Health Equity and Disparities Post-COVID-19: Real Solutions are Long Overdue

by Richard Seidman, MD, MPH Chief Medical Officer, L.A. Care Health Plan

The COVID-19 pandemic unveiled the reality of longstanding inequities and disparities in our society. It became clear early in the pandemic that under-resourced communities of color were seeing higher rates of infections, hospitalizations and deaths from the disease. These same communities also experienced increased risk because they were less able to comply with public health recommendations due to circumstances that existed prior to the pandemic, such as living in crowded conditions, serving as essential workers, and relying on public transportation. Addressing the systemic issues that produced the inequities and disparities will require a sustained, long-term effort. We simply can’t go back to the way things were before the virus delivered its one-two punch – the worst pandemic in 100 years and the devastating impact on the economy, businesses, individuals and families.

As we have progressed through our recovery efforts, I applaud the state’s inclusion of an equity metric in the Blueprint for a Safer Economy. Also notable is the Los Angeles County Department of Public Health’s ongoing efforts to distribute a higher proportion of available vaccine supply to the most at risk 25% of our population, typically under-resourced communities of color. Now, with our recent move into the Yellow Tier and as we move closer to the June 15 date the Governor has set to move Beyond the Blueprint, our work is just beginning.

The data is clear – COVID-19 has had a disproportionate impact on communities of color in the United States, with Blacks and Latinos becoming infected and dying at higher rates than Whites. In Los Angeles County, the number of deaths for Blacks and Latinos has consistently been two to three times higher than that of whites. But beyond race and ethnicity, poverty has been a predominant factor in poor COVID-19 outcomes, with those in the lowest income brackets having the highest risk of death.

For years, public health experts have pointed to the social determinants that put people at greater risk for poor health outcomes. They know that things like discrimination, housing, education and income gaps affect a wide range of health risks and outcomes. COVID-19 illustrated just how much these social factors impact health risks and outcomes.

Unfortunately, the nation’s COVID-related economic collapse worsened the situation. Blacks, Latinos and women suffered job losses at a higher rate than Whites and men, which left them even more vulnerable. A Pew Research Center analysis found unemployment rose more sharply in low-wage jobs. That left millions searching for help all across the country to put food on their tables and keep a roof over their heads.

While the economy is rebounding, some fear many low-wage jobs won’t return. Even if they do, that won’t change the inequity issues that existed before the pandemic. For that to happen, it is going to require increased funding for social services that can help to improve the quality of life in currently under-resourced communities. It will also require increased understanding and focus on addressing the systemic racism that lowers life expectancy in communities of color due to the many barriers or social determinants impacting health.

We are also going to have to take a serious look at the state of our public health infrastructure. Chronically underfunded public health systems were cut even further during the last administration, including funding for pandemic surveillance, prevention and response. The COVID-19 pandemic exposed how ill-prepared we were to deal with this health crisis. The early scramble to secure adequate and equitable supplies of personal protective equipment (PPE), ventilators, ICU beds, testing and contact tracing made the situation even worse, especially for those health systems serving under-resourced communities of color. During the fall and winter, safety net hospitals, such as those operated by the Los Angeles County Department of Health Services and Martin Luther King, Jr. Community Hospital serving South Los Angeles, had a far greater proportion of their total bed capacity filled with COVID-19 patients and used innovative ways to create additional capacity to manage the surge. Despite these heroic efforts, we experienced devastating losses over the course of the pandemic.

L.A. Care is committed to advancing health equity for our members and their communities and doing our part to ensure we are better prepared for future public health emergencies. Last summer, the health plan adopted a Statement of Principles on Social Justice and Systemic Racism and launched an Equity Council to focus on equity issues for members, providers, vendors and employees. Health care is much more than just having an ID card in your wallet. L.A. Care has gone beyond the doctor’s office in helping improve health outcomes for our members, including providing grants to organizations that provide important social services, like food and housing. L.A. Care Community Link, a web-based tool available to members, providers, staff, and the community, is used to search by zip code for resources. We are also collaborating with the Southern California Leadership Council, its members and other stakeholders to issue a Request For Proposal (RFP) to ensure an adequate supply of PPE can be manufactured, stored and distributed locally to meet routine and emergent needs in the future.

Addressing social and racial injustice, and the health inequity that it brings, is everyone’s concern. As a society and as a business community, we must do all that we can to invest in under-resourced communities of color and redirect resources to address social determinants of health. Priorities include support for affordable child care, early childhood education, better pay, access to healthy and affordable food and housing, and legal aid. Everyone in Los Angeles should have an equitable opportunity to live successful and healthy lives in the absence of social injustice and racism. We look forward to collaborating with broad range of stakeholders throughout the community to eliminate disparities and inequities and to improve the quality of life and health outcomes for all of L.A.