Inequality in Delaware cannot be overlooked during COVID-19 pandemic
When the COVID-19 outbreak first appeared, I was frightened by the unrelenting and steady spread across the state; infecting and killing a cross section of Delawareans that included men and women, as well as young, old, rich, poor, white, African-American and Hispanic/Latino individuals. Naturally, my prayers were directed to my fellow Delawareans who, befallen with the illness, had to wonder if they were going to live or die. I am thankful that I have been spared, so far. I regularly remind myself that “…there but by the grace of God go I.”
But, when statistics began to emerge describing the disproportionately high rate of coronavirus cases and deaths in communities in Delaware where low income African-Americans and other people of color live, I found it interesting that I had not thought about the situation in terms of inequality in America. But, after resetting my focus, what came into full view was the reality that these populations are at high risk for contracting the virus because they live in ZIP code areas where social problems like poverty, low pay employment and life-threatening diseases such as diabetes and high blood are prevalent.
This revelation raised two important questions: while in the midst of a world-wide pandemic that is infecting and killing a broad spectrum of Delaware’s population, why is inequality in the form of racial and ethnic disparities a matter about which our elected officials and policy makers should be concerned? and what should be done to reduce racial and ethnic disparities in Delaware?
In simple terms, health disparities refer to differences among groups in the U.S. in the attainment of healthy wellbeing that can be measured by differences in incidence, prevalence, mortality, burden of disease and other unhealthy outcomes. But, is equally important to understand that health disparities also indicate unequal differences due to factors like race and ethnicity that are separate from access to healthcare.
Given the potential impact of the COVID-19 on everyone’s health in so many ways, we all should be concerned about the extremely critical situation that is unfolding in Delaware. Statistics provided by state public health officials indicate that African-American and Hispanic/Latino residents are getting infected at a higher rate compared to white residents. As of the writing of this commentary, the rate of COVID-19 cases among Hispanic/Latino and African American Delawareans is 108.4 per 10,000 people and 61.6 per 10,000 people, respectively, compared to 18.1 per 10,000 for white residents.
Looking at the prevalence of diabetes in Delaware provides another lesson regarding the burden of health disparities on racial and ethnic groups in the state. Public health data provided by the state of Delaware show that even before Sussex County was designated a COVID-19 hotspot, the death rate due to diabetes among African-Americans was 208 per 10,000 compared to 71 per 10,000 for white Sussex County residents. These statistics mirror national epidemiological data. For example, according to the Centers for Disease Control, the rate of diabetes is 66 percent higher for African-Americans than among white Americans. The rate of hypertension is 49 percent higher. To quote a recent article, “The elevated rates of these serious illnesses have weaponized the coronavirus to catastrophic effect in black America. The coronavirus pandemic has further stripped bare the racial divide I the health of our nation.”
Questions about how factors like residence (ZIP code), poverty, and type of employment interact to create health disparities in racial and ethnic groups can be answered by examining the prevalence of COVID-19 among in the Hispanic/Latino population in Sussex County. Consider the following: At the end of April, Georgetown and Seaford were reporting the highest numbers of cases, moving Sussex County past New Castle County with the largest number of infections. Georgetown and Seaford are two small downstate towns with a large concentration of poor Hispanic/Latinos. In late April, the Georgetown area was reporting the highest number of coronavirus virus cases of any Delaware ZIP code. According to census data, one-third of Georgetown residents are Hispanic/Latino.
Moreover, a significant proportion of Sussex County 's Hispanic/Latino population is employed in Delaware’s chicken plants where to do their jobs employees are near another without adhering rules governing social distancing. Consequently, these essential workers are extremely vulnerable for infection. Appropriately, poultry factories are now priority targets for intense testing. Nevertheless, a Sussex County elected official said that testing of poultry workers is "dumb idea" because the action could lead to plants having to close.
If Delaware’s political leaders were astute about inequalities in health status and access to healthcare, and had consistently implemented long term policies and programs that aim to overcome racial and ethnic health disparities, they should have expected that poor African-American and Hispanic/Latino communities and the heavily populated places where they work would be fertile environments for the coronavirus to develop and spread. Accordingly, there should have been a proactive response that included immediately concentrating on low-income racial and ethnic communities where health inequalities are prevalent for screening, testing and treatment for the disease even when individuals did not have medical insurance. Delaware was unable to implement a plan that focused on racial and ethnic groups because the order to collect COVID-19 data by race was not given until four weeks after first case was diagnosed.
What are some recommendations Delaware’s leadership can derive from its coronavirus experience in order to enhance the state’s capacity to reduce racial and ethnic health disparities? The following recommendations are offered:
After the seriousness and magnitude of the novel coronavirus outbreak in Delaware was assessed, the governor and other officials corrected the state’s response by adopting a crisis intervention approach that included numerous executive orders intended to flatten the COVID-19 curve, organize priority screening and testing in areas (e.g., communities and workplaces) where racial and ethnic groups are concentrated and provide treatment in the aforementioned locations even when individuals did not have health insurance. It is strongly recommended that the governor mandate the same approach after the outbreak subsides.
It is further recommended that the abundance of knowledge that state agencies, institutions and health facilities have accumulated be translated into a sustainable, long term action plan designed specifically to overcome racial and ethnic disparities in Delaware. The plan must include continuous policies and programs that focus on racial and ethnic communities. The plan’s components, among other things, should insure medical insurance for uninsured persons, expand the healthcare workforce with culturally appropriate skills and knowledge that correspond to the unique social, psychological and health needs of ethnic and racial groups. It should also include strategies with measurable outcomes that are about developing enough effective healthcare resources so that they address gaps in healthcare availability in racial and ethnic communities.
The action plan should also include elements that require communication with stakeholders and community engagement as well as partnerships with health care professionals, hospital management, legislators, etc. that are intended to develop a comprehensive plan to reduce health disparities in the state’s most vulnerable racial and ethnic communities. Finally, the plan should include programs for business executives, human resource personnel and supervisors that are designed to explore attitudes, values and approaches that convey to employees that they are valued and their health and safety are not less important than making huge profits.
Dr. Marlene A. Saunders
steering committee member
Southern Delaware Alliance for Racial Justice