As COVID-19 rages, people of color, older adults and their paid caregivers remain some of the pandemic’s most at-risk populations, as evidenced by new and ongoing national data. How should our country stem these deadly inequities and ensure that equity is embedded in the recovery? As the United States manages the COVID crisis, its goal cannot be to return to the past inequities that have resulted in these disparities. Preserving the status quo is hurting America as a whole, not just people of color. In contrast, closing the racial equity gap in the United States would generate by 2050 an additional $8 trillion to the GDP.
The triple crises—the pandemic, economic shock and racial injustice—have presented an opportunity that is bigger than any of us, and we have a real chance to start dismantling our broken systems and building them anew.
The Brutal Bias of the Coronavirus
Recent data from the Kaiser Family Foundation (KFF) continue to show that coronavirus cases and deaths disproportionately impact people of color, and hospitalizations from the virus for Black, Latino and American Indian/Alaska Native people. Similarly, data released in mid-October by the Centers for Disease Control and Prevention (CDC) note that between May 1 and Aug. 31, 2020 almost half (48.7 percent) of COVID-19 deaths were of people of color, and 78.2 percent were of people ages 65 and older.
For the CDC, the marked increase in the percentage of coronavirus fatalities in the Latino cohort (from 16.3 percent in May to 24.6 percent in August) is especially alarming. In contrast, deaths in white and Black cohorts in that same period decreased. Racial bias affects data, as well; both the KFF and the CDC note that small sample sizes prevent any meaningful analysis of at-risk groups such as Asians and Pacific Islanders, immigrants and others, which limits a more expansive statistical portrait of racial inequality around COVID-19 across the country. (Other data sources help fill this data gap: recent data reveal that Filipinos represent 30 percent of the nearly 200 registered nurses who have died from COVID-19, despite making up only 4 percent of this workforce.)
From Structural Racism to Systemic Solutions
These findings reinforce what many experts have posited since March: while we are all weathering this storm, we are not in the same boat. Long-standing racial barriers will continue to make COVID-19 especially lethal in communities of color unless our country implements a wide range of strategic, large-scale, targeted health interventions across policy and practice. In April, we described how the aging services field should respond to disparities in this health crisis. What follows are 10 racial equity strategies to integrate into our national response to design not a recovery, but a reset. These strategies can also serve as recommendations for leaders in aging services, the private sector, federal and state lawmakers and biomedical researchers.
We all have a role to play in advancing racial equity. On an individual level, it is important to make equity part of conversations with family, friends, neighbors and co-workers. Be aware of your own unconscious biases and stereotypes. Get to know people who don’t look like you or share your viewpoints. Develop a growth mindset and be courageous in getting out of your comfort zone.
Organizations that are complacent about diversity, equity and inclusion are complicit in racial and social injustice. Leaders in the aging network, government and the private industry must assess current practices using a racial equity lens—with attention to age and life stage–related differences—to ensure policies work for the full spectrum of employees and the clients they serve. They must leverage lessons from the pandemic to inform future plans for organizational resilience and provide constituencies with support and resources to live longer, healthier and more productive lives.
Collect stronger racial disparity data on COVID-19. Since the pandemic’s start, states have improved reporting on race and ethnicity data for COVID-19 cases and deaths, though several states still do not report the disproportionate impact on communities of color. Other COVID-19 disparity data gaps from states: disaggregated hospitalization and testing data, the number of cases among healthcare workers and figures on deaths by underlying condition. On a positive note, California established a health equity metric to track the coronavirus by county and began requiring sexual orientation and gender identity data among COVID-19 cases.
Pilot existing solutions to close the disparities gap. Disparities are not random. Historically, health and economic outcomes have been tied to an accumulation or a lack of opportunity—and the highest bidders benefited tremendously. People of color face significant structural barriers to healthcare access, from living in communities with inadequate healthcare resources to dealing with racial bias in encounters with healthcare providers—and more. This pandemic did not create the disparities we are witnessing—it has only magnified them. There are existing solutions and ideas proposed in the past that should be funded and piloted to close the gap.
