Public Health Notes

As we turn the page on 2022 and our “tripledemic” surge recedes, let’s take a moment to reflect on health equity and disparities through the crucible of COVID-19.

Healthy People 2030 defines health disparities as “a particular type of health difference closely linked to social economic, and/or environmental disadvantage.” It further asserts that health disparities “adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group, religion, socioeconomic status, gender, age, mental health, cognitive, sensory, physical disability, sexual orientation or gender identity, geographic location, or other characteristics historically linked to discrimination or exclusion.”1 Our collective goal is health equity, described by Healthy People 2030 as “the attainment of the highest level of health for all people.” Achieving health equity requires valuing everyone equally, with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.”1

In the early 2000s, U.S. Surgeons General began to issue reports on disparities in tobacco use and access to mental health care based on racial and ethnic demographics. Since those ground-breaking reports, issues including infant mortality, pregnancy-related seats, chronic disease prevalence, and overall measures of physical and mental health have been examined through the prism of health equity. Part of the impetus of the Affordable Care Act (ACA) was to provide strategies for securing access to healthcare for traditionally underserved groups. Impactful gains were made in numbers of persons insured and access to higher quality care. However, those gains were somewhat eroded in the former presidential administration by cuts to funding for AVA navigators and outreach efforts, and the authorization of state waivers, which allowed some states to decline Medicaid expansion by instead offering their own wavers.

COVID-19 further impacted healthcare coverage losses through lost jobs and wages, resulting in increasing economic hardships, housing difficulty, and food insecurity, disproportionately affecting Black and Hispanic workers, especially those in essential in-person jobs (i.e., transportation, manufacturing, grocery, pharmacy, retail, warehouse, food processing, and healthcare). Due to healthcare workforce shortages and operational changes (e.g., video clinic visits requiring patients to have internet access), these same groups also experienced challenges to healthcare access.

During COVID-19, certain groups (i.e., Alaskan Native, American Indian, Black, and Hispanic individuals) experienced higher death and illness rates than their White or Asian counterparts, likely due in part to their work in essential jobs, higher prevalence of preexisting comorbidities for poor COVID-19 outcomes, use of public transportation, and crowding at work or home.

Additionally, according to the Kaiser Family Foundation’s survey data (The Undefeated), Black adults are more likely than White adults to report certain negative healthcare experiences, such as a provider not believing them, or refusing a test, treatment, or pain medicine the patient believed he or she needed. the Undefeated survey data revealed that Black and Hispanic individuals were less likely to have been vaccinated against COVID-19 as of April 2021. While vaccination rates against COVID-19 have risen on all ground, the gaps between White, Asian, Black, and Hispanic demographic groups have not narrowed. The effect of the health disparities laid bare by COVID-19 has been profound and predated the pandemic. For example, in 2018, the average life expectancy was four years lower in Black individuals than in White individuals, with the lowest life expectancy in Black men. That unfortunate trend continues today. In Tarrant County, the 76109 zip code in Fort Worth, a majority White neighborhood, holds a life expectancy of 82.4 years. Nearby 76104, host to historically Black neighborhoods, like Morningside, has a life expectancy of 66.7, and it is even lower for Black men at 64 years.

What can we do to address these disparities and improve the health of our county and county? The Biden administration has prioritized initiatives aimed at addressing health disparities at the federal level through several executive orders and proclamations. Locally, Tarrant county Public Health (TCPH) has created a Community Health Equity and Inclusion (CHEI) division to promote health literacy and address health equity issues concerning county residents, with the greater goal of decreasing health disparities and inequities in Tarrant County. The CHEI division educates residents and public health professionals regarding health disparity and inequity issues and engages community partners (i.e., Fatherhood Coalition of Tarrant County, Mental Health Connection of Tarrant County, My Health My Resources of Tarrant County, United Way of Tarrant County, and Brave/R Together) to find solutions that promote diversity and health equity.

TCPH continues to collaborate with community partners on annual events, such as the African American Health Expo, the North Texas Wellness Fair, and the Senior Synergy Expo. We are also participating in community celebrations, school events, and COVID-19 testing and vaccination pop-up clinics. Recently, TCPH and fifty-sic agencies- including hospital systems, institutions of higher education, city and county governmental entities, charitable organizations, and faith-based organizations- have joined forces as the Tarrant County Unity Council. This council’s purposes are:

• To identify and address health equity challenges for those disproportionately affected.
• To build, leverage, and expand fair resource allocation to safe, affordable, and accessible health, housing, transportation, and communication that advance racial equity and address other inequitable social conditions, with the purpose of reducing or eliminating health disparities and health inequities.