Respectfully, how can we, as a nation, comfortably call ourselves the United States of America when our history and current practices demonstrate otherwise? If we want to be honest with ourselves, there is a long list of words of discordance that might be more accurate.
Ableist. Ageist. Bigoted. Discriminatory. Elitist. Exclusionist. Exploitative. Homophobic. Inequitable. Marginalizing. Neglectful. Non-affirming. Oppressive. Patriarchal. Racist. Violent. Xenophobic.
This list, unfortunately, is not exhaustive. More would be needed to fully describe this nation’s disturbing and continued role in creating, upholding, and exacerbating the health inequities afflicting marginalized and underserved populations in this country. These populations are not monolithic, and the magnitude and type of inequities they experience differ, and therefore varying interventions are needed to remedy injustice. With this in mind, considering COVID-19’s disproportionate impact on marginalized and vulnerable populations, as well as its anticipated exacerbation of social risk factors, the National Health Law Program (NHeLP) commissioned the Health Equity Blog Series.
Critical Aims of the Health Equity Blog Series
The aims of the Health Equity Blog Series were to further elevate the conversation on health equity, highlight the different experiences of afflicted populations, to the best of our ability, and advocate for interventions to ameliorate health inequities of yesterday, today, and tomorrow.
Findings of the Series
Through our work, and that of our partners, the blog series detailed how decades, and in some instances centuries, of systemic oppression and intentional negligence towards certain populations in the United States has resulted in issues of access to health care; access to health insurance; access to critical technology such as broadband; barriers to fair opportunities; increased risk of imprisonment; housing insecurity; and disproportionate rates of chronic disease to name a few. Below we provide a detailed list of findings, and at the end, a full listing of the blogs.
The blog series uncovered lessons and ideas that could help ameliorate health inequities endured by populations covered in the series. The following sections, organized by topic, contain examples of such ideas. This list is not exhaustive and should be understood as a starting point for reflection, not a finish line.
- Legislative bodies and policymakers at all levels need to protect the needs of communities that are most impacted by racist and harmful practices (e.g., BIPOC, LGBTQ+, and people with disabilities) as a top priority.
- Center the needs of BIPOC LGBTQ+ individuals when addressing access and affordability to PrEP and PEP.
- Prioritize higher risk individuals (e.g., older adults, persons with chronic diseases, and COVID-19) for non-congregate housing assistance to support people experiencing homelessness.
- Expand polling place hours to reflect the needs of BIPOC communities and low-wage earners.
Improve Data Collection
- Improve data collection and reporting practices to be more robust in identifying patterns and trends in health conditions, outcomes, racial disparities in health, housing, and long-term care among different communities of color.
- Require the disaggregation of data by ethnicity (e.g., Asian subgroup) and disability status.
- Increase transparency and timely reporting of facility COVID-19 case counts to health officials, residents, and families.
- States should report weekly COVID-19 updates to the CDC about infections, deaths, and testing at assisted living facilities that also includes demographic information (e.g., race and disability status).
- Expand the types of facilities that are required to report COVID-19 data.
- Congress and the CDC should improve the fidelity, specificity, and transparency of race/ethnicity data reporting, including for Native Americans who live off reservations.
- Public health agencies should facilitate securing data sharing to help identify COVID-19 problem areas.
- Establish data collection and quality assurance checks to ensure providers and health plans address racist and transphobic practices that harm Black TGNC individuals.
Strengthen Access to Care
- Ensure eligible individuals are aware of special enrollment periods outside of open enrollment.
- Federal, state, and local governments need to make every effort to remove exclusions and barriers to health care that have specifically targeted underserved subpopulations (e.g., Immigrants).
- Federal and territorial governments need to do away with disparities in health care access for Black, Latinx, Pacific Islanders, and other POC residing in the territories.
- Federal, state, and local governments need to commit to reproductive health care access as a fundamental right, not an option.
- Federal, state, and local governments need to pass laws that protect access to gender-affirming care.
- Require states to cover home and community-based services (HCBS) the same as institutional care to allow older adults and persons with disabilities to avoid unwanted nursing home placement and reduce the spread of COVID-19.
- Do not triage and prioritize health care in an ablest or ageist manner that discriminates against older adults or people with disabilities.
- Ensure both in-person and remote access to translation services for LEP individuals (e.g., Asian and Latinx) seeking care.
