Beyond COVID-19 Data: What Can St. Louis Do To Bring About Health Care Equity?
On April 8, St. Louis health director Dr. Fred Echols penned a column for the St. Louis American, in which he revealed that the first 12 COVID-19-related deaths in the city were African Americans.
At that time, no detailed racial data about who the virus was affecting was readily available to the public.
When Echols wrote the column, other Midwestern cities — such as Detroit, Chicago and Milwaukee — already had released information on the number of African Americans affected by coronavirus. Without the racial breakdown of cases for the city, St. Louis University’s Institute for Healing Justice and Equity co-founder Ruqaiijah Yearby said racial inequalities would continue to be glossed over — particularly for African American communities.
“We have not done a good job of breaking down racial inequality. We have not done a good job of empowering those people to actually be healthy,” Yearby said. “I think the time is now to take action, which means that we shift the power to those people, we value them and give them the things that they need to be able to survive and thrive.”
Now that the city is providing racial demographic data about COVID-19 online, St. Louisans can more clearly see the disparity of who is being hit hardest by the virus.
City data shows that African Americans account for about 70% of the more than 1,000 people who had tested positive for the coronavirus by Sunday, even though black St. Louisans account for a little less than half of the city’s population.
In particular, residents of north St. Louis, which is predominantly black, are faced with the highest numbers of virus cases per ZIP code.
On April 9, St. Louis County released its racial data about COVID-19 cases. Similar to the city, African Americans are disportionately affected by the virus. As of late April, black Americans make up 53% of the county’s total coronavirus cases but only 25% of the county’s population.
As the virus has spread throughout the region, county and city leaders begged city officials for testing sites in the most at-risk communities. North city did not get a testing site until April 2. Since the release of the city's racial data, testing sites have become accessible across north city and county as well as in south city.
St. Louis Public Radio’s Andrea Henderson spoke with Yearby to learn what the data means for the city, how the reality of health care disparities should be addressed across the region and how years of disenfranchisement in black communities has led to chronic illnesses.
This interview was edited for clarity and brevity.
Andrea Henderson: Now that the city’s COVID-19 racial breakdown is available, what is your take on the information reported?
Ruqaiijah Yearby: I think that it is not surprising to see the higher cases and the higher death rates in communities of color, particularly black communities. And there are three main causes to me why we see these higher cases and higher death rates. One is because of a continuation of higher chronic diseases and people of color. Also going back to poverty and relegation to low-wage jobs, and then also housing. Here in St. Louis, we have a high equity factor in terms of health insurance: there are about 22% of Hispanics, 19% of Asians and 14% of blacks that don't have access to health insurance.
Part of this is because we haven't expanded Medicaid to cover low-wage workers who need to continue to work during this time because they cannot stop. They need to pay for food, and they're also often deemed essential workers. Another issue when you look at the data is the challenge of trying to protect people. Some of the risk factors for COVID-19 are linked to chronic diseases. And when you shut down health care institutions and stop treating these underlying causes, it just increases the risk of somebody catching COVID-19 and dying from it.
Henderson: Why was it important for the city’s health department to make these numbers accessible?
Yearby: I think it was very important to make it accessible because we already know about the racial inequalities — particularly in terms of housing-related health disparities — and those connect to some of the major risk factors for COVID-19. In fact, the city of St. Louis issued a health assessment back in 2017, noting ZIP codes that had high health-related housing violations; including no hot water or cold water and also a number of people living in a small apartment. And what we're seeing is that if you look at that health assessment where ZIP codes have really high health-related housing violations, like in 63115 and 63113, that's actually where you see the highest rates of COVID-19 infection. And these are also the ZIP codes that have a high population of African Americans.
Henderson: When looking at these numbers, what do you think they prove?
Yearby: A part of what this data does is make it clearer that the racial equity indicators that St. Louis city published back in 2018 gives another example on how racial inequality and equity [impacts communities]. They know that African Americans are more likely to be unemployed, but it really puts a face on how that then leads to poor health outcomes.