Establish a COVID-19 Health Equity Task Force, ensuring adequate funding of recommendations and resources for implementation. Several states have formed task forces to address the disproportionate impact of COVID-19 on people of color, including Arizona, Illinois, Indiana, Louisiana, Michigan, Ohio and others. Among other activities, these task forces collect and track data on racial disparities, analyze key barriers in access to services, provide regular information on COVID-19 to affected communities and propose solutions to ensure people of color remain healthy and safe.
Michigan has emerged as a model for racial equity during this pandemic, dramatically reducing the unequal share of Black COVID-19 cases and deaths within a matter of months. Solutions from these task forces must come out of collaboration among community members, decision makers and experts; a community doesn’t need to be told what its problems are, nor should a solution be thrust upon it without its input. Those closest to the problem must cocreate the solutions. And recommendations from these task forces must not sit on a shelf. There must be adequate funding allocated to advance these solutions, and advocates must hold policymakers accountable for implementing their recommendations.
‘As treatments and vaccines are developed to combat COVID-19, people of color must be adequately represented in all studies.’
Prioritize COVID-19 support to communities of color, including the care workforce. Communities of color, as well as healthcare clinics, hospitals and long-term care providers that serve large percentages of people of color, need free, rapid-result COVID-19 testing, enhanced contact tracing efforts and culturally and linguistically competent information, among other resources. Direct care workers—a largely female, non-white workforce—still need consistent access to PPE, testing and other supplies, as well as hazard pay, paid leave, childcare support, training in COVID-19 and infection control and prevention and increased workforce safety measures.
Transform the direct care job. From sporadic hazard pay and emergency leave measures to a federal rule that allows the hiring of temporary nursing assistants, most federal and state policy measures to support direct care workers through COVID-19 have been short-lived, leaving this workforce unprotected in the long term. The direct care workforce needs substantive policy reforms and workforce interventions across five areas of job quality: quality training, fair compensation, quality supervision and support, respect and recognition and real opportunity.
Diversify COVID-19 clinical trials and ensure an equitable distribution of vaccines and treatments, addressing people of color’s historical distrust of health systems. Despite their heightened risks, people of color have been historically underrepresented in major clinical trials, including recent COVID-19 biomedical research, which limits the scientific understanding of a given drug’s efficacy and safety among these populations. As treatments and vaccines are developed to combat COVID-19, people of color must be adequately represented in all studies. Once these medical interventions have been proven safe and made publicly available, they must be equitably distributed to communities of color, addressing long-standing barriers such as cost, medical distrust, language, limited health literacy, implicit bias and more.
Strengthen retirement supports to address the racial wealth and retirement gaps. A lifetime of discrimination has amplified retirement challenges facing workers of color during this crisis, as millions become unemployed, are forced to retire prematurely and will soon experience significant decreases in savings, health coverage and Social Security benefits. New data show that the majority of Latino, Black and Native American households report severe, pandemic-related financial problems, and struggle to cover essentials such as rent, food and utilities. As one core intervention, Social Security should be protected and strengthened to ensure older people of color can thrive in their retirement years.
Protect and strengthen Medicaid for consumers and workers. Medicaid has provided essential services and supports to communities of color during COVID-19, through health coverage for millions of low-income people who become ill and through significant funding for the long-term care system, including direct care jobs. Yet this program has been under constant political attack from conservatives and suffered from a long history of racist decisions. As a result, many states are grappling with strained Medicaid budgets that risk collapsing as healthcare costs increase and demand grows. More than ever, we need this program.
We must learn from this catastrophe—to prevent worsening the inequitable death toll of COVID-19 and to strengthen our public health system for years to come. Our country’s experience—and that of many others—prove how systemic racism magnifies the health crisis for people of color, at a devastating human cost. Now is the time to intervene.
Robert Espinoza is vice president of Policy at PHI, in Bronx, NY, and Jean C. Accius, Ph.D., is senior vice president of Global Thought Leadership at AARP, in Washington, D.C. Espinoza chairs the Generations Today Editorial Advisory Board, and both he and Accius serve on ASA’s Board of Directors.