A Milken Institute School of Public Health professor authored a report last week calling on President Joe Biden to focus on reducing public health inequities in responding to the COVID-19 pandemic.
Jeffrey Levi, a professor of health management and policy, wrote a report urging the Biden administration to handle COVID-19 through long-term policies, like expanding access to health insurance, that address racial inequity. Levi said the pandemic can’t be addressed by medical care alone but requires government officials to invest in tangential areas of health, like food and housing policy, to create long-term improvements in public health.
Levi compiled the report based on conversations with 50 community leaders, like health experts and people running community service-based organizations, responding to the pandemic at the national, state and local levels, according to the report. The report states the response to COVID-19 must focus on related “health, social and economic impacts,” in addition to the virus itself.
“In that way, we can view the rebuilding process as starting now, rather than waiting until after we have addressed the current emergency,” the report states. “The investments in managing the current pandemic should lay the foundation for ensuring an equitable response to future emergencies.”
The report was published through GW’s Funders Forum on Accountable Health, which funds projects relating to health provider accountability. The report is broken down between immediate, post-pandemic and rebuilding responses to the pandemic.
The immediate recommendations include accelerating vaccine distribution and expanding access to health insurance while the post-pandemic stage outlines targeting underlying health conditions that were exacerbated by COVID-19 and emotional healing for frontline health care workers. The report states the rebuilding stage should include establishing equitable health care systems in the United States, building on the policies outlined in the first two stages.
Levi said policies that fix underlying social conditions, like food and housing insecurity, are just as necessary to improve public health as medically focused policies.
“One of the problems in our country is the degree to which we medicalize our health problems, and a lot of them are not going to be solved within the four walls of the clinic,” Levi said.
The pandemic has exacerbated pre-existing disparities in public health outcomes. Data from the District’s coronavirus database reveals that the majority of COVID-19 deaths have occurred in medically underserved areas of the city and where Black residents make up the majority of the population.
“Look at any map of the prevalence of COVID in any community and where there is poverty, where there is denser housing, where there is lower income, where there is a higher proportion of people of color – you’re going to see higher rates of COVID, and that’s baked into the system,” Levi said.
The report names several goals that can be reached either administratively, like simplifying both the process of health care enrollment and providing technical assistance to states, or legislatively, like implementing broader Supplemental Nutrition Assistance Programs and removing barriers to insurance coverage.
Levi called Biden’s announcement of a temporary 15 percent increase in Supplemental Nutrition Assistance Program benefits necessary “economic support” for people in need but said he worries that its temporary nature could maintain public health disparities.
“They’re talking about this in temporary terms, that this is a ramp up, and we need to make sure that it is permanent,” Levi said.
Levi said because the political environment is “hard to predict,” the report highlights changes that can be done administratively by Biden, like the SNAP expansion, in addition to the broader policy changes that require congressional approval.
“While a lot can be done by the Biden team alone, the more systemic changes will require Congress to act as well,” he said.
Experts in public health said addressing racial disparities in health is key to combatting the pandemic and laying the groundwork for systemic improvements in public health services.
Camara Phyllis Jones – a family physician, epidemiologist and former president of the American Public Health Association – said racial inequities seen in the impacts of COVID-19 and other areas of public health have been caused in part by centuries-long injustices, including slavery, divestment from Native American reservations and Black and Brown communities and inequities in public education. She said ending the social inequities is vital to promoting public health equity.
“If we really want to be stronger as a community and not be fractured with differential impact, by race or by indigenous status or even by income, then we need to deal with all of those other sectors outside of health,” Jones said.
Tina Sacks, an assistant professor at the University of California, Berkeley’s School of Social Welfare, said improving public health goes beyond medical policy to also involve social policy. She said she agrees with the report’s recommendations and supports expansions in food stamps, housing programs and child care subsidies as ways to reduce inequities in public health both during the COVID-19 pandemic and in the future.
“We know from some comparative social policy studies is that in Western Europe, countries that do have more comprehensive social safety nets also have better health outcomes,” Sacks said. “What we need is a more robust safety net in general, and those are the kinds of policies and programs that could be put in place that would go a long way to reducing health inequities.”
Lia DeGroot contributed reporting.