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Health Care in Crisis: COVID-19 Exposes Deadly Inequalities

by |April 10, 2020
exhaust from tailpipe

Particulates from diesel exhaust, like this from a bus in Indonesia, are so small they can lodge deep in lungs, causing health issues. Photo: Dale Willman

The pandemic has made clear many of the problems facing the nation’s health care system. For-profit hospitals with tight supply chains mean that when the coronavirus reached the U.S., most facilities were not prepared with enough masks, gloves and other basic equipment needed to handle the crushing numbers of people entering their emergency rooms. For years the country has faced a shortage of primary care doctors, and legislation passed last year to increase those numbers came too late. Medical staffs across the country are struggling to deal with the demand for services. Those shortages will only be exacerbated by the depletion of medical ranks by sickness from the pandemic. And the secret of so-called medical ‘deserts’ — areas with limited or no access to healthcare facilities — is finally gaining attention.

Medical deserts exist in every state, and around the world. They are found in rural areas, as well as in communities of color and areas with indigenous populations. In Texas, 159 of the state’s 254 counties have no general surgeons. Thirty-five counties have no doctors at all. Areas with large black or Hispanic populations are more likely to lack access to health care. Internationally, some 40 million children in 25 developing countries have no access to the most basic health care.

Without access to health care, studies show and common sense tells us there will be higher hospitalization rates, in particular for chronic diseases such as diabetes and asthma. And those chronic medical conditions and others are more common in communities of color because of environmental exposures. Some of those exposures come from living near major roadways, where vehicles spew noxious chemicals and particulate matter, known as PM2.5 — tiny particles that come from burning fuel. Factories and power plants are also overwhelmingly placed in low-income communities and release a mix of chemicals into the air. So it should come as no surprise that these populations are particularly vulnerable.

These and many other issues won’t end when the pandemic does: the same communities are also more vulnerable to the heat waves, floods and fires of a changing climate. In a recent webinar, experts discussed what steps can be taken now to protect those on the front lines of COVID-19 and climate change, and to ensure a fairer, more resilient world for all. The conversation was hosted by the Resilience Media Project, which is part of the Earth Institute Initiative on Communication and Sustainability.

“We know by the data that blacks tend to live closer to air polluted areas, in the bigger cities with worse air quality,” said Dr. Cheryl Holder during the webinar. Holder is a Fellow in the American College of Physicians and has spent her career in Florida working with underserved populations. She said this exposure means blacks are much more likely to suffer from a broad number of chronic conditions. And those conditions have recently become even more deadly. “The damage that this (air pollution) has probably done to their lungs, with COVID-19 it has participated in increasing their death rates,” said Holder. “It is not solely because they are overweight or diabetic, but there is a role that being close to pollution has been proven to impact the death rate from COVID.”

Mustafa Santiago Ali serves as the vice president of Environmental Justice, Climate, and Community Revitalization for the National Wildlife Federation. He said these are not new problems. “There are exposures that have been going on for decades that for whatever reason many did not want to pay attention to. We know that 100-200 thousand people are dying prematurely from air pollution every year. Millions of people are also having their health impacted, and that is making folks more vulnerable to COVID-19.”

The numbers coming from this pandemic show that people of color are being particularly hard-hit. As of mid-March, 70 percent of those who have died in Chicago from COVID-19 have been black. In Milwaukee, more than 70 percent of deaths were also among blacks.

Holder said the viral infection rates in lower economic communities right now are probably much higher than what has been recorded because of the lack of medical care and the absence of testing. “In little Haiti, there were no testing sites — you had to drive to get tested. How many folks who are poor have access to a car to go do drive-through testing? Not many, especially in some communities.” And it’s not just inner cities that are being affected, she said. “In the central part of Florida, there were no testing sites there for a lot of the farm workers.”

Mary Heglar is a climate justice essayist for Medium and Writer in Residence at the Earth Institute. She said these are important stories for journalists to look into, but they should go beyond the ‘what is happening’ question and delve deeply into the bigger issues the pandemic has revealed. “If you’re going to talk about how black people are more likely to die of coronavirus, I just want to caution that you have to talk about why. Why is because of all these structural barriers.”

Carrie Furnaces in Rankin, PA

During their peak, the Carrie Furnaces in Rankin, PA produced more than 1,000 tons of iron a day. Their operation also released large amounts of particulates into the surrounding community. Photo: Dale Willman

Ali, Holder and Heglar also talked about the real crisis that lies ahead — what this will mean when an area is faced with fighting a ‘two-front war’ of health insults. “How climate is going to interact with [other health issues] is going to make disasters much worse,” said Heglar. “It’s going to add extra strain to the agencies that are already responding to COVID, because those disaster response agencies tend to be the same ones that would respond to a disaster.”

Heglar said there is one example of that synergistic effect happening right now. “So what happened to folks suffering from floods on the Amazon was that they had to wait for an extraordinarily long time for the government to pay any sort of attention to them, because all their attention was on COVID.”

