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Module 2: Health Inequity

Health inequity is defined as differences in health between groups of people that are avoidable, unfair and unjust. They are affected by three factors: social, including race, gender, class, sexual orientation, immigration status, etc.; economic, including institutional systems of advantage and disadvantage, etc.; and environmental, including safe access to food and exercise, crime, pollution and school institutions, systems, etc.

Culture shapes how we live. When a disease spreads through large parts of the world’s population, we cope culturally and biologically. As individuals, our bodies react biologically with responses like stress and anxiety. But as members of our culture or subcultures we react culturally. Our reactions are based in our personal histories, environments, upbringing and how we view illness and health.

The COVID-19 pandemic disproportionately affects immigrant and minority, marginalized and underrepresented communities. Due to social marginalization and systemic oppression, research indicates that members of these groups are more likely to live in multigenerational households; often work in front-facing jobs, such as grocery-store clerks; and take public transportation to get to jobs, resulting in higher rates of exposure. There also appears to be limited access to testing, a lack of culturally and linguistically appropriate public health information and underlying illnesses, such as diabetes and heart disease that disproportionately affect certain minorities. Because these factors put immigrants and minorities at a greater risk of infection and death from COVID-19, health inequity leads to inequitable outcomes.

Module Objectives

  • Step 1: Let's Get Started
  • Step 2: Time to Engage
  • Step 3: Creating a Stronger Foundation
  • Step 4: Your Turn

This step briefly introduces health inequity and provide specific objectives that will move you closer to your goals.

Play Video

The information in this step is accessible and provides a general introduction to health equity. You can listen to a podcast on your morning walk, download a resource to help your client or get a short audio summary of an article that caught your eye before fully engaging with the reading.

Webinars

Uché Blackstock, M.D., an emergency medicine physician in New York and founder and CEO of Advancing Health Equity, a company working to fight racism and bias in health services, brings light to the fact that racial health inequities are not new in the United States and they have existed well before the COVID-19 pandemic. Dr. Blackstock also discusses risk factors related to COVID-19. Sheri Fink, M.D., Ph.D., award-winning New York Times correspondent, discusses concerns related to understaffed hospitals including the patient population at hospitals and concerns with health equity.
WHY place-based works. WHAT gets under your skin and changes your physiology. HOW a framework, investment strategies, policies and systems can lead to new approaches to place-based work to address health inequity.
He identifies pre-existing conditions, food deserts, trauma center deserts, access to health care and the relationship between racism and stress levels as contributing factors to the high numbers of COVID-19 cases within Black communities.
The members of this panel discuss their experiences in the states of Georgia, South Carolina and Arkansas. The description section of this webinar provides multiple valuable resources listed with their designated links. Here are some of the topics highlighted in the webinar:
  • Discussion of health care considering COVID-19.
  • Black and people of color in the trans community.
  • Resilience and strength within these communities.
  • Privilege and access to health care.
  • Advocacy in health care for trans and non-binary individuals.
  • Community members’ health care experiences.
  • How health care organizations can use resources to better serve rural trans and non-binary clients.
  • Ideas of how we can move forward using what we’ve learned during the current pandemic.
The webinar provides a preview of the health challenges that trans and non-binary communities are experiencing during the pandemic. To further understand the additional barriers the COVID-19 pandemic has created for the trans community, you also need to understand the history of oppression and discrimination that these communities faced before COVID-19. Dr. Singh takes readers on a deeper dive through her TED (technology, entertainment, design) Talks, Trans Liberation is for Everybody (10 minute podcast) and Let’s Talk about Gender (15 minutes).
The following webinars are available as part of this virtual event series:

Podcasts

In an episode titled, Racial Health Disparities: How COVID-19 Magnified a Public Health Emergency (15 minutes), Malika Fair, M.D., MPH, addresses racism against Black Americans and what the academic medicine community can do to address institutional and systemic racism.
Defining Safe: Threats to Trans Healthcare Amplified During COVID-19 (18 min podcast) with Max Lubbers and Alex Chun, The Daily Northwestern
Interviews explore topics related to immigrant health, racism and health, early childhood experiences on life-long health and how racial and place-based inequities impact health:

Relevant Reports

Drs. Blackstock and Fink recommend the following articles published in the New York Times:

This list of materials and resources provides a more detailed description of how to apply of the tools introduced in Step 2 and requires a deeper analysis of the topic through documentaries, research articles, trainings and books. Some of the tools, like research articles and books, may have a cost attached and we recommend that your organization provide them and that you share them with other team members. Tools like trainings may require you to engage for longer periods of time than the initial resources.

Documentary

You can expect to find more in-depth descriptions of each episode followed by a short video clip, related resources and a discussion guide to accompany the documentary. These are the short video films available in this seven-part series:

Research Articles

Topics highlighted in this article include:
  • States not reporting racial data.
  • Where states do report racial data, “unknown” remains a huge category.
  • Collapsing ethnicity into race, obscuring uneven outcomes across distinct communities.
For a continuation of Dr. Kendi’s talk, visit The COVID Racial Data Tracker to learn more about how Black, Indigenous, and people of color (BIPOCare being disproportionately affected by COVID-19.
Jamila Taylor, director of health care reform and senior fellow, The Century Foundation, discusses Racism, Inequity and Health Care for African Americans in a 2019 report.
The Society for Research in Child Development addresses inequities in education in its report, Considerations for LGBTQ+ Children and Youth in the Era of COVID-19.

This step encourages you to apply what you have learned through a case vignette. We recommend that you explore the gaps present within the vignette and implement any new skills acquired through this module. Consult with others on your team to explore multiple ways to address the issues, especially as you take your role within your organization and your experience, skills and worldview into account. We provide reflection questions from the following perspectives: individual learning and beliefs, organizational learning and systemic. You can use the questions to have discussions with others and think through all the facets that are relevant to your work.

Case Vignette

Rita was a caseworker at an integrated mental health and substance use treatment clinic and moved to another town for a few years to take care of her elderly parents. Upon her return, she was re-hired and started looking up some of her previous clients. She was especially eager to see Keonte, a youth soccer star she worked with to help him and his family.

Keonte had changed in the course of three years. He had gone from a star athlete to being withdrawn and having a diagnosis of obesity. He had been suspended from school and failed one grade level. The trouble began when the youth soccer league closed because it was no longer a safe place to practice and there was a lack of reliable transportation to the field. More recently, Keonte suffered a minor injury that was never treated and had several family members who died preventable deaths during the COVID-19 pandemic.

Rita and Keonte were happy to see each other, but Rita burst into tears when he left. She had many ideas to provide Keonte the help he needed, but she felt resentful that the sudden decline in his health was so preventable.

Reflection questions

  • Rita became emotional witnessing the results of health inequity. How do you deal with your emotional reactions to inequity? (individual learning and change)
  • Inequity can often be the result of neglect or receiving less effective treatment for minor problems. A little problem turns into a big one over time. How does your organization ensure that everyone gets the preventive care they need? (organizational change)
  • There are societal forces at work against Keonte starting with inequitable policies in school in terms of suspension that start at Pre-K for Black and African American preschoolers. What role do schools play in enhancing or detracting from health? (systemic change)