yet we have some of the worst health outcomes on average, compared to other developed countries.
But averages obscure a more troubling story: there is a large range of health outcomes, with the worst disproportionately affecting people of color and people living in poverty. Differences in life expectancy have been widening, with the wealthiest Americans now living 10–15 years longer than the poorest. The strongest predictor of life expectancy in the US is geographic- census tracts and zip codes. Black women experience four-fold higher maternal mortality rates than Whites, and this disparity persists even when income and education are taken into account. Poverty is associated with more years of lost life than smoking and obesity combined.
How is this playing out in Washington?
We can see this operating in our own state. Compared to the rest of the US, on average we are at the top of life expectancy because our most populous areas are not as economically distressed and the state has a relatively higher White population. Six percent of Washingtonians live in an economically distressed community, which have high correlations with poorer health outcomes and life expectancy. Yakima county has much lower life expectancy than King County. Recent increases in COVID cases in Yakima county include outbreaks in 8 agricultural facilities, where POC and migrant workers are disproportionately represented. Our economy depends on these essential workers getting the protection and health care they deserve and need.
Our Health System is Deepening Socioeconomic Inequities
Financing of health care in the USA is regressive, with poor and middle-class individuals paying a larger share of their incomes for care than the affluent, thereby deepening inequalities in disposable income.
Rising insurance premiums for employer-sponsored private coverage have eroded wage gains for middle-class Americans. Medical indebtedness is common among both insured and uninsured Americans, and often leads to bankruptcy. The threat of medical bankruptcy, initially significantly reduced by the Affordable Care Act, is now back on the rise, due to the Trump Administration"s efforts to weaken the protections of the ACA and of course, the COVID crisis.
Social and Economic Inequity Deepens Health Inequity
Unmet social and economic needs serve as a barrier to adherence, limit treatment options, and shape the flow of clinical interactions. Prioritizing one’s health can be difficult under the best of circumstances, but it can be so much harder when people struggle with many pressing issues—challenges such as affording a safe place to live, tenuous employment, difficulty paying for healthy food, social isolation, and the stress of being a caregiver.
No one is surprised that the COVID-19 epidemic is hitting communities of color harder than White communities, given that racial and ethnic health disparities have been with us from the beginning of the US. In fact, the roots of American resistance to universal health care in this country can be traced to racism, when former slave owners were deeply ambivalent about Black people being allowed to get the same health care as Whites.
COVID-19 has laid bare the fragility of our health system and health inequities. Before the pandemic, employer-based insurance was already contributing to these inequities. Even when employed, people of color and less-educated people are less likely to have insurance through an employer.Pandemic job losses are disproportionately falling on Hispanic and Black workers who did not have health insurance.
The Time is NOW for Reducing Health Inequities, and it Begins with Universal Healthcare
A crucial element of a functional healthcare system is that it must provide equitable access to all. The US is long overdue to making health care a human right. Our healthcare system must remove the faulty structures, barriers and biases that contribute to and exacerbate health inequities and make all of us more vulnerable to delivery system crises and pandemics.
This moment, with the COVID crisis and a burgeoning movement for racial justice present a unique opportunity to strengthen alliances between health and social justice causes, and to bring the case for universal, publicly funded care to elected representatives and community leaders at all levels of governance.
Our ability to defeat the virus depends on our collective will and imagination to overcome long standing barriers to equitable health care with bold and innovative health care reform. The Health Care Emergency Guarantee Act is one such example of health innovation which would rapidly respond to the COVID crisis of people losing their health insurance. HCFA-WA is promoting legislation that expands access to care, such as the Washington Health Security Trust (WHST), working to ensure existing healthcare programs and funding are not subject to state budget cuts due to the COVID budget shortfall, and participating in the Universal Health Care Work Group. Now is the time to use the momentum of this unique moment, a confluence of the COVID crisis and racial justice movement to build unprecedented support for health care for all, and justice for all, two interconnected threads of our social fabric.