Public Health and Social Justice: Health Equity Is More Critical Than Ever Before

The COVID-19 pandemic has proved the powerful connection between public health and the economy, businesses, and people across the globe. While the outbreak revealed that certain communities are more vulnerable to infectious diseases and deaths compared to others, recent protests in response to police violence further underscored another public health challenge in the U.S. inequities in the health and social justice systems.

Undeniably, public health involves a complex matrix of socioeconomic and geopolitical factors. Viral threats like the coronavirus are no longer just a public health issue, but also a social justice matter that need to be addressed now more than ever. Consumers, patients, and partner networks are increasingly diverse and are voicing expectations for inclusion, diversity, and equity. Healthcare providers, insurers, and pharmaceutical companies need to be mindful of not only existing health disparities among patients, but also business practices that may exacerbate disparities and perpetuate systemic racism.

Health equity and social justice are responsibilities of the government, academia, communities, and society at large. However, the healthcare industry has a particular responsibility, and the opportunity, to address inequities in the healthcare system to better serve customers and patients in the most effective and just way possible.

Health Disparities in the U.S.

Historically, certain communities in the U.S. have faced barriers to accessing health and social benefits due to their socioeconomic status, race, gender, ethnicity, or geography. Youth of color living in low-income neighborhoods are more likely to develop diet-related chronic diseases than white children[1] due to lack of secure housing, access to healthy and nutritious foods, quality education, and affordable healthcare.[2]

COVID-19

The COVID-19 pandemic has revealed that racism is also a social determinant of health that has a significant influence on patient and population health. The outbreak in the U.S. has hit communities of color particularly hard.

• Predominantly black communities in the U.S. have experienced three times the rate of infection and six times the rate of COVID-19 related deaths as predominantly white communities.[3]
• Among Medicare beneficiaries, Hispanic and Asians were more likely to be hospitalized than white people.[4]

While socioeconomic factors contribute to these trends, including the disproportionate representation of black and immigrant women among frontline health workers, they are exacerbated by systemic racism and unconscious bias that plague all institutions, including the American healthcare system.

• When the COVID-19 virus began to quickly spread, officials issued guidance directing people who experience coronavirus symptoms or suspect they were exposed to the virus to contact their primary care physician (PCP) to request a test. This guidance failed to recognize that many Americans do not have access to primary care due to costs, healthcare workforce shortages in their communities, or lack of transportation. In fact, uninsured or racial minorities are more likely to lack a PCP than others.[5]
• The primary sources of healthcare for people who are at a higher risk of infection are community health centers (CHCs).[6] While CHCs serve as a safety net for millions of Americans with little or no health insurance, many CHCs are struggling due to the financial impact of COVID-19,[7] potentially putting vulnerable Americans who rely on CHCs at another disadvantage to accessing quality, affordable healthcare.
• Furthermore, a recent study found that race plays a role in clinical decision-making, including whether a patient receives treatment, as many race-adjusted formulas guide doctors’ decisions for patient treatment.[8] Racial and ethnic minorities were denied treatments or services while they were made available to white patients, suggesting that people of color infected with COVID-19 could experience even more severe effects in the long-term.

Civil Unrest

COVID-19 is just one threat that poses a disproportionate risk to the physical and mental health of people of color in the U.S. Researchers estimate that one in 1,000 Black American men will be killed by police in the U.S. in their lifetime,[9] a grim statistic with reverberating implications for the health of families and communities. Since the recent police shootings, rates of mental health issues have spiked among people of color.[10] After the video of George Floyd’s death became public, the rate of Black Americans showing clinical symptoms of mental health problems increased from 36 to 41 percent, representing 1.4 million people. The negative effects on mental health were not limited to Black Americans: the rate of mental health symptoms among Asian Americans increased by six percentage points.[11]

Implication for Businesses

As protesters call for systemic change to address racial inequality, companies have begun speaking up to assert their values in support of social justice. As more organizations convey the value of equality in their communication and business strategies, addressing social justice will be a critical way to stay competitive among peers that will brand themselves as transformative, socially responsible, and doing more to solve health inequities. These may include, but are not limited to:

• Conducting a leadership diversity audit to consider whether the executive leadership within your company accurately reflects the communities they serve;
• Working with policymakers and stakeholders to raise awareness of the importance and benefits of eliminating barriers to access of quality healthcare for all Americans, in ways that are authentic and genuine to every community; and
• Making meaningful investments in initiatives that provide increased support and care to historically underrepresented communities.

Healthcare companies have the ability to not only make a statement but to also make a difference. Racism is an underlying public health issue, and health inequity is a crucial social justice matter. To eliminate disparities in health risks and outcomes, the industry must go beyond efforts to address affordability and focus on ensuring accessibility and quality for diverse patient populations. Businesses will need to do more to address the problem in order to improve their corporate reputation, market share and brand recognition with clients, including the young, diverse client base that is highly socially conscious and expects more from the people they are doing business with. ‘Doing more’ may entail drifting away from traditional business models that may have previously failed to truly embrace the moment of collective transformation in the way they serve all customers and patients equally – regardless of race, ethnicity, gender, class, sexual orientation, and religion.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4888796/

[2] https://www.ers.usda.gov/webdocs/publications/42711/12716_ap036_1_.pdf

[3] https://www.washingtonpost.com/opinions/racism-is-killing-black-people-its-sickening-them-too/2020/06/04/fe004cc8-a681-11ea-b619-3f9133bbb482_story.html

[4] https://subscriber.politicopro.com/health-care/whiteboard/2020/06/new-data-shows-racial-disparities-among-covid-19-patients-3981800

[5] https://www.usnews.com/news/health-news/articles/2019-12-17/fewer-americans-have-a-primary-care-doctor-now

[6] https://www.kff.org/coronavirus-covid-19/issue-brief/impact-of-coronavirus-on-community-health-centers/

[7] https://stateofreform.com/news/washington/2020/04/financial-impacts-of-covid-19-may-force-over-half-of-community-health-centers-in-wa-to-close/

[8] https://www.nejm.org/doi/full/10.1056/NEJMms2004740

[9] https://www.pnas.org/content/116/34/16793

[10] https://www.washingtonpost.com/health/2020/06/12/mental-health-george-floyd-census/?arc404=true

[11] https://www.washingtonpost.com/health/2020/06/12/mental-health-george-floyd-census/?arc404=true