While Black and Latinx people make up only 13 and 18 percent of the U.S. population respectively, as of November they represent more than 50 percent of the country’s Covid-19 hospitalizations. In Los Angeles County, deaths among Latinx people have increased more than 1,000 percent since November, nearly triple the rate for white residents. Native Americans have been nearly twice as likely as white people to die from Covid-19. The virus has killed a disproportionate number of Filipino nurses. To bring desperately needed relief to the communities of color that have been ravaged by the pandemic because of the effects of structural racism, the Department of Health and Human Services should declare racism a public health emergency.
There is momentum behind this idea. Across the country, cities and states have declared racism a public health crisis. The American Academy of Family Physicians has also called for the declaration of a public health emergency. Last year, Senator Elizabeth Warren and Representatives Ayanna Pressley and Barbara Lee proposed a bill that would instruct the Centers for Disease Control and Prevention (C.D.C.) to create a center addressing the impact of racism on public health. The White House has created a Covid-19 health equity task force that will make recommendations to improve the federal government’s data on racial disparities and its response to them.
Studies and recommendations are good, but communities of color need action now, and a declaration by H.H.S. that racism is a public health emergency would have immediate impact. Under the Public Health Service Act, the declaration would allow HHS to allocate resources and personnel to tackle the issue, much like it has for the pandemic as a whole and for the opioid crisis. For instance, the it could allow workers from hard hit communities of color who lost their jobs because they had to take time off after becoming ill to use National Health Emergency Demonstration Grants to find employment.
It’s true that and policies designed for individuals of particular races may face legal challenges. But the programs that flow from a declaration that racism is a public health crisis could avoid this by targeting communities rather than individuals. A study published in August by amfAR, the Foundation for AIDS Research, found that predominately white counties had the lowest levels of coronavirus infection. This is no surprise, given that high rates of illnesses among Black and Latinx people can be attributed in part to racist housing policies.
Central Falls, R.I., whose population is 66 percent Latinx and 13 percent Black, provides an example of how this could work. The tiny town of only 1.2 square miles had the highest positivity rate in the state — around 20 percent. In December, the state offered vaccinations to all adults who lived there. They were offered in December in two public housing buildings, and since then the state has held vaccination clinics at the local high school and elsewhere. As of late February, weekly number of new Covid cases has dropped 80 percent compared to 65 percent state wide. About 33 percent of residents have received one dose, and 21 percent have been fully vaccinated.
“While there is a higher concentration of people of color in the city, the community-based nature of the effort has also helped to address issues around accessibility and vaccine hesitancy,” said Dr. Philip Chan, the consultant medical director for the Rhode Island Department of Health.
Still, Rhode Island, like every other state, lags in its effort to vaccinate nonwhite people, emphasizing the need to expand such programs. A declaration of a public health emergency would allow the federal government to deploy members of volunteer medical corps and the public health commissioned corps to other communities similar to Central Falls to establish vaccination clinics, engage in door-to-door outreach, and offer free testing. It would also allow governors to request the reassignment of health department staff funded by the federal government to assist with these local operations. Through the Public Health Emergency Fund, funding could be used to procure hotel rooms to serve as quarantine housing for people who test positive.
In recent months, one criticized study published in the journal JAMA speculated that Black people have higher rates of Covid-19 because they have a higher expression of enzymes in the nose that allow viruses to enter the body to cause disease. Other scientists suggested that physical separations be stratified by, among other factors, “ethnicity’”— erroneously treating Covid-19 risk as innate rather than structurally constructed. The declaration would provide an important balance to such messages by formalizing for the public that it’s racism, not race, that causes Covid disparities.
The emergency powers provided by a public health emergency declaration are limited, but they are meant to lead to further action. In 2017, the Commission on Combating Drug Addiction and the Opioid Crisis advised Donald Trump to declare the opioid crisis a national emergency, in part to raise awareness about the issue among Americans and “force Congress to focus on funding.” A declaration here would provide a similar impetus for legislative action. Since the declaration would need to renewed every 90 days, it would serve to draw regular attention to the government’s progress.
It’s well known that structural racism is behind the massive disparities in Covid-19 infection, death and vaccination. A declaration on this issue would be the first step toward fixing the problem.
Abdullah Shihipar (@ashihipar) is a public health researcher who leads Narrative Projects and Policy Impact Initiatives at the People, Place and Health Collective — a research laboratory in the Department of Epidemiology at the Brown University School of Public Health.
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