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