PA POST – To observe that various social and environmental factors contribute to African Americans having worse health outcomes than other groups and to suggest that structural inequities underlie those factors is not particularly novel. Physicians and researchers have made such observations for decades. But the coronavirus pandemic has laid bare the consequences of these social determinants of health.
African Americans are more likely to encounter the coronavirus, less likely to be tested for it, and more likely to die from it. They are also less likely to have jobs that allow them to work from home, to have high-speed internet to access telemedicine and online education, and to live in the types of low-density residential environments most conducive to social distancing.
These realities are fueled by what panelists at a state Senate hearing on Thursday said is a pandemic of racism that has afflicted American public policy for decades in areas from education and employment to housing and health care. As a result, these experts say, African Americans face a disproportionate risk both to contract the virus and to have underlying health conditions that exacerbate its effect.
A quartet of African-American state senators is looking to seize this moment to begin to address the structural features that underpin African Americans’ worse health outcomes. Against the backdrop of protests against police brutality and amid news that George Floyd, the black man who died in police custody after an officer kneeled on his neck for nearly nine minutes, had tested positive for COVID-19, the senators convened a hearing of the Senate Democratic Policy Committee to identify why African Americans have suffered disproportionately during the coronavirus pandemic.
“COVID-19 hit the African-American community harder than other communities because of systemic inequities that gave rise to comorbidities that always existed,” said state Sen. Sharif Street (D-Philadelphia) during his opening remarks at the hearing.
Nine health care practitioners or researchers, all people of color, presented data and insight into a disease that, according to Morehouse School of Medicine surgeon Dr. Shaneeta Johnson, is 2.4 times more likely to kill African Americans than white people and 2.2 times more likely than Asian Americans and Latinos.
“As tragic as this is, it was entirely predictable and possibly even expected based on the transmission characteristics and the capacity of this virus,” said Dr. Orlando Kirton, chair of the surgery department at Abington Hospital.
The panelists offered policy recommendations that Senate Democrats appear eager to adopt.
And while Democrats are in the minority in both chambers of the Pa. legislature, state Sen. Art Haywood (D-Montgomery and Philadelphia), the ranking Democrat on the Senate Health & Human Services Committee and one of the conveners of Thursday’s panel, said he believes several proposals could attract bipartisan support. He pointed to expanding broadband access, prioritizing frontline workers for coronavirus testing, and disaggregating testing data by race as areas where the Senate can move quickly and make a material impact in the fight against COVID-19 for the African-American community.
“We will move forward everything that is a high priority that we think has a good chance of getting bipartisan support,” said Haywood in an interview after the hearing.
Haywood, Street, and state Sens. Vincent Hughes (D-Montgomery and Philadelphia) and Anthony Williams (D-Delaware and Philadelphia), said they feel a sense of urgency to take action, and with the legislature having passed a five-month budget ahead of its June 30 deadline, they hope to use the remainder of this month to pass legislation in time to ease the impact of a potential second wave of the virus in the fall.
“This virus is silent, and it’s deadly,” said Hughes in an interview Friday. “It is susceptible to a lot of people, very susceptible to black and brown folks … and we need to see that we’re all in this together.”
The most urgent policy objective for Hughes and Haywood is to scale up a massive coronavirus testing and tracing operation that accounts for how African Americans live and interact with one another.
Dr. Carmen Guerra, Associate Professor and Vice Chair of Diversity and Inclusion in the Department of Medicine at the University of Pennsylvania, said access to testing is one of the most pronounced disparities of the pandemic that can be readily addressed. Philadelphia’s richest zip code is conducting tests for COVID-19 at more than six times the rate of Philadelphia’s poorest zip code, she said. She recommended deploying mobile testing units and partnering with black churches to expand testing access and diffusion, a suggestion echoed by former Pennsylvania Secretary of Health Dr. Calvin Johnson, who testified that African Americans are frontline workers prone to come into contact with the coronavirus at higher rates than others and should therefore be prioritized for testing. Panelists broadly agreed.
Broadband & Internet Access
Another issue that has emerged during the coronavirus shutdown is a lack of access to high-speed internet.