Research indicates that climate change will lead to more intense hurricanes. And with hurricane season just two months away, and a pandemic that likely won’t have ended by then, Florida could be dealing with two major crises at the same time. “How do you then respond with sheltering of a population when a hurricane becomes category four or five across the coast? How do you then respond?” asked Holder. “Where do the people [go] who have the worst house, the worst shelter, which is often the poorer folks who would often go to these huge shelters, with COVID?”

The big question, of course, is what can be done to change these conditions. Holder said that when writing about health care issues, it’s key to use an equity lens — one that is colorblind. “When you’re using an equity lens, you’re using resources that addresses the need, and not looking at black or white.” One example of this, she said, is providing rapid testing facilities in communities that don’t have access to good transportation, rather than making people in those communities walk or take buses, potentially infecting others. It’s about distributing health care fairly, she added. All three also agreed that more needs to be more done legislatively to assure access to basic health care for everyone.

This was a timely discussion, but as frequently is the case we didn’t have enough time to explore everything. The most urgent topic, of course, is exploring more regarding what can be done to resolve the disparity in health care. I hope we’ll be able to address that in a future webinar.

One of the priorities of the Earth Institute’s new Initiative on Communication and Sustainability is improving the interface between journalists, scientific expertise and vulnerable communities. This is the latest webinar in a series I’m developing on covering factors that either boost or impede community and ecological resilience in the face of the landscape of hazards in this era of rapid change. More videos can be found on the Resilience Media Project page.

Resource Links

What U.S. cities are least prepared for climate change? Those with the greatest vulnerabilities to its effects

How climate change is making hurricanes more dangerous

Healthcare deserts in rural America

Coronavirus will make inequality worse — but we can change that

Climate changes health: Ensuring environmental justice underlies public health’s climate change work

How health systems are meeting the challenge of climate change

The fight for climate justice requires a new narrative

The economics of the Pandemic

Environmental Justice for All Act

RELATED: After the Pandemic: Designing a Just and Resilient Economy for All

Sounding the alarm for vulnerable communities

In times of pandemics, we must protect our first responders

COVID-19 may teach us how to avoid some of the worst consequences of climate change

Climate justice in frontline communities: how to really help

COVID slows de-carbonization

From Mustafa Santiago Ali:

COVID-19 is disproportionately threatening communities that have already suffered from environmental injustice

Coronavirus information from the NAACP

Social Justice in a Time of Social Distancing

Decolonizing community care in a pandemic

Treating Yellow Peril: Resources to Address Coronavirus Racism, from Jason Oliver Chang

10 Ways Inclusive Leaders Can Mitigate Bias When Communicating About Coronavirus, from Brevity & Wit via Medium

‘Wash your hands’ is tough advice for Americans without soap or water

This tweet

From Mary Heglar:

Climate and environmental rules being rolled back during Pandemic

From Cheryl Holder:

Address African American residents’ heightened risks of coronavirus

Story Ideas

How does health in your U.S. county fare against other counties?

As coronavirus layoffs surge in richer countries, poorer ones lose vital remittance payments

Models of community-building

One of the most significant aspects of each of these examples below is that the progress came, not from government intervention, but from people in the communities seeing a need and finding different ways to solve it. These are grassroots examples that might serve as inspiration for stories in your own community. Not all have health connections, but each story is one of hope, resurgence and community. And in each case, the work of these organizations has been transformative.

Community Development Corporations can create positive change, as they are in Spartanburg, South Carolina. There, ReGenesis has created 500 affordable housing units, numerous jobs and built six health clinics (bringing good health care is a major need in many poor communities). Look for such organizations in your community or ask why none have formed. What neighborhoods would be good targets? What are the needs to be filled? What’s the best way to do that?

Ivanhoe, a neighborhood in Kansas City, Missouri, was revitalized by a neighborhood association. They have developed green space, parks and urban gardens, all of which have immense public health benefits for the community. Does your city or town have neighborhood associations? Why or why not? How affective have they been? What can they learn from places like Ivanhoe? How can such efforts bring positive change for communities?

Turkey Creek is an African-American community in Gulfport, Mississippi. Derrick Evans grew up there, then moved to Boston to teach. The community was one that had a strong connection to the waterway on which it resides, but that connection had become lost over the years. After returning home Evans began the Turkey Creek Initiative to fight a range of political and ecological threats. He did this through, among other things, helping the community to find its own voice. The organization also got the community back out on the water, helping to renew their long-standing connection. This example has many entry-points for journalists, especially those working in multimedia.

For 30 years the Environmental Health Coalition has worked on environmental justice issues in San Diego and Tijuana. They focus on the cumulative effects of pollution, along with social, political and economic issues, including climate change. (Resilience issues are complex, and can rarely be labeled as part of just one issue.) What can your community learn from this organization? What lessons might they have to share?

EPA Creating COVID-19 Sacrifice Zones

Are there ‘sacrifice zones’ in your community? Where does the most pollution come from? Where is it located? Who is affected? How have regulatory roll-backs affected people living near those sites, and how are they being mostr affected by the pandemic?

Hidden by the Pandemic – Trump Administration Rolls Back Clean Car Standards

Where are the most-traveled roads in your community? What populations are going to be most affected by the increased pollution? What is PM2.5, and why is it important in this context?

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