Incentivizing equity investments to address disproportionate Latino COVID-19 impacts

One of the accepted horrors of the pandemic is that Latinx populations sustain a disproportionately high burden of COVID-19. Take the city of San Antonio and surrounding Bexar county, for example, whose population is 60.7% Latinx.¹ Of the COVID-19 cases and deaths where race/ethnicity was identified in the medical report, 75% of cases and 65% of deaths are Latino/Hispanic.² Contrast this with the fact that Bexar county is 27.1% white while only 18% of COVID-19 cases are identified as white individuals.^1,2 It is important to keep in mind that undocumented populations often avoid preventative or primary care, possibly due to fear of deportation, making these numbers likely underestimates of the true impact.³ Although the vaccine rollout is ongoing, the pandemic continues to claim the lives of countless Latinos in Texas: decisive action is even more imperative at this stage.

We can gain insights into how to better prioritize health equity in a public health context by comparing the responses of Texas and California to the coronavirus. Introduced on August 28^th, 2020, California’s Health Equity Metric is a valiant attempt to tackle health disparities at the community level.⁴ As part of their Blueprint for a Safer Economy, California has created a multi-tiered risk stratification protocol for coronavirus disease burden at the county level. To move to the next stage of reopening, a county is required to ensure those in the lowest quartile of what is called the “Healthy Places Index” (HPI)  do not have a significantly higher test positivity rate than the county average.⁵ The HPI acts as a proxy for both socioeconomic status (SES) and community health status in one consolidated measure. Under the plan, if the lowest quartile of the population as indicated by the HPI is disproportionately affected by COVID-19, the county will be barred from reopening. San Antonio should implement the same measure to help protect Latinx communities in the near term until the vaccine administration can provide a definitive solution. 

Dr. Claradina Soto works as a Clinical Professor at the USC Keck School of Medicine in the Institute for Health Promotion and Disease Prevention Research. When asked if California’s Health Equity Metric policy has the potential to save lives, she stated “Absolutely…It’s all about trying to understand how to navigate and reach these communities to help save lives.” Indeed, looking at the statistics we see that the US has surpassed 550,000 deaths resulting from the COVID-19 pandemic.⁶ This grim marker reminds us of the human costs of failing to swiftly implement effective public health policy.  

A comprehensive view of Texan communities must be considered when evaluating the feasibility and utility of such a health equity policy. An easily lobbed criticism of the health equity metric is that it puts the state government in charge of the reopening stages, leaving small business vulnerable to the virus and government response. Instead, critics of the policy espouse a free-market approach, leaving businesses to survive on their own in the harsh pandemic market conditions. However, that concern can be mitigated by coupling the equity metric with other federal policy measures such as the recently passed $1.9 trillion COVID-19 relief bill under the Biden Administration. The Biden plan calls for providing $15 billion in flexible, equitably distributed grants along with an additional $35 billion dollar investment in small business lending and financial programs from Congress. This support can help small businesses weather the COVID-19 recession without putting the lives of additional Latino front-line workers at risk.

The disproportionate impact of COVID-19 on Latinx communities is due to a variety of factors, including high representation among essential workers, high percentages of overcrowded housing, and low levels of insurance coverage.^7,8,9 The equity metric is a unique approach to incentivize COVID-19 prevention investments – such as targeted contact tracing, testing, and health communications— so that they can be distributed equitably to the populations that need it most. Counties are incentivized to invest in community health support systems by linking outcomes to reopening criteria. If counties do not reopen as soon as possible, they miss out on generating much needed tax revenue at the local and state levels. Studies find that in the event public procurement programs fail to explicitly tie equity to legal regulations, the impact on resources creates stronger incentives not to implement equity considerations.¹⁰

There is a unique elegance to solutions like the health equity metric as it can be difficult to incorporate equity considerations into public policy. Equity can be put into numbers that measure disparate impacts of COVID-19 cases, but it is difficult to measure and articulate the traumas associated with living in a disadvantaged community. That is not to say data is unimportant, in fact, implementation of California’s HPI metric was only possible due to a previous investment in statewide public health data program designed to measure SES and community health statuses. However, we should also recognize the intangible benefits derived from policies designed to uplift communities of color. More than this, incentivizing equity in public policy will produce great yields for future generations that will inherit the fruits of previous generation’s efforts to realize a more equitable future.

References

1. United States Census Bureau. (2019). QuickFacts Bexar County, Texas. Retrieved from https://www.census.gov/quickfacts/bexarcountytexas
2. COVID-19 San Antonio. (2021). COVID-19 Surveillance . Official website of the City of San Antonio. Retrieved from https://covid19.sanantonio.gov/About-COVID-19/Dashboards-Data/Surveillance
3. Beck, T. L., Le, T. K., Henry-Okafor, Q., & Shah, M. K. (2019). Medical Care for Undocumented Immigrants: National and International Issues. Physician assistant clinics, 4(1), 33–45. https://doi.org/10.1016/j.cpha.2018.08.002
4. California Department of Public Health. (2020). Blueprint For A Safer Economy: Equity Focus. Retrieved from https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/CaliforniaHealthEquityMetric.aspx
5. The California Healthly Places Index (HPI). Public Health Alliance of Southern California. Retrieved from https://healthyplacesindex.org/
6. Centers for Disease Control. (2021). Trends in Number of COVID-19 cases and deaths in the US reported to CDC, by State/Territory. Retrieved from https://covid.cdc.gov/covid-data-tracker/#trends_dailytrendscases
7. Centers for Disease Control. (2021). Trends in Number of COVID-19 cases and deaths in the US reported to CDC, by State/Territory. Retrieved from https://covid.cdc.gov/covid-data-tracker/#trends_dailytrendscases
8. Mejia C. Marisol, Cha Paulette. (2020). Overcrowding Housing and COVID-19 Risk among Essential Workers. Public Policy Institute of California. Retrieved from  https://www.ppic.org/blog/overcrowded-housing-and-covid-19-risk-among-essential-workers
9. U.S. Department of Health and Human Services. Office of Minority Health. (2019). Profile: Hispanics/Latino Americans. Retrieved from https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64
10. Sarter, E. K. (2020). The Development and Implementation of Gender Equality Considerations in Public Procurement in Germany. Feminist Economics, 26(3), 66-89. http://dx.doi.org.libproxy1.usc.edu/10.1080/13545701.2020.1718731

Rit Shukla is currently a Master of Public Policy Candidate at the USC Price School of Public Policy and a Gehr Center Student Innovator Fellow at the USC Keck School of Medicine. His research focuses on equity considerations within health policy. Prior to attending Price, he attended the University of Texas at Austin and received his bachelor’s in Biology.

Edited by Nikki Thomasian

Image credit: BP Miller