The COVID-19 pandemic has bared public health shortcomings in communities of color.
Though racial disparities in health outcomes have been well-documented for years, the pandemic's prevalence makes it the right time to tackle sweeping changes needed to correct them, local and state leaders said.
Their effectiveness, however, will hinge on how well leaders can connect with those communities, despite deep-seated distrust and the failure of traditional public health messaging.
Local faith-based group A.C.T.I.O.N. plans to present more on the issue during a virtual forum tonight (June 4).
“Attacking COVID-19 — Conversation on Racial Disparities” is set for 6 p.m. to 7:30 p.m. on the Zoom platform. Pre-registration is required. Click here to register.
Panelists include Leigh Greene with Youngstown’s Office of Minority Health; Carol Bennett, Youngstown State’s assistant provost for diversity and inclusion; medical geographer Lashale Pugh and others.
The forum intends to analyze persistent social structures that contribute to health disparities.
"We're dealing with a culture and community by which — although we're resilient, and we've displayed that and we've shown that — the reality is that there's situations and circumstances that have not been mitigated throughout the years," the Rev. Lewis Macklin, pastor of Holy Trinity Missionary Baptist Church in Youngstown, is quoted in a release.
'LIFE AND DEATH ISSUES'
In Mahoning County, African-Americans account for 12 percent of the total 1,434 COVID-19 cases reported Friday and 36 percent of Youngstown’s 302 cases, according to a county health board report from that day. African-Americans represent 42 percent of the city’s population, as well as 16 percent of the county’s population.
African-Americans account for about 26 percent of total cases statewide and 17 percent of the total deaths, yet they make up only 14 percent of the state’s population, Ohio Gov. Mike DeWine said last week. Those estimates, however, are likely lower than the actual statistics, due to missing racial data in virus case-reporting, DeWine added.
“This is something that should concern every single Ohioan,” the governor said. “When we see something disproportionately affecting some of our citizens, we have an obligation to act. … These truly are life and death issues.”
Ohio’s Minority Health Strike Force, tasked with developing a plan to target underserved minority communities during the pandemic, has released a preliminary version of that plan, with full recommendations expected this month.
“It’s really putting it on a table. … Not in the backrooms; it’s in the front room now. We’re dealing with it and putting it on the agenda,” said Youngstown Mayor Jamael Tito Brown, who’s a member of that state strike force.
“I just think because of COVID-19, it’s going to be something we’re going to talk about. While we’re talking about it, these minority health disparities are on the agenda as well.”
See the Minority Health Strike Force’s interim report below. To view a full-sized version, click the icon in the upper-right:
DeWine and Mayor Brown noted these disparities existed long before the pandemic.
In Mahoning County, African-American babies are three-times more likely to die than white babies, according to the county’s 2019 Community Health Needs Assessment report, released in September, which called the difference in infant mortality rates “alarming.”
Between 2013 and 2017, more than 16 of every 1,000 African-American infants died prematurely, compared to nearly five per 1,000 for white babies. The rate of babies delivered pre-term was also higher for African-Americans.
Life expectancy statewide is about 77 years old for whites, but 72 years old for African-Americans, DeWine said. A December county-level study found a resident of Youngstown’s North Side is likely to die an average 18 years earlier than someone living in Canfield, as life expectancy dips along with poverty rates.
“It is unacceptable that your ZIP code, on average, can predict how long you will live,” said Ohio Department of Health Director Dr. Amy Acton during a Tuesday briefing on the state’s coronavirus response.
“I’ve taught whole classes on why racism is a public health issue," she continued. "We have got to do better. We have a state health improvement plan that puts health equity as the underlying premise of all of it. And all of our cabinets are coming together to move policies and programs forward."
Lashale Pugh, who plans to present during Thursday’s A.C.T.I.O.N. forum, is a doctor of geography specializing in the study of disease spread patterns across different areas. A study she published in 2016 analyzed the years of potential life lost among Mahoning County residents who died before reaching an average life expectancy age of 75, according to 2010 vital statistics records.
The Ohio Commission on Minority Health uses that measure, called Years of Potential Life Lost, to triangulate health disparities.
Pugh’s study found Mahoning County residents who lost the most years of life overall in 2010 lived in urban census tracts, which are characterized by higher African-American populations and poverty rates, as well as lower property values. Those living in the county’s other suburban, rural and old industrial regions — which are largely white — lost fewer years of life overall, the study found.
Pugh said she plans to present more current county-level data Thursday, though she struggled last week to collect the data points she needed due to reporting gaps created by medical privacy laws.
“Black people already know what’s going on,” she told Mahoning Matters. “But what I want is those people who don’t have our same experience to gain a better understanding of where the disparities come from.
“The recent killing in Minneapolis [of George Floyd] is a prime example. [Inequity] is in every aspect of our society. I want people to understand that these things are not happening by happenstance. They’re happening due to hundreds and hundreds of years of government programs, slavery and a host of other things that have brought us to where we are now.”
