Gov. Mike DeWine has called the coronavirus statistics for Ohio’s African American “simply unacceptable.” To date, he has:
- Asked for recommendations from a Minority Health Strike Force that he formed to study the effects of the coronavirus on minority populations in Ohio.
- Announced a partnership with more than 400 community health centers around the state to connect people with testing.
- Announced a new top-level health department position: deputy director of social determinants of health and opportunity.
African Americans account for 25% of Ohio’s COVID-19 cases and 17% of deaths but make up just 13% of the state’s population. Latinos make up just 3.9% of the state’s population but account for 6% of its COVID-19 cases.
DeWine has said the racial differences in infection and death rates might be even higher. Not all cases and deaths include the race of the patient, which is leaving the data picture incomplete.
The COVID-19 mortality rate among blacks in Cincinnati, where the population is 43% African American, is triple the rate for blacks statewide. The city has had 45 COVID-19-related deaths as of Friday; just under half have been among blacks.
Dr. O’dell Owens, Interact for Health president and chief executive officer, concluded Tuesday that the difference between death rates for blacks across Ohio and in Cincinnati is population-driven. In the city, there are more than three times the amount of African Americans than in the state. Most blacks in Cincinnati live in denser housing, he said. The majority work jobs without sick pay and they often battle access to health care, Owens explained.
Social determinants of health – economic and social conditions that dictate access to health care – also impact a person’s health outcomes. African Americans are more likely than whites to have access to good education, higher paying jobs and safer neighborhoods.
It leaves the black community vulnerable and without equitable health care options.
“The coronavirus has really sort of pulled back the curtain on some things we already knew, that is that there are very clear and longstanding racial disparities in the health of our citizens,” DeWine said during the briefing.
In late April, DeWine formed the Minority Health Strike Force group to address these health disparities, ones that stem from social health determinants.
African Americans have higher rates of heart disease, hypertension and diabetes, DeWine noted, all of which are preexisting conditions that exacerbate COVID-19 symptoms.
The governor listed social conditions that drive 70% of health outcomes need to be addressed: Access to health care, housing, transportation, employment and nutritious food.
But before you can address these broader issues, access to complete data is key.
Owens said the task force, where he serves on the data committee, is looking to uncover what’s causing the race of so many cases and deaths to be labeled as “unknown.”
“The biggest issue across the U.S. lies in the failure to identify race data,” Owens said Tuesday.
Obtaining the age, race and gender of a patient is Day One medical school teaching, Owens said. For doctors, it’s an “intellectual shortcut.”
Demographic markers communicate to doctors what patients can’t often articulate, and these indicators are imperative in the pandemic’s wake. A better demographic understanding of communities that are most vulnerable to the pandemic’s hold would dictate intervention – communities that need antibody testing.
On Wednesday, unknown COVID-19 deaths made up almost 10% of the Cincinnati Health Department’s tracker. The state’s database only reports 2% listed as an unknown race.
Ohio isn’t alone in bringing clarity to the race of its COVID-19 patients and dead. And in comparison to surrounding states, it’s doing better.
The COVID Tracking Project partnered with the Antiracist & Research Policy Center to identify states whose data weren’t comprehensive. While other states remiss race reporting altogether, the project, which assigns state grades that account for race reporting, scored Ohio a “B.”
While the data remain incomplete, it’s not an excuse to slow down working toward solutions.
There isn’t an overnight fix
This isn’t a time to “point fingers,” said Renee Mahaffey Harris, president and CEO of the Center for Closing the Health Gap, about racial disparities in health. Now, it’s about collectively coming together to focus on shifting decades-old structural and institutional systems that perpetuate those disparities, she said.
“We didn’t get here overnight,” Ohio Department of Health director Dr. Amy Acton said during the Thursday afternoon briefing.
Acton turned to Cincinnati Vice Mayor Christopher Smitherman, who made a virtual appearance at the briefing, for advice to heal and make forward progress on health care disparities. Financial support to execute given recommendations and equitable and fair testing are the two priorities, he answered.
“Testing, testing, testing in an equitable and fair way is a consistent message” that the task force on which he serves has heard, Smitherman said Thursday.
He said it takes messaging to reach minority communities, testing, accessibility to that testing and collaboration with faith-based groups and organizations such as the Urban League of Cincinnati and the NAACP.
Funding of recommendations and initiatives laid out by the strike force will be particularly important for addressing vulnerable populations during the pandemic.
Measuring the toll of poverty
“A pandemic will expose how a country takes care of its poor people,” Owens said.
Cincinnati’s poverty rate hovers above 25%, more than double the most current national reading of 12% in 2018, and roughly 32% of the city’s African Americans lived in poverty that year.
Living near or below the poverty line comes with a cost – among them a lack of health insurance, difficulty in accessing adequate health care and having spacious living quarters to isolate from the already-ill. All three are paramount during a pandemic.
“That person is living in four rooms with seven other people, and grandmas there who has hypertension and diabetes,” Owens said. “Where are we going to put these people?”
And packed into these homes are frontline workers.
The U.S. Census Bureau’s Public Use Microdata Sample showed Cincinnati’s blacks made up roughly 47% of frontline workers, overwhelmingly staffed in public transit, cleaning service, child and health care. While many of these positions are deemed essential during the pandemic, paid sick leave is not a guarantee.
There’s a discrepancy, too, in people who can work from home, Mahaffey Harris said.
The frontline workforce may have personal protective equipment when they get home, they may not. And if they’re living in tighter quarters, it means a greater spread of COVID-19. But to financially support their families, bring food to the table and put a roof over their heads, frontline workers are forced to face the pandemic’s dangers.
And there’s another, more systemic layer that exists if a minority frontline worker gets sick with the virus.
“Even when we talk about access to care, you can’t put a period right there,” Owens said. “It’s all about quality to care, your relationship to care. It’s about how they view preventative medicine – to trust.”
But House Minority Leader Emilia Strong Sykes called DeWine’s plan “too little, too late,” according to a release from her office after the briefing.
“The recommendations he mentioned represent the easiest path forward, the lowest possible hanging fruit, and such simple steps should have been implemented six weeks ago to have any significant impact,” said Sykes, D-Akron and a strike force member.
“If the Governor is unwilling to even say structural racism is the root cause of health disparities and desperately needs to be addressed then I cannot take anything else he says on this topic seriously,” Sykes said. “The discussion today felt impersonal and insincere; if he is unwilling to expose the real truth of the situation, he should move on.”
The strike force plans to issue its recommendations by June.
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