Covid-19 and Health Equity — when thinking big

That high personal income does not buy large amounts of human immunity from cholera, typhoid, and ignorance, and cannot ensure the slow and reluctant opportunity of education and the positive benefits of economic security in moral prophecy. Until it turns out, due to degeneration and economic disasters, society will begin to make collective preparations for the needs that he himself cannot provide, even if a normal individual has worked overtime for his lifetime.

— RH Tawney, equality (1931)

The Covid-19 pandemic has exposed the magnitude of US health inequalities. The World Health Organization defines this as “avoidable, unfair, or correctable difference” in health. It also emphasizes institutional racism, institutions, practices, practices and policies that discriminately allocate resources and opportunities to increase inequality among racial groups. Covid-19’s mortality rate is more than double that of the black, Latin, and indigenous populations, and more than twice that of the white population, with data on strong socioeconomic gradients (https://covidtracking.com/race/dashboard).^1-3 As doctors with diverse identities (Jewish men, black women, South Asian American men) who work with a focus on health equity, when we are vulnerable people need us We are very aware that our profession has failed.

Recognizing that health inequalities have structural causes that justify policy-level solutions, the Covid-19 Health Equity Disasters both improve health equity and improve pandemic response. We believe it will bring some lessons that can lead to practical policy goals for.

The pandemic shows that our public health response is inextricable with public policy: federal and state legislation, federal and state program management, and local ordinances. People cannot keep social distances if it means to remain unfulfilled with their basic needs. Even before Covid-19, many Americans faced basic unmet needs. Currently, one in four workers may lose their jobs, seizures and evictions may reach record highs, and food insecurity can triple, resulting in miles of food pantry lines. Will be.^Four These devastating effects put pressure on those most vulnerable to Covid-19 to take health risks just to make a break. Moreover, inadequate federal support for basic needs and insensitivity to changes in what people need to survive this crisis has led to anger directed at national-level public health measures such as social distance. I will. That anger, in turn, contributes to the decision to lift these measures prematurely. Public policy should allow people to be socially distanced, not motivate them to oppose it.

Public policy must also equip state and local governments to address Covid-19. The Federal Reserve provided more than $2.3 trillion to support the financial system during a pandemic, but much less to state and local governments. In many cases, these governments need to cut spending when revenues fall, as they cannot run deficits. Such reductions will probably have some detrimental effects: reduced public health efforts, financing state programs to address basic needs, and spurring public sector layoffs that hinder economic recovery.

The failure of these policies disproportionately affects marginalized communities with a high incidence of underlying medical conditions. Moreover, in a pandemic, anything that increases the chances of transmitting a disease affects everything. This is the inequality paradox. Even wealthier are poorer than if the system is more fair.

In addition to identifying the need to integrate public health efforts with broader public policy, Covid-19 once again demonstrates the oversized role of structural racism and social determinants of health. .. Black, Latino, and indigenous Americans are more severely ill and have a higher mortality rate than white Americans when exposed to the same virus. These disparities are made up of the conditions that individuals are “born, grow up, live, work, and age.”^1,2 Greater investment in hospitals and clinics that serve marginalized communities is urgently needed.^Three However, clinical care alone cannot supplement the longevity of accumulated detriments and dismantle structures that endure health inequalities.

Achieving health equity requires reaching beyond the healthcare system. New social policies in some key areas could advance both health equality and Covid-19’s response.

First, we propose to establish a universal food income. Food insecurity is a health equity issue that disproportionately affects racial and ethnic minority groups, low-income people and rural communities.^Four The Supplemental Nutrition Assistance Program (SNAP) is effective, but it has its limitations. Profit levels are often insufficient to allow a healthy diet, yet many people with incomes above the SNAP cutoff are food insecure. Universal Basic Income is now a serious policy consideration in the United States, but the objection is that unconditional cash payments can be misused. Or, offer a universal food income that provides every household in the United States with a monthly payment of electronic benefits whose use is restricted to SNAP-covered foods.

Profit can be linked to USDA’s moderate cost food plan, which reflects the nutritionally recommended dietary costs. This policy may be enacted by federal law (eg, farm bills) and has a significant public health impact by ensuring sufficient income for a healthy diet. In addition, food programs typically have a “money multiplier” effect, where every dollar invested in a program often yields more than $1 in subsequent economic activity, which supports economic recovery.

Second, we recommend reforming unemployment insurance. Working conditions vary widely by race and ethnicity, and precarious employment, low wages, and lack of benefits can undermine pandemic mitigation efforts. Prior to the advent of Covid, unemployment insurance systems had lower levels of income substitution and were not adapted to the current working conditions (for example, independent contractors and “gig economy” workers were Is not included even if it represents the increase in. The Coronavirus Aid, Relief, and Economic Security (CARES) Act addressed many of these issues, but will expire on July 31, 2020.^Five The amendments should be extended by federal law during the current crisis.

But ultimately, state-level reforms that increase income replacement rates and increase eligibility are needed. Unemployment insurance reforms could enable social distances by allowing more people to stay home. It also helps improve health equality over time by providing better bargaining opportunities for workers. A stronger unemployment insurance system will not let workers feel pressure to accept dangerous or unfair working conditions.

Finally, we need a policy that supports our investment in community development. Neighborhood-level differences in housing availability, education, and economic opportunities are the main drivers of inequality. Historic and ongoing isolation, red lines, and scarcity of investment have depleted resources in the neighborhood by scarcity of quality, affordable housing.

Two key elements of the federal Community Development Act are the Low Income Housing Tax Deduction and the Community Reinvestment Act (CRA). Rulemaking by the Monetary Authority and the Federal Deposit Insurance Corporation also serves as an important tool to influence the implementation of the CRA. Community-developing companies, affordable housing developers, and financial institutions that benefit the community will be able to expand affordable housing, mitigate toxic environmental conditions, and increase local economic opportunities. , A strength-based approach based on regional assets should be adopted. Such developments not only help communities respond to pandemics, but also improve long-term health equity by improving living conditions.

Decades of systematic underinvestment contribute to health disparities, and it is unrealistic to assume that health equality will be achieved without a large investment in resources. Where society spends its resources, it shows its value. It is weird to say that we assess health equality if we are not willing to make the necessary investments to correct inequality. If the Federal Reserve can raise $2.3 trillion to support the financial system during a pandemic, providing adequate support to individuals is a matter of political will, not economic feasibility.

Covid-19’s pandemic affects everyone, but not equally. This health crisis summarizes the same patterns of power, privilege, and inequality throughout the lives of Americans. Nevertheless, all Americans are vulnerable to Covid-19. This fact should stimulate the value of collective action, solidarity, and universalism. Undoubtedly, some would think these suggestions are radical or catastrophic. But if you want to take health equality seriously, it’s time to think big.