Addressing equity in the age of COVID-19

Today’s guest post is by Carlene Pavlos, MTS, executive director of the Massachusetts Public Health Association. In March, the association created an Emergency Task Force on Coronavirus and Equity with community partners, releasing recommendations that call on state policymakers to make equitable decisions on COVID-19.

Since February, staff at the Massachusetts Public Health Association have recognized that we would be playing some role in addressing the expanding coronavirus outbreak.

MPHA has been working for years to address a poorly organized and funded local public health system in Massachusetts, and it was clear that local public health would be needed to respond to this soon-to-be emergency. On the policy side, we could also see that solutions would be needed to address health inequities that would be worsened both by the epidemic itself and by the public health strategies being put in place to prevent its spread. 

MPHA has a long history of focusing on equity issues, including the intersection between racism and poverty and health outcomes. But in the early days of the outbreak, we didn’t realize how profoundly the coronavirus epidemic would impact all of us and our work together.

One of the key moments for me in deepening my understanding of all the ways in which this public health emergency would affect people and families already struggling was listening to a mom of four who was being interviewed before the schools were closed here in Massachusetts.

She was asking how she was going to afford the increase in her grocery bill if her four kids were at home every day eating breakfast and lunch rather than having access to school meals, especially if she was laid off from her job or got sick and couldn’t work. 

It brought home to me, with a seed of real panic, that the economic hardships on the horizon were going to be every bit as damaging to the health and welfare of marginalized communities as the outbreak itself. 

As we talked about it in the office — and, yes, we were still together in the office, then — my colleagues had examples of their own and were feeling the same sense of dread. We knew that this outbreak would follow all-too-familiar lines, hitting hardest in the communities already facing marginalization and discrimination. 

We knew we needed to act. But we also knew we couldn’t act alone. MPHA neither had all the answers, nor the political clout to develop and move a policy agenda of sufficient scale to respond to this emergency. 

We decided to convene an emergency task force, to develop a focused set of policy recommendations and reached out to allies to gauge interest. The support was instantaneous and overwhelming. The only question seemed to be how quickly we could to do it.

The task force met almost a week later, with Sandro Galea, dean of the Boston University School of Public Health, and Cheryl Bartlett, CEO of a community health center and a former state public health commissioner, as co-chairs.

More than 80 leaders from an astounding diversity of fields and organizations came together in a virtual meeting, broke into subgroups and shared their expertise. They came to consensus on four policy priorities, calling on the Massachusetts governor, attorney general and state Legislature to:

• pass emergency paid sick time;
• ensure everyone has access to safe quarantine;
• enact a moratorium on evictions, foreclosures and termination of public benefits; and
• ensure immigrants have safe access to testing and treatment.

Three days later, we held a virtual press conference with than 400 participants. We now have more than 135 organizations — from major health care systems and elite academic institutions to grassroots community groups, labor unions and social service organizations — that have endorsed the recommendations. 

We are calling on our political leaders to act — and to act immediately — on these urgent policy recommendations, as people’s health and lives are in the balance. We are monitoring movement on these policies and applying pressure with unrelenting persistence. We will keep doing so until we see action. 

Looking ahead, MPHA will continue doing everything we can to develop policy solutions to ease the suffering of marginalized communities affected by this public health emergency.

As the longstanding health inequities in our society are laid bare, our hope is that we will be able to recover from this crisis in a way that builds a foundation for greater equity in the future.

Because if anything has become clear through this crisis, it is that equity is not only a fundamental value, it is indispensable for true public health.