It is now clear that COVID-19 is not an equal opportunity pandemic. As reflected in numerous reports by public health agencies, the press, and the Federal Reserve Bank of Atlanta, COVID-19 is disproportionately impacting communities of color — especially the American Indian/Alaska Native, Black, and Hispanic/Latino communities — as well as other communities with greater barriers to health, economic, and social opportunities.
For those of us whose work focuses on health disparities, this comes as no surprise. Many reports have pointed to the high prevalence of chronic diseases as the underlying reason for this disproportionate impact. While part of the answer, this overlooks the underlying causes of increased chronic disease and other health conditions in these communities. The U.S. Department of Health and Human Services defines health disparities as health differences "closely linked with social, economic, and/or environmental disadvantage." Increased chronic disease and disproportionate rates of COVID-19 are both symptoms of a much broader problem — the systemic racism that we as a society have for too long failed to meaningfully acknowledge and address.
The same historical and contemporary policies and practices that lead to racial residential segregation and barriers to education, housing, and economic opportunities, also lead to increased health risks and worse health opportunities and outcomes. It is not by chance or due to lack of personal responsibility that there is a 13-year life-expectancy difference between Buckhead and Bankhead in Atlanta and similar disparities between urban and rural areas in our state. Long before Dougherty County was devastated by COVID-19, it ranked 152 out of 159 Georgia counties in health outcomes.
Georgia consistently trails the nation for a range of health outcomes, including being one of the worst states for maternal mortality. In spite of the Department of Public Health's report that 60% of maternal deaths are preventable, little meaningful action has been taken to address the 3 to 4 times' increased risk for Black mothers. The Georgia Legislature's recent legislation to extend postpartum Medicaid coverage from 60 days to six months is a positive development. More action will be needed to significantly improve our state's maternal health outcomes. As a society, we have accepted that it is easier to talk about "equal opportunity" than to ensure equitable access to those opportunities.
Given the longstanding health disparities in our state and in our country, it is critical that we not only track the disproportionate impact of COVID-19 on communities of color, but use that data to inform policies and practices to protect those communities. To date, we have done a poor job tracking COVID-19 cases by race and ethnicity. According to the CDC, we lack race and ethnicity data for more than half of all cases nationally. In Georgia, data is missing or unknown for almost 25% of reported cases. In spite of missing data, approximately 36% of cases and 48% of deaths are among Black people and over 16% of cases are among Latinos. These disparities are also reflected in a CDC report showing that 83% of hospitalized COVID-19 patients in Georgia were Black and a recent report documenting the disproportionate impact on nursing homes with higher percentages of Black or Latino residents. Having accurate data to guide public health strategies is essential.
Ensuring access to testing and treatment is also critical. To date, Georgia has established many drive-thru, but few walk-in, testing sites. People of color are over-represented among those without access to a car, creating an unnecessary barrier to testing. At the same time, they are over-represented among low-income workers, who are both more likely to be in essential industries and service jobs that increase their risk of exposure and less likely to have access to affordable health insurance coverage, due in part to Georgia’s failure to expand Medicaid. Those falling into the coverage gap, not eligible for Medicaid or a health insurance subsidy, were estimated at more than 250,000 prior to the pandemic. This number is growing daily as record numbers of Georgia workers have lost their jobs.
Low-income communities and communities of color are not only more likely to experience serious health complications from COVID-19, they are also at greater risk for social and economic consequences. A public health response requires addressing the social and economic impacts that are integral to health and safety. This means ensuring a strong social safety net to support critical areas like economic assistance, food access, and housing stability. There are urgent steps our state can take today to support Georgia families. These include expanding economic assistance, extending access and reducing barriers to food support, and enacting a moratorium on housing evictions and foreclosures. This must also include relief for borrowers, whether homeowners or landlords. As noted by colleagues from Georgia State University, Georgia Tech, and Emory University, families cannot provide a stable and secure environment for children or vulnerable elders, without stable housing.
Public health leaders recognize that our nation is now facing two public health crises — the COVID-19 pandemic and the longstanding pandemic of systemic racism. Federal and state leaders must take targeted action now to address both public health crises and ensure the health, safety, and stability of those communities being disproportionately impacted.
Harry J Heiman, M.D., is an associate professor in the School of Public Health at Georgia State University. Rodney Lyn, Ph.D., is interim dean at the School of Public Health at Georgia State University.
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