Not Just a Pandemic: Why COVID-19 Is a Health Equity Issue
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We've long known that social, economic and environmental conditions play a sizeable role and helped outcomes, and unfortunately, these inequalities have become even more pronounced in a time of a pandemic. So how can we better respond to the social determinants of health and address the rapidly rising health disparities? Witness during the Cove in 19 Pandemic and beyond You're listening to reach MD. This is Cove in 19 on the front lines. I'm Ari Onassis Novich. And here with me is Dr Renato Scavo, a senior lecturer on social medical sciences at Columbia University, founder and president of the board of directors of the Health Equity Initiative and editor in chief of the Journal of Communication and Health Care Strategies, Media and Engagement in Global Health. Thanks so much for joining us today. Granada. Thank you very much for having me, Meyer. So let's begin by taking a closer look at Cove in 19 through this lens of health equity. First, is this pandemic a health equity issue and if so, why? As you know, Mario, pandemics do not discriminate, and everyone is susceptible to contract any kind of infectious disease, including Cove in 19. Yet pandemics have a way of showing us the magnitude off health and social inequities that many people experience, which in turn, after fact that ability to protect insults. But that makes actually tried on inequalities, since what some people may consider easy protective behavior are actually know TC for everyone. For example, hand washing is not easy for homeless. People often lack access, water and soap. It can't even produce social distancing because of overcrowded conditions in which they leave if they are in a shelter. If we go factors influencing vulnerability during a pandemic, many of these factors are preexisting to the pandemic. Itself has to do with many social and political determinants of elves that are set the ability of people to protect themselves, but more in general to lead a healthy and productive life. So which communities or populations specifically have been disproportionately affected by this virus? Well, there are many vulnerable, marginalized low income. A population were being disproportionately affected by the pandemic. As you know Mario in us, we have seen that the pandemic is having a bigger toll within communities. So caller that this is the result, a lack of investment in these communities, social discrimination, Raissi's mouth segregation, lack of access to services and opportunities, which in many community has resulted in poverty and higher rates of chronic diseases such as diabetes and asthma, which are all condition it increase the risk for severe consequences. Cove in 19 also want to speak about Children live in poverty who may not be a degree, too for life threatening consequences. So contracting cov 19 but in many cases depend on being in school for their meals and have been short changed by the pandemic and limited efforts. Historically speaking, toe address poverty alleviation. So the pandemic has shown us that we need to think of additional system to the liver. Nutrition toe. 20 plus 1,000,000 Children live in poverty in the United States, especially in communities, so callers that have be marginalized, discriminated against for centuries and feeding entirely poverty. And what are some of the barriers identify for low income in marginalized communities during a pandemic like this? Well, a few groups 50 50 bears come to mind, for example, for many of the option of staying home of protecting themselves by practicing social distancing or else isolating or others. It's not really an option because many people don't have access to pay leave or PC Cleve and need to choose between staying home and pay event and putting food on the table. So I know that I'm basically provisioning. The Family First Corner Bars Act is a step in the right direction, but all the addresses a minimal fraction of what we need with that 1,000,000 of workers are left out from these provisions that these workers Centobie specifically from communities or colors. So women or other low income populations the many cases these workers who are putting their lives at risk so people can stay safe and have access to basic necessities such as food and pharmacy cashiers. We also know that many marginalized populations such people leaving with homelessness, disability or mental illness lack the kind of social support resources toe adopted sustain protective behaviours in some cases, such as for the homeless, maybe a physical resources, something as simple as water and soap by in others, maybe the lack of structural, urban or social resources and support to comply with the commander behaviors. Finally, we know that in some hospitals, sources such as ventilator mask it, other perfect evict keep him, and maybe even scar. Sirs, this is likely to be the case in low income communities and communities of color because of the historical lack of investment in these communities. So this is why I've been advocating for professional association and community leaders to come together. A new team is to develop guy lines for the youth of Carson sources, which should be basil needs in furnace and equity principle. Now, another important aspect of this that I'd like to bring up is the influx of inaccurate information about the virus, which itself is often labeled as an info Didem IQ. Can you speak to that issue and how it impacts vulnerable populations in particular? This is a very important question. Mario. Yes, we are in the midst of a Cuvee 19 in for that make. There's a lot of misinformation out there on ALS. The topics we have disguised that much more social media may not have been in issue in past epidemics. Cities saw breaks, but it's definitely an issue now decent for me, particularly concerning for low health, literacy, population and other former population who may not have training tools, the resources toe distinguish between evidence based information and fake news, for example. Many of them may not use social media where a lot of information Oxus happens to circulate, but they're still speaking with people who get information from social media. So for these, it's important to continue to strengthen this communication system by engaging community leaders. Have trusted sources, address the foxes directly in occupied social media with the right information because if we don't do it, others will occupy the media with the wrong information. For those just tuning again, this is Kobe. 19 on the front lines on Reach MD. I'm Mario National vich and joining me to talk about Covert 19 as a health equity issue is Dr Renato Scavo from Columbia University. So we're not it. Now that you've given us a better understanding of the barriers faced by the