If the COVID-19 pandemic has taught us anything, it is that health is a commodity bestowed readily on some and denied to so many others. Within months of the COVID-19 virus reaching U.S. shores, it became clear that the disease hit certain groups harder, contributing to more severe illness and higher hospitalization and death rates among Black, Latinx and American Indian/Alaska Native communities, and those of lower socioeconomic status.
The reason for that skewed impact doesn’t have so much to do with biology or genetics as it does a myriad of other factors, such as where people live, how clean the air they breathe is, what they eat, whether they work and if they do, what jobs they hold, and whether they rely on public transportation to get around. Dr. Rochelle Wolensky, the new director of the U.S. Centers for Disease Control (CDC), knows this dynamic well. As division director for infectious diseases at Massachusetts General Hospital, her research and clinical work focused on HIV, and she has served on Massachusetts governor Charlie Baker’s COVID-19 advisory board, helping to shape pandemic policy in that state. “I came from a place of taking care of patients with HIV and infectious diseases and those who work in public health have known forever that the diseases afflicting the poor, and afflicting those with access to health care, and afflicting racial and ethnic minorities are different than the diseases afflicting white Americans, or more privileged Americans,” says Walensky. “I came to the job with that reality every single day.”
COVID-19 simply trained a searing spotlight on that reality. According to the CDC, the ratio of Blacks and Latinx Americans who are hospitalized are around three times that of whites, and death ratios are around two times higher. And in that harsh truth, Walensky sees opportunity.
On April 8, she is launching a new agency-wide initiative called Racism and Health, to refocus the CDC’s public health efforts on recognizing, acknowledging, and, most importantly, taking action on the multitude of ways race impacts people’s health. From historical mistreatment that’s led to ongoing hesitancy and fear of the medical establishment among certain racial and ethnic communities, to lack of access to good care, to lack of representation in research studies and among the ranks of health care workers, racism has long been ingrained in the U.S. health system.
“I have been pretty articulate in declaring racism a serious public health threat,” says Walensky. “The word racism is intentional in this [initiative] for the CDC. This is not just about the color of your skin but also about where you live, where you work, where your children play, where you pray, how you get to work, the jobs you have. All of these things feed into people’s health and their opportunities for health.”
It’s not the first time the CDC has committed to addressing health inequities due to race. In the late 1980s, the agency was the first in the Department of Health and Human Services to create its own Office of Minority Health & Health Equity. Leandris Liburd joined the office soon after it was formed, and is now its associate director. Liburd acknowledges that while some of the agency’s divisions have robust efforts to address racism in their staff as well as the work they do, others do not. What the new Racism and Health Initiative will do, she says, is elevate health equity as a priority for everything the CDC does. “We can now extend our net and really engage fully to address these issues,” says Liburd.
That entails a shift in focus, says Walensky, from observation to action. She has charged all of the centers and offices under the CDC to come up with interventions and health outcomes that they will measure in the next year to address racism in their respective areas, whether it be childhood immunizations, nutrition or chronic disease. In two agency-wide virtual meetings she has held with 30,000 staff members since becoming director in January, she has made it clear this is a priority for her directorship. “It has to be baked into the cake; it’s got to be part of what everybody is doing,” she says.
COVID-19 is serving as an effective vehicle for accomplishing that. Through additional funding from the federal government for COVID-19, the CDC has $2.25 billion at its disposal to address COVID-19-related health disparities, and in understanding why certain communities were disproportionately affected by this pandemic, Walensky says the country will be in a better position to understand, and hopefully change that trend before the next outbreak. Key to that is understanding the so-called social determinants of health—the epidemiological catch-all for the non-medical factors that can influence people’s health. People living in areas with little access to fresh produce, for example, are more vulnerable to developing obesity and chronic conditions such as diabetes and hypertension that are related to less nutritious diets. And because the same demographics without access to fresh produce are those less likely to access care, these conditions are more likely to lead to serious complications that could be life-threatening.
Walensky’s vision is to more effectively harness the power of the CDC as a national health body to embed awareness of racism in every endeavor the agency takes on. That starts with a refreshed Racism and Health website “with the CDC brand and CDC’s weight behind it,” she says. The site will be a hub for the public to learn about the intersection between race and health, and the ways that the CDC is working to erase inequities and address gaps driven by race.
“There has been a lot of documenting the problem,” says Walensky. “I want to start thinking about…how we can intervene to solve the problem. Not all of them will be successful but I’d really like to think about how we can start looking at interventions that make a difference.”
The seed for that will be more aggressive community-based efforts to vaccinate underserved communities against COVID-19, including a new $300 million effort to fund community health workers—key local leaders that can range from faith-based leaders to barbers to other trusted local figures who live in and know the communities that are left out of the existing health network for economic, cultural or other reasons. With the additional funding, local public health departments, for example, are supporting mobile teams to go to people where they are, and remove the burden of traveling to a vaccination site. Faith-based leaders and their churches are also becoming community vaccination centers, as congregation members convince others to get their COVID-19 shot.
“Now is the time because there is attention drawn to it, and resources drawn to it,” says Walensky of building off of the COVID-19 vaccine rollout. “We are making a concerted national effort to reach those who have not been reached because we are making ties to local folks and trusted messengers. I just really want to make sure that as long as we are doing that effort, and reaching people where they are, that we do so in a way that will allow us to not only vaccinate them for COVID-19 today but vaccinate their children for any missed immunizations and treat their blood pressure and screen them for cancer and do all the things that have been long neglected because they lacked access.”
Both Walensky and Liburd realize that won’t happen overnight, but say being more intentional throughout the agency about addressing the ways that race affects people’s health is an important step. As COVID-19 has exposed the deep divides in access and outcomes that exist among different racial and ethnic groups in the U.S., “to continue as if they don’t exist is counter to all the principles of public health, and counter to the ethical practice of public health,” says Liburd. “We now have the opportunity to really elevate and accelerate our attention to these issues for sure.”
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