Guerra said that the effects of a lack of access to the internet in the Black community is becoming increasingly acute. As telemedicine continues to expand, Guerra said she is concerned that internet access could become a social determinant of health.
“I am very nervous and fearful that these disparities will only deepen,” she said.
And Dr. Priscilla Mpasi, a pediatrician at CHOP in Philadelphia, pointed to data showing that nearly half of children in the Philadelphia School District do not have Wi-Fi access at home. Not being in school, she said, is holding those children back in numerous ways.
Expanding internet access has historically been a bipartisan issue in Pennsylvania with a particular focus on rural communities. Haywood said that he is hopeful bipartisan support can emerge to get internet access to any Pennsylvanians who need it as the Commonwealth prepares for a potential second wave of COVID-19 cases later this year.
State Sen. Kristin Phillips-Hill (R-York), who chairs the Senate Communication & Technology Committee and is the co-chair of the bicameral Broadband Caucus, said in an interview Friday that she would welcome the opportunity to work across party lines to move forward on expanding internet access. Several reports on the issue, mandated by legislation last year, are due this month, and that makes it a ripe time for action, she said.
“What this pandemic has revealed is that our need to connect with one another is greater now than ever before,” she said.
Other areas discussed at the hearing are more deeply embedded, which could make finding solutions more complicated.
“If we’re going to invest in truly addressing the reasons that African Americans are dying at such higher rates than other Americans, particularly white Americans, then we cannot have this conversation without discussing the historical health disparities embedded within the structural and institutionalized racial inequities that have permeated this country for over 400 years,” said Dr. Argie Allen-Wilson, a relationship therapist with F.A.I.T.H. Connects.
The ability to engage in social distancing, she said, is a privilege.
Overcrowded housing, unsafe working conditions for frontline workers, lack of trust in the health care system, lack of internet access, inability to work from home, food insecurity, and inequities in education are among the social determinants of health that disproportionately impact African Americans and can lead both to increased likelihood of exposure to the virus as well as to comorbidities that make the virus more deadly.
“Structural racism through social and economic policies that have disadvantaged black people have placed black Americans at risk for illness and death,” said Dr. Uche Blackstock, an emergency medicine physician and founder and CEO of Advancing Health Equity. “This moment must be used for structural change in the form of, among other social determinants of health, safe and adequate housing, gainful employment, access to quality education, access to healthy foods, and healthcare for all.”
Brookings Institution and University of Maryland sociologist Dr. Rashawn Ray said that, according to his analysis, about six weeks ago Pennsylvania did not have a notable disparity between African Americans and other groups in terms of COVID-19 deaths. But as of this week, African Americans account for 20 percent of Pennsylvania’s COVID-19 deaths but just 12 percent of the population.
He proposed creating local task forces composed of health care professionals, educators, pastors, essential workers, and other community leaders to develop solutions at the community level. More broadly, he suggested it is time to “reimagine a new America” through a range of structural reforms, including reparations for African Americans.
Haywood signaled support for the task force idea, which he called “the right way to go.” He said that access to broadband service and coronavirus testing are structural issues, but that issues that point towards social determinants of health — like education, housing, and job opportunity — are “more long term challenges.”
Hughes, long a proponent of raising the minimum wage, said doing so now would be a particularly important step to help “put some money in people’s pockets, so you relieve the stress of having to work four jobs at a wage rate that pays below the poverty level.”
The path forward
Thirteen session days remain on the Senate calendar in the month of June, and while there is no guarantee the chamber will use them all, having already passed a budget, Hughes, Haywood, and others would like to spend time focused on some of the issues raised Thursday as part of the legislature’s efforts towards a pandemic recovery plan.
Some of the issues have ideological divides, but Hughes said the bipartisan — and unanimous — fashion in which the legislature directed $2.6 billion in federal CARES Act funding gives him hope that this might be a season of cooperation and productivity for the legislature.
“I think there’s great hope that that allows for spending on this issue,” said Hughes. “I saw Democrats and Republicans coming together, I saw work with the governor, and that makes me hopeful that we can go on that path and get something very significant done. We cannot let up on this issue.”
PA Post is an independent, nonpartisan newsroom that covers politics and policy in Pennsylvania. Read their reporting at PaPost.org.