Even though COVID-19 was initially labeled the “great equalizer,” as it appeared to affect people irrespective of age, sex/gender, race/ethnicity, or socioeconomic status, we quickly realized that we were not all in this together (https://bit.ly/3i4GgLb). In fact, the toll of COVID-19 has been amplified by existing racial/ethnic, social, economic, and health inequities. People who shoulder the greatest burdens of social and structural discrimination and racism, occupational hazards, political exclusion, and health and health care inequities have incurred the highest COVID-19 morbidity and mortality.
In this issue of AJPH, we have assembled a special section of articles highlighting the overlapping inequities marginalized communities endure and how the double jeopardy of COVID-19 and systemic racism has widened these inequities.
Basu (p. 1448) begins with a clear-eyed discussion of the programmatic and policy changes needed to address not only COVID-19 morbidity and mortality but also the unequal burden of other chronic and infectious diseases in marginalized communities. Importantly, he calls for public health advocates to embrace a multidisciplinary approach to testing and evaluating novel welfare, employment, housing, environment, and city-planning policies for their impacts on health. Acknowledging that our health care system is failing the most vulnerable, Moon and Ascher (p. 1451) describe how our health care system must address social and structural determinants of health but lacks the capacity to do so, given the ill-structured models of health care access and delivery in the United States. They call for greater application of community-based models of care as well as using community health workers to better meet those needs. Our added caveat is a reminder that community health workers must be valued and appropriately compensated if they are to effectively address the drivers of health inequities facing communities with greater needs.
Next, Liebman et al. (p. 1456) shed light on how COVID-19 has exposed the occupational risks and health disparities experienced by farmworkers in the United States. Liebman et al. describe how community partnerships can be used to narrow the gaps in health inequities as well as the social and structural injustices that farmworkers face. In short, basic occupational protection for farmworkers is good public health policy. Similarly, Gwynn (p. 1459) describes the paradox of “essential workers” who are overexposed, overworked, and overburdened, and at the same time underpaid, undervalued, and underinsured. Blackstock (p. 1462) lays out recommendations for sustaining efforts to end the HIV epidemic, by supporting Medicaid expansion, partnering with community-based organizations, and supporting housing and employment opportunities—echoing the calls for structural changes that Basu and Moon and Ascher make. Emerson and Montoya (p. 1465) offer approaches to developing Indigenous-framed public health interventions. And Tsui and Huynh (p. 1470) issue a call to action for local health departments and schools of public health to be critical engines of change to address anti-Asian American and Pacific Islander racism and oppression.
The consistent message across all these articles is to dismantle structures and policies that have upheld marginalization and systemic racism at the federal (https://bit.ly/3fZQqKm), state, and local levels (https://bit.ly/2SFHq5t). The time has come to bring power back to communities, strengthen health care access and delivery, and, above all, confront racism in all of its forms to end its impact on health. We need these actions now to address the health of not just marginalized communities but the population as a whole.
Luisa N. Borrell, DDS, PhD
AJPH Associate Editor
Farzana Kapadia, PhD, MPH
AJPH Deputy Editor
13 Years Ago
Community Health Workers As Social Justice and Policy Advocates
Community health workers are the integral link that connects disenfranchised and medically underserved populations to the health and social service systems intended to serve them. Worldwide, community health workers . . . increase access to care and provide health services ranging from health education and immunization to complex clinical procedures in remote areas where they are often the only source of health care. . . . Although the central role of community health workers is to be outreach workers who help clients access health or social services, they do more than merely link individuals to a doctor’s office. Community health workers play a paramount role in connecting people to vital services and helping to address the economic, social, environmental, and political rights of individuals and communities. . . . Their history and the breadth and scope of the roles they serve distinguish them as social justice and policy advocates for underserved communities across the world.
From AJPH, January 2008, p. 11
33 Years Ago
The Moral Price of Inequity in Health Care
In both academic and public policy circles, the debate over health care reform often assumes that our society is on the verge of having to make tragic choices regarding the rationing of scarce medical resources. . . . We do not believe that assertions about the necessity of making such choices are well grounded. Indeed, we believe that given the capacity of the American economy . . . it is possible to undertake dramatic efforts at reform that will meet the challenge of inequity in the health care system and that will do so at a social cost that is tolerable. . . . [T]he creation of universal health insurance protection is a moral imperative. . . . Rather than ask: “Can we afford the cost of justice?”, we believe it is time to pose the question: “Can we any longer afford the moral price of inequity in health care?” . . . The question is not cost, but rather whether we have the moral imagination and political will to strive for justice.
From AJPH, May 1988, pp. 583 & 588, passim
Biography
