Mass. Public Health Leaders To Address Health Inequities Amid Coronavirus Outbreak

Some of the top figures in public health in Massachusetts are now part of a task force looking at social, economic and political forces that will contribute to inequities in the prevention and treatment of coronavirus.

The Massachusetts Public Health Association formed the Emergency Task Force on Coronavirus and Equity. The group includes social service providers who work with the elderly, immigrants, low-wage workers, and other marginalized populations.

They'll be drawing up recommendations for Governor Charlie Baker's administration and state lawmakers, to insure that vulnerable people are protected and receive services they need.

The dean of the Boston University School of Public Health, Dr. Sandro Galea, is co-chair of the task force.

Dr. Galea told WBUR's All Things Considered host Lisa Mullins that major crises — from natural disasters to pandemics — put health inequities into stark relief; and one of the groups most vulnerable to the coronavirus is people experiencing homelessness.

"With groups that are homeless, first of all, this is a group that's not connected to regular care, [and] as a result does not have clinicians who they have regular access to.

"Secondarily, they are living in shelters when they are inside, which are difficult to maintain a level of hygiene that one would want ... with people crowded together. So it's a group that's actually at greater risk of being exposed to the virus because they do not have the flexibility to avoid some of the main threats, which is public spaces and maintaining proper hygiene, while simultaneously not having access to care or other measures that might actually protect them.

Lisa Mullins: [This is] a difficult question, because you want those people to have a roof over their heads and you want people who are homeless to have adequate care. Are they safer in terms of contracting the virus if they're not in a shelter?

"That's a really tricky question. It really is a devil's bargain, right? And it gets to the fundamental point that I've tried to make in some of my writing — that we shouldn't even be having this conversation lightly, that we should be building a world where we do not have to make that kind of trade-off.

"Now, I'm a pragmatist ... I think the answer at the moment is, those who are homeless should always be housed as much as possible. And those who are responsible for housing the homeless are making every effort that they can to institute hygiene and as much social distancing as possible within the confines of those setups."

What about the issue of low-income communities and people of color? How might coronavirus disproportionately affect them?

"There are several things that are a particular danger. Number one is the levels of access to care. Number two, it's social integration, which means the extent to which such communities are willing to come forward and declare themselves if they are at risk of having contracted coronavirus. Number three, it is the medium and [long-term] economic consequences of a lot of social distancing measures that we are adopting as a society.

"Many low-income populations are marginally employed. They're dependent on any number of jobs, all of which depend on a highly functioning economy, all of which depends on there being clients, there being consumers, there being people who use public transit or public spaces.

"As we limit those, we are seeing more places of employment shutting down. We are seeing more retail establishments suffering from lack of business. And that's going to result in ... people being laid off from work or people who are hourly not being required to be at work. And these are people who often have no sick leave, who really are paid for the work they do. And if they're not working, they're not paid ... I mean, we are dealing with at least half the population here. This is a large group of people."

You're saying half the population of the U.S.?

"Correct."

How often are these people who don't have health insurance?

"This group disproportionately has less health insurance than overall. I mean, our overall prevalence of no health insurance now is in the teens, although it's been rising in the past few years. But this group will likely be up to a quarter of no health insurance."

The immigrant population and refugees, they might be dealing with many barriers. Tell us what you're most concerned about.

"Obviously, the more precarious the population is, the less likely it is that these populations will come forward to seek care as they need it. It is less likely that the population that will have access to stable employment that will protect them from an economic downturn or from loss of jobs, less likely to have the kind of social connections and facility with language that makes them aware of the resources that are available."

One of the issues that's affecting the overall population is a lack of testing. How does that hit those who are most vulnerable? And can you see that changing for them?

"Well, we know that when there is a shortage of anything — shortage of any clinical service, including tests — it is vulnerable populations who are less likely to get those kind of tests. Frankly, you and I probably can figure out a way to, through our connections into our regular care provider, to get such testing. But marginalized populations have a much harder time with it. So I would expect that, unless we make a particular effort to level the playing field, these populations are less likely to get the kind of testing that could help if they are exposed."