Opinion: Society Designed the Systems That Created COVID-19 Inequalities — We Can Redesign Them

A flower vendor at work in downtown Los Angeles last month. Photo by Ana M Amortegui.

If it sounds like we’re suggesting a complete transformation of our society in response to this pandemic, that’s because we are.

Last Thursday, California Senator Kamala Harris announced that she and Congresswoman Robin Kelly of Illinois are introducing essential legislation to address the disproportionate toll COVID-19 is taking on people of color. Their call for a COVID-19 Racial and Ethnic Disparities Task Force that digs into the root causes of these health disparities came a day after the Centers for Disease Control and Prevention released devastating data showing that more than 80 percent of COVID-19 patients hospitalized in Georgia were African American.

Chrissie Juliano 

This is just the approach we desperately need — one that treats the root causes of our health inequities, not just the symptoms.

Why is COVID-19 disproportionately taking the lives of African Americans, Latinos, Native Americans, Asian Americans and low-income workers? While most Americans think about health as a matter of personal responsibility, this view misses the larger context. Health outcomes are shaped far more by the environments in which people live — the air we breathe, the water we drink, the wages we earn, and the homes we live in (if we have one) — than by what happens inside the walls of a doctor’s office or our individual “lifestyle” choices.

Rachel A. Davis

The reasons why the disparities we’re seeing — not just in Georgia but in San Francisco and Los Angeles — are so vast go beyond personal choices, access to health care and higher rates of underlying medical conditions like hypertension, diabetes and heart disease.

They go to the most basic foundations of health inequities: the community conditions that all too often undermine health and wellbeing for low-income people and people of color.

For example, exposure to air pollution has been linked to excess deaths and may be one of the major drivers behind racial inequities in COVID-19 deaths. Why are the lion’s share of polluting industries and transportation corridors in or next to African American neighborhoods? Because of discriminatory zoning policies that go back to the days of redlining.

Also, why are communities that are poor more likely to be paved over and have fewer parks, green spaces and trees to cleanse the air? Because of decades of policies that have treated parks primarily as amenities for wealthy neighborhoods rather than as essential infrastructure for health and wellbeing.

To achieve a more just and equitable future, we’ll have to change the policies that for decades have unevenly distributed health-promoting resources — and, consequently, left large segments of our population without the opportunity to live healthy lives. The goal of Harris and Kelly’s COVID-19 Racial and Ethnic Disparities Task Force should be to create communities that are healthy and resilient enough to not only survive the next pandemic, but also to support more routine health and wellbeing in “regular life.”

If it sounds like we’re suggesting a complete transformation of our society in response to this pandemic, that’s because we are. 

As public health professionals, we look at the data and make the best decisions possible to help the most people live healthier and safer lives. In this case, the data tell us that the systems that shape lives and determine the opportunity to be healthy — from housing and transportation to education and economic development — are broken. Instead of supporting health, they are creating health inequities.

The good news is all of these things are within our power to change. We — as a society — designed the systems and policies that created the problems, and we can redesign them to produce health instead of disease, and to reduce, rather than exacerbate, inequities.

We can make sure all families have access to safe, affordable housing and healthy food. We can make sure all low-wage workers have paid sick leave so they can stay home when they’re ill. We can make sure every neighborhood has parks, green spaces and sidewalks that are safe to walk on.

The call for a COVID-19 Racial and Ethnic Disparities Task Force is an important first step toward a national examination of the systems that have failed too many communities across the country. And it can affirm that we are all truly in this together. 

We are only as healthy as the least healthy person among us. And that means achieving better health for all of us — especially people of color and people who are poor — is in the best interest of everyone.

Chrissie Juliano is the executive director of the Big Cities Health Coalition. Rachel A. Davis is the executive director of the national public health nonprofit, Prevention Institute.

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