These past four months have been uniquely challenging times for our communities. The rapid spread of COVID-19 has required us all to adapt to new norms and adjust to the notion that life will never be the same. The pandemic has also exposed new and existing health disparities, requiring us to think critically about how we would like to shape our communities and our future.
As part of It’s Time Texas’s mission, we work to empower Texans through our Community Lab project, powered by our Build Healthier team. Community Lab is an innovative, web-based forum that brings together individuals from Community Health Collaboratives (CHCs) across the state to discuss best practices and to help each other troubleshoot obstacles in their community. When COVD-19 struck, the conversation naturally shifted toward how the pandemic was affecting our work. This month, Community Lab focused on the topic of health equity within the context of the pandemic and how we can work together to build healthier, more equitable communities. Our conversations with CHCs across the state shed light on how communities are grappling with health disparities laid bare by COVID-19 and how the power of collaborative relationships can help move us in the direction of equity.
The plurality of health disparities exacerbated by COVID-19
During our Community Lab session, we found that there were notable health disparities that affected every community represented on our call. They ranged from lack of internet access within rural and low-income communities – making it harder to work from home, participate in home-based education, or seek medical attention – to gaps in food access, placing an additional burden on the 37 million individuals, including 11 million children, who are already food insecure. Vulnerable populations, such as those who are homeless or living in prisons, jails, or nursing homes also face increased difficulties when it comes to social distancing and accessing services they would normally be able to find.
As we continue to see more published data on the effects of COVID-19, we are finding that the virus disproportionally affects communities of color, a group that is over-represented in low-wage “essential” jobs and at a higher risk of living with chronic underlying health issues. In Louisiana, for instance, where black individuals comprise just 33% of the population, they account for more than 70% of coronavirus-related deaths. This unbalance is less the exception than the rule. According to a recent analysis by NPR, there are 32 states in which African Americans are dying at rates higher than their proportion of the population. The disproportionality is seen most starkly in metropolitan areas like New York City, where the likelihood of dying from the disease is twice as high if you are black or Latino compared to your white peers.
Looking at disparities through the lens of equity and social determinants of health
While the coronavirus has brought certain health disparities into sharper focus, it’s important to remember that health disparities as a construct are nothing new. Long before the pandemic became a topic of daily conversation, communities of color experienced higher levels of diabetes, obesity, stroke, heart disease, and certain cancers—all conditions that elevate the risk of serious complications from COVID-19. Rural communities also suffer a higher percentage of deaths from potentially preventable causes as compared to their urban counterparts. The same holds true for other marginalized communities, including veterans, LGBT populations, and those living with disabilities.
Underlying persistent health disparities are deeply entrenched inequities bearing down on social determinants of health – factors like housing, education, employment, social support networks, healthcare access, and physical environment that influence health across the lifespan. While the sociopolitical roots are varied, they include discriminatory housing and employment practices, biases within the education, criminal justice, and healthcare systems, and political redlining – the denial of government resources to predominantly black neighborhoods – which has pushed generations of African Americans and other minority groups into economically underdeveloped areas that lack access to healthy food options, quality housing and transportation, and other basic needs. Closing the gap on health disparities will require dismantling the social and political structures that have contributed to the perpetual marginalization of communities – most saliently along racial and ethnic lines.
According to the CDC, health equity is achieved when every person has the opportunity to “attain his or her full health potential” and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.” In Community Lab, we acknowledged the difficulties in addressing inequities in health – a topic almost overwhelming in its complexity and scope. Yet, there is little doubt that it’s time to have the conversation. Within our communities, we are seeing signs of movement.
Posing difficult questions. Re-examining core assumptions.
During our discussion, Community Lab members were asked to share what they are seeing and hearing around health equity. Almost unanimously, members acknowledged a growing gap in terms of poverty and access to healthcare, healthy food, and other resources. Yet, as social movements like Black Lives Matter gain national attention, we are also seeing more widespread recognition of the role of racism and discrimination in creating the gaps that influence health, prosperity, and wellbeing. At the local level, people are showing up to listen and engage in conversations happening around access and local policy. We are seeing people take a more active interest in shaping their communities.
As our conversation progressed, we proceeded through a list of “thinking questions,” posed to help us examine our perceptions. Are there common lenses being used to describe health inequities? What’s the perception of those who aren’t thriving? Through dialogue, we began to rethink some key assumptions, starting with the idea that the causes of health disparities are what they appear to be on the surface. For example, we’ve heard that having chronic health issues raises your risk for contracting COVID-19, but if we backtrack and look at why certain populations have a higher prevalence of these issues, part of that goes into how policies were created and just how inequitable those policies were—fostering communities wherein these problems to go untouched while also making it harder for these communities to access care.
Another assumption we need to challenge is the idea that nothing can be done. Community Lab member Rafael Curiel brought up how, within the wellness community, there has been a lot of discussion on the idea of resilience. In the past, there was the notion that resilience was something you were born with – you either have it or you don’t. But now, we’re finding that resilience in the face of stressors is something that can be built, starting with a base of solid nutrition. This idea may be especially important among populations for whom the social determinants that contribute to resilience seem out of reach. When you are surrounded by barriers to health and wellness, there’s a temptation to toss caution to the wind – to accept poor health as an inevitability, so why do anything to try to change it? In his collaborative work within the Rio Grande Valley, Rafael is helping to spread the message that what you do from one generation to the next matters. Even if it takes time, you can build that base of health and resilience so it will be there for future generations.
The role we can play in eliminating health disparities
While the pandemic has caused a whole host of issues, one positive outcome many of our communities have seen is the opportunity to create new partnerships and networks to address the heightened need. Many have had to think outside the box when addressing disparities around food access, housing, and the digital divide which has led to greater collaboration with members and organizations they had not previously worked with. With these new relationships comes the opportunity to connect more individuals – especially those who have been hardest hit by the pandemic – with community services that can assist them now and into the future. While progress takes time, continued collaboration creates a stronger foundation for future generations to build on.
As we look at long-term actions, collaboratives have a unique power in regard to advocacy. As a collective group, their united voice can create the change they want to see in their community. We have seen how the coronavirus has overwhelmingly affected communities of color, who are often at a higher risk of chronic disease and make up a large portion of the essential worker population. Advocacy highlights the disparities and needs that are present in our community and allows for us to engage with community members to unite around common goals. These can be simple things like the dissemination of accurate health information during a pandemic, to long-term solutions like increasing SNAP benefits for those in need.
Join the conversation
Starting June 29 and extending through October 29, 2020, our Healthier Texas Summit Series will convene hundreds of Texas’ thought leaders and health champions to continue critical conversations on health and wellbeing. Kicking off with a conversation on Health and Social Justice, topics will span social determinants of health, community health, cross-sector partnerships, health disparities and equity, and health communication. Content for the series will also focus on community-level responses to COVID-19, including successful collaborations and novel approaches to addressing the social factors that influence health during a crisis. This free digital experience is a collaboration between It’s Time Texas and the University of Texas System, presented by Blue Cross and Blue Shield of Texas. Registration is now open at healthiertexassummit.com.
To learn more about Community Lab, including how you can be a part of the discussion, visit ittcommunitylab.org.