at risk populations, what actionable steps can we take to protect them During and after the Cove in 19 pandemic, we mentioned before the importance of expanding Paley provisions to protect workers now a behind pandemic bonding upon Corrine systems to deliver nutrition. Two Children live in poverty, but in underlying principle among these and other kind of provision, which all started recollecting real data, these ethnicity and language data that can actually give us an idea or who exactly the pandemic is impacting. We know that has a higher border and community of colors in this advantage, glowing can communities, but the data need to be there need to be disseminated broadly. But in addition to which, I think that the very big fact is to try to think about advocating for an expanded role of government is stimulating the economy, protecting worker from Lincoln community who are more likely to lose their job doing or after the ban Demming, as well as for essential services that people need for the response now in the future. And that's the perfect Segway into our discussion on community engagement and advocacy during and after this pandemic. How do we go about engaging those community leaders and local support networks in public health and get them involved in terms of unprecedented time like this, but also allowing them to remember that this is something that is pervasive and has happened before this pandemic and will continue to happen after this pandemic? I feel the community engagement and our focus a really key during pandemics because removing barriers to protect your behavior, so also is linked to community on a ship off solutions for implementing such protective behaviours. So ultimately, this is linked to the sustainability, all the health and social behaviours and policies and goods and services that need to be disseminated and implemented during this pandemic and beyond. So when we involve communities is more likely that they are going to endorse. For that to be, they're going to find local solution to implement them, that these behaviors recommendations reflect their values and the conditions in which they leave. And ultimately we change the system as a whole. We create community and patient ownership or solutions. So this is a very important action that has been demonstrated to be helpful also in their pre control and this communication across the seven pandemic and epidemics of from SARS H and wanting one and Ebola taking a bowler just like the latest example of those pandemics. Several key started in Sierra Leone and Liberia by UNICEF showcase that Ebola crisis started to be mitigated. Holy one community got involved in becoming trusted source of information with their community members about in developing kids centers, designing solutions and much more. Colby 19 Pandemic, for example In the United States and communities Bean installing temporary things for the homeless is to provide them a resource for washing their hands. But in order to channel that maximize impact of these community efforts, we need really to connect with a Bacchus organization with research groups to work directly with these communities. Have the ability to actually provide resources and training for community leaders to reach policymakers and influence policy making. And we also need to use the agree Tarver or media or blogged for the Internet. Of all of these kind of resources toe amplify the voice of community leader. So I think the community engagement and advocacy are really connected to each other and are very important during the cov 19 crisis and behind. Lastly, Renato, you've been out spoken even before this current pandemic began about the need for a paradigm shift from a disease Onley based approach toe, one more attuned to the social determinants of health. Can you elaborate what this looks like compared to the current system and how you would change things going forward? As you know Mario, it is This approach tends toe focus on how conditions on the medical courses on symptoms, how we treat them, how we prevent them and the focus primarily on the behavior. So patients and the people who can influence them. But these are projects often very a believe you. So the number of various people experience in having to implement the recommended behavior, whether it's protective behavior. So helping Avery In general, it is a project it for as a very limited sustainability because he doesn't have a better driven strategy behind your commanding These healthy behaviors so happy never kating for a while for a social determined and project it to move forward, addressing the root courses, the people expedience in the living and working environment to implement lt Be able. These are projects to do it community and patient engagement because, as I mentioned before, it's important together endorsement the ownership of communities, patients in every kind of change we want to make. So I feel that this approach is particularly important with Corden talks or the hoping many economies underway and I feel there are some important condition. Toby bad. Even before we can start contemplating dis option, we need an increased amount of funding to strengthen the public health and social infrastructure to build strong civilians. A tested system it addressed many barriers people face, whether it's a leave or nutrition or others. If we do it right, it will be beneficial also for population and community health outcomes outside of this pandemic. I strongly believe the systems the signed with pandemic in mind, I likely to help we chronic disease prevention. We decreasing in for the maternal mortality bought also in United States with alleviating mental health issues and preventing substance used in suicide. Just to name a few of the many issues that assistant that is designed with pandemics in mind may help alleviate these walls, improve our preparedness to respond to epidemics and emergency ceases or break bought the during this cov 19 pandemic and in future outbreaks. This is only possible, in my opinion, if we use the health equity lands and methodically address the key social determinants of L to the key barriers people experience in protecting yourself and ultimately leaving healthy and productive life. Well, with that closing comment, I'd like to thank Dr Banana Scavo for joining me to shed light on the rising magnitude of health disparities across social, economic and environmental lines, but even more importantly, the steps we can take to protect these vulnerable and marginalized populations. Granada It was great having you on the program today. Thank you very much for inviting me. Mario for Region. Dion Mario, NASA Novich to access this episode and others from Kobe, 19 on the front lines visit reach MD dot com forward slash Kobe 19 Where you could be part of the knowledge. Thank you for listening.