“Public Health and Social Justice during COVID-19”

“Public Health and Social Justice during COVID-19”  

Shivali Vashisht MS., MPH.

In the midst of the coronavirus pandemic, I joined the public health workforce. When my final semester began back in January, I was excited to transition from my benchwork research role and start manifesting a public health career that would recognize the intersections of basic science and population health. Little did I know, the upcoming months would bring the threat of infectious disease and global loss as a lived reality. I was humbled to be onboarded by the New York City Department of Health and Mental Hygiene (NYCDOHMH) as a Research Scientist assisting with the COVID-19 response during April 2020.

            The NYCDOHMH is constantly crafting new approaches and adapting programs to respond to the pandemic. I most recently helped with piloting contact tracing and surveillance investigations with the Bureau of Communicable Diseases (BCD). Contact tracing is a core public health function which has been used in the scope of many infectious diseases (TB, STIs and Legionella). Nations like South Korea, Singapore, Turkey and China have implemented this tactic successfully to address COVID-19 and mitigate population exposure to contain viral spread. Contact tracing involves calling a patient within days of a positive COVID-19 diagnosis and chronicling symptoms, as well as household contacts and outdoor contacts. This enables local health departments to keep tabs on cases in the community and, offer wrap-around services like free testing and hotel accommodations to isolate, if needed.

            Speaking to COVID-19 patients and obtaining sensitive data was a heavy task. The stories that New Yorkers shared with me during their interviews were raw and compelling. During my first week on the job, I would stay up at night and think about my cases and their families. Especially those living in congregate settings, those who could not isolate, others who could not afford medical care or take time off from work and, people who were simply overwhelmed with their diagnosis. My cases would sometimes require translation services and candidly express their communities lacked PPE. Patients would reject wrap-around services, due to medical mistrust and the looming sense of uncertainty. One of my cases said he meant no disrespect but he “does not want to be left to die alone,” and refused hotel accommodations because he has heard “bad things”. He would rather live with his 8-person family in a 2-bedroom apartment. I felt helpless and quickly saw that coronavirus is not a great equalizer. It is imperative to recognize the disproportionate impact of COVID-19 on the outer boroughs and vulnerable populations, such as minorities and Black and Brown communities.

My home borough of Queens is home to 1.1 million immigrants, most belonging to the working class, who occupy city jobs or are essential workers. The main employment sectors include healthcare, transportation and retail. Communities are filled with small businesses and the self-employed. In addition, 13.7% of residents live below the poverty line. People have no choice but to work. This, paired with unique social determinants of health (SDOH), have synergistically crafted the perfect recipe for disaster and made Queens the epicenter’s epicenter back in April. 

Minorities have higher rates of chronic illness and less medical access, making them particularly susceptible to coronavirus. Preliminary research suggests that for every 100,000 people, the death rate for Latino New Yorkers is 233.42 and 219.77 for African Americans. In contrast, the death rate for White New Yorkers is 109.69 out of 100,000 and for Asians/Pacific Islanders, the rate is similar at 102.46. Hispanics/Latinos and Blacks/African Americans additionally have the highest hospitalization rate and disease prevalence in the city. This emergency has not only demonstrated that resources on the frontlines are scarce, it highlights how the health system is overwhelmed and uncomfortably discriminatory. Having the ability to shelter in place is a privilege. 

Infectious disease perpetuates health inequity, and gaps in medical care become lifelong barriers for marginalized communities. We have historically combated pandemics through surveillance, testing, research, development and prevention. Yet, for every government dollar spent on healthcare today, only three cents are put towards public health infrastructure. In an already broken system where minorities, immigrants, the incarcerated, the detained, and the uninsured are disenfranchised, COVID-19 exposes the reasons why we are unprepared. Adopting an equity lens, policy-based reform and public health initiatives would provide much needed stabilization and support for vulnerable populations at this time.

Systemic racism and residential segregation depicted by COVID-19 data is our call to action. The public murder of George Floyd and the policing protests in the US have additionally primed the nation for further dialogue in regard to systemic biases, inequality and the trickle-down effect of poor health outcomes for Blacks and Hispanics. ASPPH (Association of Schools & Programs of Public Health) has acknowledged racism as a public health crisis and, policing can be seen as a social determinant that has a profound impact upon health consequences, according to the Harvard Pubic Health Review (2015). As New York begins its re-opening, the safety of vulnerable populations should be prioritized, and a cross-sectoral effort is needed to tackle not only COVID-19 but the virus of ethnic and racial prejudice and inequity. I hope that individuals, local organizations, health departments, public health professionals and the federal government can contribute in their own ways and collaborate on issues like housing insecurity, occupational safety and poverty. We are failing Black and Brown communities and need a new normal. 

As a newly minted member of the workforce, the current events have supplemented my MPH coursework in way that I never imagined. Public health measures are not panaceas; rather they aggressively tackle problems through strategy, instead of damage control. Being a person of color should not be a death sentence. Public health, as a discipline, can lead us to safe, patient-centered addendums at this critical time of recovery. As COVID-19 continues to try our resolve, we are presented with the unique opportunity to acknowledge healthcare inequity and take steps in dismantling it. People of color are paying the biggest price for both of these crises and, as a nation, we have a pressing need for game-changers and innovators willing to reconfigure the healthcare system. I strive to belong to a generation that does not accept complicity and inaction.

Data Source: New York City Department of Health and Mental Hygiene, 2020, COVID-19: Data, Case, Hospitalization and Death Rates stratified by Race/Ethnicity, City of New York, viewed 5 June 2020, <https://www1.nyc.gov/site/doh/covid/covid-19-data.page>.