Will COVID force public health to confront America’s epic inequality

Will COVID force public health to confront America’s epic inequality?

Around the world, life expectancy is generally shorter in countries with a high Gini coefficient, a measure of income inequality. A value of 1 indicates complete inequality, where one person in a population receives all the income and others receive nothing; a value of 0 shows full equality, where everyone in a population has the same income.

A century of research has demonstrated how poverty and discrimination drive disease. Can COVID push science to finally address the issue?

As COVID-19 devastated disenfranchised communities in the San Joaquin Valley (see map), grass-roots organizations joined with local researchers to provide help. They’ve organized testing drives and educated communities about the disease and vaccines. But much of their work falls outside medical care, such as advocating for labour rights and subsidies for housing.

These types of social and economic intervention are what’s really needed to address health disparities, but many academics and health officials are reluctant to push for such measures publicly, says Mary Bassett, an epidemiologist at Harvard University in Cambridge, Massachusetts, who is a former commissioner of New York City’s Department of Health. That reticence needs to change, she says. “We need to be more outspoken about things that aren’t in our lane.”

Bassett is one of a growing number of researchers who are getting political, and who hope that COVID-19 will be a catalyst for change in the field. “The pandemic has turned up the dial, and to me it brings out a sense of urgency,” says Arrianna Marie Planey, a medical geographer at the University of North Carolina in Chapel Hill. Not content with simply identifying the social determinants of health, she says public-health researchers should be doing more to address them.

“I see a study saying COVID is higher in farmworkers, and I’m not interested — I want to know what’s next.”

Equity boosts life expectancy
Around the world, life expectancy is generally shorter in countries with a high Gini coefficient, a measure of income inequality. A value of 1 indicates complete inequality, where one person in a population receives all the income and others receive nothing; a value of 0 shows full equality, where everyone in a population has the same income.

In the United States, higher income correlates strongly with longer life expectancy, even if income percentiles are adjusted to contain the same proportion of Black, Hispanic and Asian adults.

The wage gap in the United States has widened considerably since the 1980s. As wages have increased for high earners, they have decreased or remained static for those on lower salaries.

In 2019, the highest proportions of people earning less than $15 per hour were Hispanic women and Black women.

Black and Latinx people and Indigenous Americans are roughly three times as likely to be hospitalized and twice as likely to die from COVID-19 as are white, non-Hispanic people in the United States.

The pandemic has the potential to widen economic inequality. Low-wage workers experienced some of the heaviest job losses in 2020, whereas higher-wage workers gained nearly one million jobs.

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