Improve Availability and Reduce Cost
- Support designating PrEP as an “A” recommended preventive service through the U.S. Preventive Services Task Force (UPSTF).
- Ensure ancillary services associated with PrEP use, including HIV testing and counseling, are included with improving PrEP access without cost-sharing.
- Cover PrEP under the ACA for all plans and at no cost to patients seeking HIV, kidney function, sexually transmitted infections, and pregnancy testing.
- Expand cost-free coverage for all COVID-19-related testing and treatment; access to affordable testing; and relax quantity limits on certain prescriptions for Black TGNC individuals.
- Prohibit benefits designs with prescriptive requirements on gender identity.
- Increase federal funding to invest in provider rates, prevention services, and needed infrastructure (e.g., ventilators and intensive care beds) in the U.S. territories.
- Permit open-ended Medicaid funding in the U.S. Territories to allow the appropriate response necessary to safeguard their health and well-being before, during, and after emergencies and economic downturn.
- Fund non-congregate settings for people experiencing homelessness.
- Increase funding and direct resources to underfunded IHS and tribal economic recovery efforts.
- Invest in early voting and vote-by-mail systems and infrastructure.
- Invest in continuous provider education on caring for Black TGNC individuals.
- Governments should invest in creating the infrastructure – connectivity, equipment, and education – to make telehealth promise a reality.
- Re-design existing immigration and health care systems to provide truly universal and immigration-consequence-free health coverage to everyone.
- Restore the VRA and dismantle discriminatory policies that suppress voting rights and meaningful voting access.
- End strict voter ID, voter purging, and disenfranchisement laws that target trans people and BIPOC.
- Pass non-discrimination laws against TGNC individuals.
- Adopt culturally sensitive language and inclusive spaces in care facilities.
- Develop policies to ensure providers and health plans use updated medical standards and research.
- Ensure Medicaid and Medicare beneficiaries know their legal rights and can access advocates to represent them in appeals (e.g., legal services corporations).
- Suspend detaining immigrants in detention facilities and immigration enforcement through the public health pandemic crisis.
- Support rapid re-housing for persons experiencing homelessness, emergency rental assistance, and at least a 12-month moratorium on evictions and foreclosures.
- Require medical examiners have relevant professional experience with specific authorization requests.
- Providers should receive cultural competency (e.g., racial justice and implicit bias) and gender identity training and the support needed to address both disparities and prejudice within the care setting.
- Improve digital literacy for providers, staff, and patients.
- Ensure broadband (high-speed internet) is available and affordable to every individual.
It is imperative that individuals hold representatives and governments accountable to fulfill their obligations to safeguard the health and well-being of the population. However, we must not forget the importance of hearing each other’s voice and seeing one another.
For only until we comprehend the experiences of diverse communities and find shared community will we be able to attain the understanding and power necessary to achieve our goal of health equity. Only through deep commitment to learning and growth can we understand systemic injustice, how identity and experience impact health, and how multiple such identities may intersect or multiply with each other. Ensuring health rights for all and the eradication of health inequities is within our reach, if we are united in our purpose. Remember: our history is not just defined by the oppression we have endured, but also by our continued resistance and resilience.
Health Equity Blog Series blog list:
- The Effects of the Coronavirus (COVID-19) Epidemic on the African American Community
- Expanding PrEP and PEP Access in California
- Advancing Health Equity for Asian American in the time of COVID-19
- The Unveiling and Magnification of Healthcare Disparities in America
- COVID-19: Exacerbating Old Barriers for Immigrants
- Excluding Immigrants from COVID-19 Relief: What’s Old is New Again
- COVID-19 Highlights Unequal Treatment of People of Color in U.S. Territories
- Black, Disabled, and Uncounted
- Homelessness and Health in the Time of COVID-19
- The Effects of COVID-19 on America’s Hispanic and Latinx Communities
- More Broken Promises? Native Americans Endure COVID-19
- On the Centennial of (White) Women’s Suffrage, Reproductive Health Injustice Persists
- Changes Are Needed in the Health Care System to Meet the Needs of Black Transgender and Gender Non-Conforming People
- Health Disparities Facing Older Adults of Color amid COVID-19: Guest Blog by Justice in Aging
- Will telehealth provide access or further inequities for communities of color?
- Call to Action for Solidarity for Black Trans Lives