The Ohio Legislative Black Caucus on Tuesday introduced a resolution to declare racism a public health crisis. The measure, if passed, would create new educational and community engagement efforts to dismantle systemic racism. Ohio would become the first state to enact such a resolution.
“Our citizens of color have been subjected to the effects of racism since the founding of the State of Ohio in 1803,” reads the resolution’s call for Ohio House and Senate co-sponsors. “Since that time, Ohioans of color have endured unequal education, unsafe work conditions, inadequate health care services, subpar housing and an unjust criminal justice system, based on policies that were rooted in a belief that people of color are not worthy of the American Dream.
“By declaring racism a public health crisis, we acknowledge that racism impacts all members of our society and deserves action from all levels of government.”
LACK OF ACCESS
All facets of that unfairly stacked system — lack of access to transportation, workplace health benefits and health education, healthy foods and technology to connect with health providers — contribute to poorer health outcomes for communities of color, said Mayor Brown.
Public health has been underfunded for years, until coronavirus appeared — and minority health efforts moreso, he said.
Youngstown officials have found COVID-19 is more prevalent in high-rise communities that are mostly homes to minorities who haven’t been tested for the virus and are underinsured or uninsured, Mayor Brown said. The state strike force’s plan recommends expanding mobile or walk-up testing efforts to communities like those and ensuring those residents have a way to get to those sites; or bringing testing sites to minority churches and community centers.
Beyond the scope of COVID-19, many local African-Americans don’t have primary care physicians, Mayor Brown said. Seventeen percent of African-Americans who responded to the county’s health needs survey said they don’t have one, and a fifth of respondents said they hadn’t had a check-up in the past year.
“We see too often people don’t go to the hospital until they’re sick — then they go to the emergency room,” he said. “That’s not health care.”
It’s the same reason some Hispanic migrant farmworkers can’t access COVID-19 testing, said Veronica Dahlberg, executive director of Latino advocacy group HOLA Ohio.
“You’ll have farmworkers that migrate into the state of Ohio for the seasons and they could be living in a labor camp in a very remote part of the state. Somebody comes down with symptoms, what are they supposed to do? … Do you go to the hospital? The hospital won’t test you. They’ll say, ‘Who is your primary care doctor?’” she said.
Doctors advise those patients to instead stay home and monitor their own symptoms — but thermometers are in short supply, Dahlberg said. That’s why HOLA has been stockpiling and delivering them to quarantined workers inside kits that also include masks and COVID-19 information written in Spanish.
Dahlberg said she’s learned those employing migrant workers will often continue to pay wages to those who test positive — but not for their contacts discovered during virus tracing, who are also subjected to a two-week quarantine.
“This is a big economic hardship, especially for people who are already living on the margins,” she said.
Often, non-native Hispanics run into language barriers at the doctor’s office, or with epidemiologists working to trace the spread of coronavirus in their communities. HOLA has taken up contact-tracing and case management efforts for those people, Dahlberg said.
“Sometimes people are reluctant to get tested; they’re reluctant to share their information. They don’t know what it’s going to lead to,” Dahlberg said, later referencing the country’s “destructive” immigration policies.
African-Americans are less likely to be forthcoming during virus tracing investigations, Mayor Brown said. Minority communities have a deep-seated distrust of government and healthcare systems, including non-minority doctors, he said. The same goes for census-takers.
“If they don’t know me, they think it’s a scam,” he said. “Mistrust is big. … We want to have contact tracers that are familiar. Someone in the Spanish-speaking community would be excellent.”
The state strike force’s plan will call for more “culturally appropriate and accessible” coronavirus tracing and notifications for patients who’ve unknowingly been exposed to the virus.
It would also create ombudsmen dedicated to advocating for underserved minority populations — a go-between for those who feel they’re not getting equitable treatment, who can “restore public faith and trust in the efforts being made to protect communities of color,” the interim report states.
Minorities are also disconnected from traditional public health messaging, Mayor Brown said, and the state strike force notes a different approach is needed. Brown pointed to “cookie-cutter” PSAs on COVID-19 with actors who “don’t look like me.”
That distrust reaches lines of communication as well, he said.
The state’s plan would identify draw in influential figures in minority communities — faith leaders, elected officials and small minority-owned businesses such as barbershops, hair salons and restaurants to join advocacy and civic engagement groups.
“If my pastor is telling me there’s something I need to do, I trust it,” Mayor Brown said, speaking figuratively. “If my local friends and family are telling me, I trust it.”
Minority health outreach campaigns are nothing new, but neither is the red tape keeping the proper funding from the local nonprofits working on the ground-level in those communities every day, Pugh said.
Often, big-ticket grants are awarded to larger organizations that have the means to roll out new outreach initiatives, but don’t understand the communities they’re trying to serve, she said.
“The people at ground-zero, those people who are actually working with individuals, with community organizations, trying to be the change — they don’t get support,” Pugh said. “But those are the people [who] have access to those individuals that they’re trying to help.
“More funding is needed at the local level for the nonprofits that are actually out here doing the work.”