How California Can Advance Health Equity in the COVID-19 Era

Man having his temperature taken at a COVID-19 Testing Site
Najee Ali’s temperature is taken at a free COVID-19 testing event for Black workers in Los Angeles on April 24, 2020. Photo: Ringo Chiu / ZUMA Wire

Communities of color, particularly Black people and Latinos, are bearing the brunt of the COVID-19 pandemic. Black Californians make up 11% of deaths, nearly double their share of the state’s population. Latinos between age 18 and 34 account for two-thirds of all deaths in an age bracket considered by many to be at low risk of serious symptoms. Pacific Islanders are dying at a rate that is more than double their share of the state population. This pattern also holds true in nursing homes. Those with more than 25% Black and Latino residents are more than twice as likely to have at least one COVID-19 case as nursing homes with less than 5% Black and Latino residents, regardless of location, size, or quality rating.

The disparities we are seeing in COVID-19 deaths are a result of historical racism and inequity across the system. Communities of color have a higher burden of chronic disease because of systemic failings such as exposure to environmental hazards, lack of resources, and bias in health care.

We must eliminate these disparities, but we cannot do so without a full commitment to health equity and prevention that cuts across sectors, governments, and communities. Equity is not just one of the many issues we should tackle urgently, it is the lens through which we must respond to this crisis.

Here are four things that California needs to do right away:

1. Address Immediate COVID-19 Health Needs in Communities of Color

California should focus immediately on the communities most affected by COVID-19. This starts with ensuring access to testing for low-income communities of color. A new study in San Francisco’s Mission District confirmed that the virus is more widespread in communities whose residents:

  • Have less access to accurate and timely public health information
  • Have many low-income essential workers who are less able to shelter in place or self-isolate
  • Are more likely to live in crowded housing
  • Are less likely to have adequate access to basic legal protections, such as paid sick leave

Additional testing capacity is needed in neighborhoods with these characteristics because they are more likely to experience community transmission of the virus. We ought to eliminate numerous barriers to testing, such as lack of language accessibility, misinformation, inadequate information, and limited operating hours at testing sites. In addition, the requirement that a physician must issue a formal referral for a test presents a barrier in communities without easy access to primary care physicians.

There is ample information demonstrating the negative effect of the pandemic on mental health. We anticipate that the communities most harmed by the pandemic will experience trauma caused by fear, isolation, job loss, and deaths. Consumers with low incomes must have expanded access to critical medical services, including mental health care. Medi-Cal members should be told how to find currently available mental health providers who can meet their urgent needs while other providers remain closed, and community-based navigators should be armed with this information to assist consumers in finding care. We should also be prepared to offer culturally and linguistically responsive mental health treatment that is community-based and accessible.

As the health care delivery system adapts to the realities of physical distancing, anticipated surges, and reduced revenues, we have to put consumers first. We must speak out against efforts, made in the name of industry flexibility in the pandemic, to relax liability standards for health care providers that render substandard care to consumers. Those would cause disproportionate harm to communities of color that safely access care by relying on enforcement of protections such as language access, quality-of-care standards, and anti-discrimination policies.

With digital health care technologies proliferating, it’s important to learn more about how receptive consumers are to them in communities of color. While telehealth presents opportunities to improve access to care, policymakers should be mindful of the need for low-income communities to be supplied with phones, tablets, and internet service to overcome the digital divide to get culturally and linguistically responsive care.

2. Address Immediate Social, Economic Effects of the Pandemic

At a time when California leaders are contemplating painful cuts to close the projected $54 billion budget gap, we must reject the urge to reduce spending for our most vulnerable and instead prioritize and strengthen safety-net programs.

As we map a route out of this pandemic, we know that our efforts to test for the novel coronavirus and follow up with contact tracing (PDF) will only be effective if Californians are able to self-isolate to protect themselves and others. Without a strong safety net, Californians with low incomes do not have this ability. People will need job-protected paid leave, access to childcare, adequate housing, and access to health care. Cutting these programs, as the state has done in previous recessions, would be a huge mistake that would ensure inequities continue for generations.

3. Increase Funding for Public Health

While COVID-19 is a crisis that requires intense focus, it is imperative that we not neglect the work needed to address future, long-term systemic inequities. The pandemic has highlighted the persistent weakness of California’s public health infrastructure after years of underfunding, especially in low-income communities of color. We need to build a public health system for the future that allocates resources equitably and is designed with the full engagement of people of color. A public health system should be capable of addressing the root causes of health disparities and preventing the unequal effects we are experiencing with COVID-19.

4. Address Systemic Inequities Now to Prevent Disparities in Future Crises

It is time to double down on our efforts to improve health care quality and fairness in communities of color and to hold the delivery system and elected officials accountable for those communities’ health outcomes. It should no longer be acceptable for people of color to bear the highest burdens of chronic disease and the most severe impacts of mental health issues. Let’s have an honest conversation about the role that race plays in health outcomes and life expectancy. To eliminate disparities in these outcomes, we must commit to address not only bias in the health care delivery system, but also racial and ethnic bias in education, criminal justice, and other societal institutions.

By tackling implicit bias and systemic barriers in the time of COVID-19, we can prevent the pandemic from exacerbating historic inequities. Only then can we create a healthy California for all.