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SPECIAL SECTION: The COVID-19 Crisis COVID-19 Puts Spotlight on Glaring Structural


Inequities That Need Addressing For vulnerable populations, ‘COVID is a funhouse mirror amplifying issues that


have existed forever’ By David Raths


C


OVID-19 is hitting some communi- ties much harder than others. In Philadelphia, the neighborhoods with the highest rates of COVID-19 infec- tions are predominantly black. Across the country, areas that have the highest rates of COVID-19 infection are also the areas that have the highest percentage of minority residents. Researchers who focus on vulnerable populations say this should come as no surprise and that the crisis is much bigger than COVID-19. Shreya Kangovi, M.D., an associate


professor of medicine at the Perelman School of Medicine at the University of Pennsylvania, is executive director of the Penn Center for Community Health Workers. Penn Medicine’s IMPaCT (Individualized Management for Patient- Centered Targets) program hires and trains trusted neighborhood residents to become community health workers, and the program has been scaled up across the country. During an April 10 virtual seminar put on by Penn’s Leonard Davis Institute of Health Economics, Kangovi joined two other researchers focused on vulnerable populations to talk about the impact of COVID-19. Kangovi stressed the need to broaden the frame of this conversation. “This is not just about COVID. COVID is a funhouse mirror that is amplifying issues that have existed forever. People are not dying of COVID. They are dying of racism, of economic inequality and it is not going to stop with COVID,” she said.


There is a big public health fallout happening as people lose their liveli- hoods and as they become socially isolated and defer preventive care and healthy behaviors. “We need to not be surprised about this and not talk about it as a narrow COVID infectious response,” she added. “The positive feedback loops between poverty and pandemics are


very well established. We need to talk about action. My work is about hir- ing those exact same individuals who are in disadvantaged circumstances or communities, and who are natural helpers in those communities and put- ting them into healthcare systems and community-based organizations where they can effectively reach out and sup- port individuals with a whole range of issues that may be affecting their health — the social determinants as well as medical determinants. We have established this model and it is nation- ally scaled and now we have pivoted it to this new world where a lot of the support is even more critical than ever. The real push right now is how we can reimburse these workers so that they are a part of the national response, not only to COVID, but also to the wave of consequences.”


Digging deeper and asking why Gina South, M.D., is an assistant profes- sor of emergency medicine at the Perel- man School of Medicine. Her research focuses on how neighborhood context impacts health and safety in urban environments. She stressed that the racial dispari- ties we are seeing with COVID-19 mir- ror many of the racial disparities we see with other health outcomes, such as maternal morbidity and mortality, cancer rates and death. “These COVID disparities aren’t really a surprise,” South said. In some Zip codes in West and South Philadelphia, which are pre- dominantly black, up to 50 percent of adults have a diagnosis of hypertension. And although social distancing is a key way we can protect ourselves and our families from getting this disease, it is not easy for everyone. “When you think about black communities, you have a lot more multigenerational homes. It is much harder to separate kids who


may be asymptomatic carriers from the elderly who are going to be at higher risk.”


Many essential workers who earn low wages are predominantly minorities. “Think about food services, environ- mental services, custodial staff, trash collectors, grocery clerks, bus drivers,” South said. “I saw an estimate that only one out of fi ve black workers is able to stay home now.” They are more likely to have to take public transportation. There is early evidence that living in neighbor- hoods with high levels of air pollution is associated with higher morbidity and mortality from COVID-19. Blacks and Latinos make up 56 percent of the U.S. prison population. People who are in prison, by defi nition, cannot socially dis- tance themselves, she said. “We know all these things,” South said. “We need to dig deeper and ask why. Why is life expectancy so differ- ent at baseline? If you look at Society Hill, one of the richest neighborhoods in


“This pandemic won’t fade, because the pandemic isn’t COVID. The pandemic is poverty.”


-- Shreya Kangovi, M.D.


Philadelphia, it has an average life expec- tancy of 88. But if you go a few miles north to Strawberry Mansion, one of the poorest, you have a life expectancy of 68 years. That is a difference of 20 years within a few mile radius. Why are black communities more likely to be located in areas with higher air pollution? Why are low-wage workers we have deemed essential paid so little, and why are they


continued on page 22 MAY/JUNE 2020 | hcinnovationgroup.com 21


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