Hopefully, what it also does is to widen the lens on who should be protected workers. We often just focus on health care professionals such as nurses and physicians, but that should include workers in a lot of these low wage jobs. So, the home health care workers who are still going into people's homes and providing care, people who are working in meatpacking jobs, cable installers, the people who are working on the transit, grocery workers, janitors and food service workers, those are people who we need to support. There are some specific things that we need to do right now to support these workers, which include hazard pay and if they die, they need then for their survivors to get benefits.
They also need to get protective gear, training and access to health care. So, for me, we need to implement the solution and actually move forward to trying to achieve racial equity by helping people get out of poverty, helping people get access to health care and then helping people be in environments that are better for their health.
Henderson: And when you take a look at the demographic cases by race, you can't help but notice the stark difference between black Americans and white Americans. What does this data say about the city and its health care system?
Yearby: Well, I think what it says is that when you see the most cases as women of color — particularly black women — and you look at some of the prior reports, you notice that this is not anything new. Women of color do not have equal access to health care and often die more of maternal mortality, diabetes and heart disease. So I think it says a lot about the history and the demographics of St. Louis, and then you can make it even specific to some of the central workers who are working under COVID-19 trying to help others but they are not being supported.
Henderson: From the data, we also know that there are inequities here in St. Louis among all racial groups, so why should these health disparities matter to not only the city but also to the community?
Yearby: This should matter because we are all citizens together. Even though it can impact different communities disproportionately, we are all here. If a major part of our population is dying off, we should care and want to do something about it. I think that it often signals when one population has a problem, the overall problem within the city and that includes access to health care. It includes the issue of poverty and unemployment, which is quite high in state with across the board, no matter race, sex or age. I think it also calls into question how do we raise the issues related to housing? How we don't have affordable housing in St. Louis is how people are packed together because of poverty, which increases the spread of some of these diseases. I would say that this is an example you see here in St. Louis. It's an example you see in Chicago. It's an example you see in Detroit, that when you don't put the money that you need into social services in terms of housing, employment and health care, your overall population will suffer.
Henderson: Now that we see the virus has exposed these health and social disparities here in the city, in what ways do you think that the city should address these inequities?
Yearby: I would say that one of the things that I hope that they would do is that they would implement some of the solutions from the Forward Through Ferguson report and that were also included in their racial equity indicator report. I think another example is to actually have more testing, but also more resources in the places where we see are hit the hardest.
I think it's also dispensing transit for the people in those areas who have to go to work and continue to go work. I think it's also seeking and using the federal support that has been released to give support to people in those areas who are hardest hit and who have to continue to work just to make ends meet. So, I think those are a few things that they can start off right now and then build upon that.
Henderson: Is there any other type of data or research that can be done or that we need as community members of the city of St. Louis, so we can look deeper into these health care disparities?
Yearby: I'd say definitely some of the data that can be pulled is through community groups who are working with people most affected. I think that there are many community clinics and groups that are providing services to people in north St. Louis and hard-hit communities that we need to make sure that they get the money to continue providing health care services to the community but also to begin to ask the community what they need.
Henderson: Will this data change things for the city in regards to health care inequities?
Yearby: I think it can. Data is always great, but you can't point to data to actually lead to change, so the key is that we need to use the data to make some kind of change. It’s great to hear that people are going around to help educate people about being healthy, but it would be good to use examples in other places.
In Chicago, the mayor has already announced that they're establishing a racial equity rapid response team to engage members, conduct regional briefings on the streets and for outreach workers in terms of testing. I think that's so important, but you also have to make some changes, whether that is structurally to ensure that people don't get kicked out of their houses and have access to clean water. But also, it means that you understand that they are going to need mental health support right now, because living through this tragedy is affecting people.
Follow Andrea Henderson on Twitter: @drebjournalist
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