It has been literally just about two months since I developed that fateful cough and slight breathlessness barely a month since COVID-19 had entered public health vocabulary. COVID-19 (short for Coronavirus disease-19) is caused by SARS-CoV-2, a type of virus that belongs to the same family of viruses that cause SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome). The World Health Organization declared COVID-19 a global pandemic on March 11, 2020,  reinforcing the contagiousness of this viral disease (1). As public health practitioners, we understand the severity of a viral pandemic that can have devastating consequences on the population. As of today, COVID-19 cases have been detected in all continents except Antarctica. 

​I live in New York City, one of the first epicenters of the disease in the United States. One may automatically assume that NYC is adequately equipped to handle a pandemic the magnitude of COVID-19. I was incredibly lucky to have recuperated from COVID-19 without the need for hospitalization. But that does not stop me from reflecting on the glaring health disparities that COVID-19 has exposed in our community. While this is nothing new to public health practitioners such as myself, let us not underestimate the fact that COVID-19 has only amplified the many health inequities that already plague marginalized racial and ethnic communities in the United States. In other words, these inequities already existed!  The pandemic merely exposed them.

​“The single biggest problem in communication is the illusion that it has taken place,” said George Bernard.
 
I’ve been thinking about the phrase that is circumventing our society, “stay safe at home.” While it’s used as advice to the general public, this term means different things to different people.
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What if you lack a home? What if you are in an abusive relationship? What if you cannot afford basic amenities to live?
 
As communication professionals, we have to acknowledge that one common message cannot always translate, in words or in actions, for everyone. Just because a message is received, doesn't mean everyone can act upon that message.
 
I’m a Health Communication Specialist who believes in the power of communication to improve health equity. But I’ve found that there is a great deal of hesitation when it comes to health communication professionals communicating about health equity. I’ve broken my hypothesis into three probable reasons. 

​Policy change has the ability to impact health and social outcomes during pandemics such as this unprecedented COVID-19 outbreak. As we know, the COVID-19 pandemic does not discriminate on the basis of geography or whether or not someone has a home where they can shelter-in-place. Rates of infection have been concerning both across urban and rural areas, including New York City and its suburbs, and rural areas in Louisiana, as well as international settings such as Lombardy, Italy. Reducing exposure to COVID-19 is critical to limit infections. As recommended by public health and medical experts, exposure to the virus can be reduced by closing schools, limiting operations of or closing non-essential services, staying home (if you have one) and practicing social distancing. In addition, fair public policies are essential for managing hospitals, COVID-19 testing, and the utilization of ventilators for patients in Intensive Care Units (ICUs).
 
The Families First Coronavirus Response Act (FFCRA) includes an Employee Paid Sick Leave Rights provision. Yet, due to the economic disruption COVID-19 has caused, such a provision is insufficient to address ongoing financial insecurities faced by employees—whether they qualify or not for FFCRA benefits. In fact, the FFCRA and the related Paid Sick Leave legislation further expose a variety of health and social inequities that are concerning. Namely, FFCRA does not meet the needs of people who are historically and disproportionately impacted by poverty, which often goes hand in hand with low or no health insurance coverage (1,2). People who don’t qualify for FFCRA benefits and are also disproportionately impacted by poverty are likely to feel challenged by any potential decision of staying home, and reducing exposure, and instead may feel they should go to work, where unfortunately, their risk for contracting COVID-19 would increase.

If you are reading this post, you are likely dealing both as an individual, an organization, and a member of your community with the ongoing COVID-19 pandemic. Us too!

At Health Equity Initiative, we are deeply concerned about the potential impact of this outbreak on vulnerable and marginalized populations both in the United States and globally. These communities are likely to be the most affected by the outbreak as they face many barriers to recommended COVID-19 mitigation measures.

For example, while for many it's a privilege to work from home in these trying times, many Americans are part of the gig economy and/or don't have access to paid leave, so they sadly have to choose between putting food on the table and protecting themselves. Some people may even lose their jobs as restaurants and other facilities are closing worldwide. Across the world, elderly people increasingly live in isolation and lack the kind of community and social support to shop safely for food or make sure they don't run out of life-saving medications for chronic conditions that may affect them. Homeless people and people who live in jails in the United States, or rural communities in many parts of the world may not have the resources (yes, I am talking about soap and water) for complying with something as simple as washing one's hands. Many college students may not have a "home" to go back to because of poverty, marginalization, broken homes, and other socially-determined factors. For people who live in overcrowded homes or shelters, it may not be easy to practice "social distancing." Access to affordable and quality care varies for millions of people. Many immigrants may fear seeking help because of increasing xenophobia and doubts on whether to trust there won't be any legal consequences. And finally, the millions of children who live in poverty in the United States had to wait or are still waiting for new approaches to get the meals they need being delivered outside of schools.

by Alka Mansukhani, PhD, MS ​

We don’t often associate the built environment of our cities as having a major role in health outcomes but as the world’s populations become increasingly city dwelling, the impact of where people live work and play on their overall health is coming sharply into focus. Besides access to affordable health care, access to affordable housing and healthy food markets, and proximity to safe playgrounds, parks, sports fields and community spaces all play a role in contributing to people’s sense of well-being and their health outcomes. In other words, your zip code is more important than your genetic code in determining health outcomes!1,2 
 
All around New York City there is an up-zoning and building frenzy in older neighborhoods, which is creating a mushrooming of highrise luxury towers without enough attention paid to community needs, particularly truly affordable housing. Older residents are being displaced, income inequality and segregation are exacerbated as neighborhood’s communities fragment and infrastructure is strained.  Yes- new development is good, but how can it be made to be more forward-thinking? How can we develop strategies to make it more comprehensive, sustainable and resilient to climate change while addressing the communities’ needs?

Happy New Year from all of us at Health Equity Initiative! May 2012 bring better chances for better health among vulnerable and underserved populations! Yet, this may not be possible without first building a social movement around health equity issues.

Ask yourself: how often do people in your community, family, organization, and/or professional networks speak about health equity or are even aware that the health experience of vulnerable or underserved populations may differ from the experience of other more privileged groups? How many people know that the place where they live or work, or their ability to access not only healthcare services, but also transportation, adequate housing, education, health information, jobs, social support, or others may affect their opportunity to stay healthy or effectively cope with disease? Not only is good health a fundamental human right, but it is also a necessary pre-condition to secure and maintain jobs or succeed on one’s studies and/or many other small and big endeavors of everyday life. Advancing health equity is key to making sure that people can be happy, self-sustaining and productive in their everyday lives.