Its time to rethink public health

[Music]

back in march of 2020

a colleague and i were debating whether

a new strain of coronavirus

called sars kovi ii would have a

measurable impact on u.s mortality

the media hype was building and he

thought this was going to be major

i was skeptical to prove the alarmist

stories wrong

i began downloading and analyzing daily

covet 19 debts on my laptop

well turned out i was wrong

a story without data is a myth but

data without a story are just a bunch of

numbers

i’m an epidemiologist getting to the

stories behind the data

is what attracted me to this field

building on that academic debate with my

colleague

i paired up with a team of researchers

and students at emory university

to track how social factors impact

covid19

across u.s communities together

we built the kovit 19 healthequity

dashboard

it’s an interactive data visualization

tool available to anyone

the data we track paint a very troubling

picture

of the u.s pandemic and our response

as americans we are disproportionately

dying

of covid19 only one in 25 persons on

this planet

is an american yet we account for one in

five of all kovid 19 deaths globally

how are we letting this happen in the

richest

most technologically advanced country in

the world

i believe some of the answer lies in a

tale of two counties

county a is a suburb and county b is a

neighboring city in the midwest

both have similar age and sex breakdowns

and in the past year

both counties recorded similar numbers

of covet 19 cases per capita

but county b has a death rate from covet

19

that is three times as high as the death

rate in county a

hearing that you might be surprised and

even question the data a little

what if i tell you that county b has a

riskier transmission environment

a more medically vulnerable population a

more strained health care system

and now what if i tell you that county b

has a larger share of african americans

and it is in this group that per capita

cases was highest

are you still surprised

this is not just the story of washington

and wayne county in michigan

where i was born this is a story line

playing out all across the united states

we all heard media reports of emergency

rooms and icus

filled with black and hispanic patients

at first

these reports confused me covet 19

is caused by a novel pathogen and

therefore

nobody should have immunity yet the

picture in hospitals and later the

statistics we tracked

suggested who was experienced a severe a

severe

outcome was not random

so then what are the factors that lead

to a severe

outcome for covet 19 in the united

states

factor one it starts with coming into

contact with the virus

people working jobs in nursing homes

home health care

factories and grocery stores where there

is no option for remote work

are more likely to be exposed to this

virus

black and hispanic americans make up a

large share of adults working in those

jobs

and when the economy reopened last

summer

we saw cases rise in these groups in

many states

factor two once infected several

underlying medical conditions can affect

one’s chances

of being hospitalized or dying from

covid19

conditions like obesity and diabetes the

conditions i studied prior to the

pandemic proved to be particularly

deadly

black hispanic and native americans are

more likely to have several of these

conditions

and as an aside it’s not our genetics

that really matter

for disparities in these conditions the

research shows that it’s social factors

like income education and access to

healthy foods that play a larger role

and that brings me to factor three

once someone experiences severe symptoms

from covid19

that person needs treatments that only

hospitals can provide

in a pandemic access to timely and high

quality healthcare

is a life and death issue

black hispanic and native americans are

less likely to be insured

and even when insured they are more

likely to live in areas with low

quality health care these three

contributors

to fatal covid19 outcomes cluster

in communities of color making some

americans vulnerable

multiple times over an effective

pandemic response means that we

acknowledge this as we allocate health

resources

it means that we allocate these

resources equitably

now equity is a term you’re probably

hearing a lot these days

and i get asked about the difference

between equity and equality

on the left hand side we have an equal

allocation system

in this system everyone gets the same

crate regardless of where one stands

you can see why that’s problematic on

the right hand side

we have an equitable allocation system

everyone gets the crate

needed to achieve the goal

equity is often discussed as a concept

grounded in fairness

and that’s important but equity is not

just about fairness in a pandemic

equity is about effectiveness

let’s take the u.s covet 19 vaccine

campaign

for example as a nation our first

priority was to protect americans

working

in high risk occupations and protect

americans

vulnerable to severe disease a public

health response that’s successful would

be proportionate to these needs

and by either measure virus exposure

or disease vulnerability we would expect

communities of color to be prioritized

yet three months into the vaccination

campaign

black and hispanic americans are lagging

behind

we hear a lot about vaccine hesitancy in

communities of color and certainly

that’s a contributing factor

but vaccine hesitancy alone can account

for this disparity

so beyond motivation to get vaccinated

let’s talk about

what it takes to get your shot in

america

you need internet access or a lot of

time to wait on the phone

to fill out complex forms and navigate a

fragmented appointment system

black and hispanic households are less

likely to have high-speed internet

you need to be able to get to a

vaccination center

in most of america that means owning a

car or knowing someone who does

black and hispanic households are less

likely to own a vehicle

and in the south they typically have

farther to travel to get to one of these

sites

and you need time off of work not just

to get

to the center but sometimes wait for

hours in line once there

thinking back to the types of jobs that

many black and hispanic

americans have time off of work is at

the discretion of the employer

and not the employee it can also come

with a financial hit

the emergent picture is one of multiple

intersecting

systemic barriers that predate the

pandemic

it’s about a history of social and

economic exclusion

that has impacted the access to

life-saving infrastructure especially

among

black hispanic and native americans

but what happened in some communities of

color early in the pandemic

was a warning sign for the entire nation

since last august cases and debts have

been rising

in rural america many of these

communities

which are predominantly white also

experience

high poverty a digital divide and

limited health care services

what i’ve described for you is not a

myth in which we are powerless

this story is backed by data that show

us where we’re falling short

beating this pandemic means that we

don’t blindly use

a one-size-fits-all approach and just

hope that it will work

beating this pandemic means that we use

the data

to guide us on how we best leverage our

vast technological

and financial resources to head on

address

the barriers we’ve been talking about

that’s equity

now some of you might be thinking that

the only kind of equity that directly

affects you

is the type that involves your line of

credit i’m going to ask you to think

again

because equity is not just about helping

the disadvantaged

if the virus continues at high levels of

circulation

we all have greater chance of coming

into a contact

with a new variant that threatens our

past progress

we all face the possibility of

intermittent economic

shutdowns and travel restrictions

if hospitals run out of beds or

ventilators

because of stretched healthcare capacity

that might affect your chances of

survival

should you ever have the misfortune of

needing these services

so why then do we leave equity to the

social justice warriors

why isn’t equity everybody’s business

where we go from here is in all of our

hands

it’s on all of us to drive conversations

on how and whether

we weave equity into a rethink of our

health policies our economy our schools

and our communities at large i call upon

the tedx community

to seize this critical moment in

america’s history

and imagine a new narrative for america

an america

with no fence an america in which all of

us can thrive

no matter where we live thank you