The COVID-19 pandemic has challenged our region like nothing ever before. Tens of thousands of residents in the New York metropolitan area have lost their lives and many are suffering from the lingering effects of the disease. While it will take years to fully measure the impacts of COVID-19, RPA and many others have flagged that low-income communities and communities of color have disproportionately borne the brunt of the effects so far.
In this context, RPA hosted a conversation on June 17 as part of the Assembly to discuss the impacts of COVID-19, the underlying health inequities in our region, and the most effective strategies for addressing the crisis. Dr. Jo Ivey Boufford, Immediate Past President of the International Society for Urban Health and Clinical Professor of Global Public Health and New York University, interviewed Dr. Richard Besser, former acting director for the Centers for Disease Control and Prevention and the current President and CEO of the Robert Wood Johnson Foundation. This pair of international experts on health equity discussed the intersections between racism, planning, and public health, and fielded questions from the audience on how we can become a more healthy and equitable region.
Where you live should not determine how you do in this pandemic. What your income is, what the color of your skin is, shouldn’t determine your mortality rate. In America right now, that unfortunately is the way it is.”
That COVID-19 has exploited our region’s deep inequities did not come as a surprise to either physician. It is well known that residents already face disparate health outcomes because of race, income, and the built environment around them. Everyone should have a fair opportunity for health and wellbeing. But as Dr. Besser put it, the United States entered the pandemic with the deck already unfairly stacked. “I’m right now sitting in Princeton, NJ. A child born here in Princeton has a life expectancy at birth of 87 years. I volunteer as a pediatrician in Trenton, NJ, which is our state capital, 14 miles away. A child born there has a life expectancy of 73 years. So 14 miles and a 14-year difference in life expectancy…That’s the context in which this pandemic is hitting our country.”
Drs. Besser and Boufford discussed a number of reasons behind the disproportionate impact of COVID-19 on communities of color. For example, high proportions of Black and Latinx Americans fall into the category of essential workers who do not have access to adequate personal protective equipment, may not have health insurance, and live in multi-generational housing.
“If you think about who truly has a decision about, well, I’m gonna stay home, and protect myself, protect my family, protect my community, or I’ll stay home and work remotely, or am I gonna go out and work so I can put food on the table and pay rent? A high proportion of people of color are low income workers. The wealth gap between White and Black is so substantial, that the ability to truly make that decision and decide not to work is not spread equally around society,” said Dr. Besser.
Drs. Besser and Boufford agreed that drawing a line between planning and health is critically important. Communities that are designed to have better air quality, more integrated mixed-income housing, and transportation systems that provide access to good paying jobs are key to improving public health.
As the region reopens, Dr. Boufford asked if the issue of equity is on the mind of state advisory committees. Dr. Besser, who is involved in some of the committees in New Jersey, said that the Robert Wood Johnson Foundation has proposed several equity principles for restart and recovery for state and local leaders. Obtaining better data to see the impact of COVID-19 by race, income, and zip code, and engaging with communities to ensure better contact tracing will be critical during the reopening process, Dr. Besser stated.
“Different communities have had different experiences with public health. Some have had experiences that would lead them to not trust public health. You want to have contact tracers who are from the neighborhood, and you want to have opportunities for isolation and quarantine that come out of decisions and discussions with communities if you want to be successful,” said Dr. Besser.
In terms of next steps, states and local governments will need to address policy gaps and provide support for public health departments to do the work of data collection, contact tracing, and community engagement, which is a hurdle for states and cities balancing budgets. Dr. Besser also noted that we need to think holistically about long-term solutions. “What does it truly mean to have a vibrant community? That is in sync with the environment, that has jobs that pay good wages, and housing that meets people’s needs that’s safe and affordable - that’s part of the long-term solution.”
RPA is grateful to both Drs. Besser and Boufford for their commentary during this health crisis. Watch the full conversation here.
