In honor of Martin Luther King Jr. Day, I had the honor to volunteer at a COVID-19 vaccination site at the Community Protestant Church on East Gun Hill Road in the Bronx. It was an amazing experience to see New Yorkers come together for a cause bigger than themselves on a mission for Health Equity. While volunteering, we scanned the line for seniors waiting outside in the cold with walkers and canes and moved them up so they could be seen sooner. We talked through the vaccination process with essential workers to get through some of their nervousness and jitters. We helped wheelchair-bound New Yorkers get through narrow doorways and escorted them to and from the vaccination observation rooms. After this experience, I honestly believe that if we all give just a little bit, it will always be more than enough. As Aristotle, a philosopher in Ancient Greece, once said, “the whole is greater than the sum of its parts.”
However, one thing stuck out to me while I was volunteering. The vaccination line was not as diverse as the neighborhood it was in. This struck a chord with me and galvanized me even more in my pursuits of Health Equity. As we enter February to celebrate and reflect during Black History Month, I cannot help but think about the current state of Black Americans. We are a population that has been hit so hard by the pandemic in a so many ways from employment, healthcare coverage and access to the COVID-19 vaccine. Here is a look at the staggering statistics and hope for a path forward.
At the height of the COVID-19 pandemic, unemployment for Black Americans spiked to 16.7%. The only time unemployment had been higher in the past 50 years for Black Americans was back in January 1983 when it reached 21.2% at the height of the 1980s recession (U.S. Bureau of Labor Statistics, 2021). While the unemployment rate decreased to 9.9% for Black Americans by December 2020, the national unemployment rate for the nation as whole was 6.7% (U.S. Bureau of Labor Statistics, 2021).
Prior to the pandemic, 11.4% of Black Americans lacked comprehensive health insurance coverage (Kaiser Family Foundation, 2020). This was 5% higher than the 10.9% national average. However, states that chose not to expand Medicaid eligibility under the Affordable Care Act had an uninsured rate that was 42% higher than the national average reaching 15.5% uninsured. Of the twelve states that still have yet to adopt Medicaid expansion, Mississippi (38.9%), Georgia (33.5%), South Carolina (28.0%), Alabama (27.8%), North Carolina (23.1%), Tennessee (18.0%), and Florida (17.6%) represent states with the highest percentage of Black American residents as a percentage of their overall population (U.S. Census Bureau, 2019). Texas also makes the list of states that have not adopted Medicaid expansion. While Black Americans only represent 13.5% of the Texas state population, it still represents more than 3.9 million Black Americans, making the Lone Star state the largest population of Black Americans to lack access to the Medicaid expansion in the country.
COVID-19 Vaccine Equity
Lastly, the United States was reawakened to the issues of racial inequities last summer after the murder of George Floyd. We witnessed that Black Americans were 2.8 times more likely to die and 3.7 times more likely to be hospitalized by the coronavirus than their White, Non-Hispanic peers (Centers for Disease Control and Prevention, 2020). Since then, policy makers have been working hard to put in pragmatic solutions that can unwind systemic racism and root out implicit bias that can be found in our healthcare system. In fact, President Biden has not only nominated one of the most diverse cabinets to the Executive Branch (Tenpas, 2021), he also has issued various executive orders seeking to advancing racial equity and support for underserved communities through the federal government (Biden, J., 2020).
However, despite our best efforts, we have begun to get our first look at vaccine equity from around the country. During the first month of COVID-19 vaccinations in the United States, 12.9 million Americans received at least 1 dose of either the Pfizer or Moderna vaccine in over 64 jurisdictions around the country. 63% were women and 37% were men. 55% were 50 years or older. Race and Ethnicity was reported for 51.9% of the vaccines. Among that cohort, 60.4% were White and 39.6% represented racial and ethnic minorities, including 11.5% Hispanic/Latino, 6% Asian, and only 5.4% Black (Painter EM, 2021).
Even states as diverse as New York have felt the pain. Based on New York City Department of Health data, only 60% of patients provided ethnicity at the time of vaccination. Of those that did, Black New Yorkers have received half the share expected for them based on the city’s population make up. Specifically, Blacks make up close to 24% of New York City but only represent ~10% of those vaccinated (Pereira S, 2021).
What Can Be Done?
These statistics need to be further researched. However, hypotheses as to why this is happening have policymakers asking questions. For example, despite the best efforts of New York State, many vaccinations are only available through online appointments via an English only website that was not written at an 8th grade reading level. Right from the start, we begin to see barriers emerging that could hinder immigrant and low-income communities from accessing the vaccine. Additionally, many essential workers do not all have the same ability or wherewithal to work from home and refresh vaccine appointment websites searching for an open slot or leverage “bots” that can crawl through various websites locating vaccine appointments. Lastly, vaccine hesitancy due to mistrust of disinformation has caused some community vaccine locations in Black neighborhoods to see out of towners take up vaccination appointments while the community wrestles with whether to get vaccinated.
That is why at Healthfirst, we have created a dedicated unit that not only can answer questions about the COVID-19 vaccine but will also schedule appointments on behalf of our members and even arrange transportation for them if needed. We are also focused on bringing vaccines to the community by supporting local provider partners who are from those communities to supplement mass vaccination efforts. Healthfirst has provided volunteers to many COVID019 vaccination sites, including the new one recently opened at Yankee Stadium focused on Bronx residents.
This is just a few examples of how we use a health equity lens to look at the world around us. Personally, after several conversations over three months, I was elated to help schedule my 68-year-old mother for the Moderna vaccine last week. She is happy, doing well, and had little to no side effects after her first dose. She eagerly awaits her second dose later this month. Helping someone through their hesitancy takes time and takes patience. Their fears are real and should be validated. With love and patience, I’ve learned, they will slowly come around. Science always win.
There is Still Hope!
There are very few times in your life when you can make a monumental impact on someone’s life that will change both of you and will also help to alter the course of history. I believe in my heart of hearts, volunteering during this COVID Pandemic to help our fellow New Yorkers get vaccinated is one of those times. If you are ready, willing, and able to help, I encourage you to sign up and volunteer in your neighborhood. If you are unable to volunteer due to health concerns or have other issues, cheer on the men and women, who are essential workers, helping to fight the COVID outbreak in the field every single day and never have the opportunity to work from home. We are all in this together.
For more information on Health Equity, I will be a panelist on a free YMCA webinar on Addressing Racial Inequities in Health Care on February 23, 2021 at 3:30PM. For registration or more information, click here – https://ymcanyc.org/community-action
Biden, J. (2020, January 20). Advancing Racial Equity and Support for Underserved Communities Through the Federal Government. Retrieved from U.S. White House Briefing Room: https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/20/executive-order-advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government/
Centers for Disease Control and Prevention. (2020, November 30). COVID-19 Hospitalization and Deaths by Race/Ethnicity. Retrieved from COVID-19: https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html
Kaiser Family Foundation. (2020, November 6). Key Facts about the Uninsured Population. Retrieved from KFF: https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/
Painter EM, U. E. (2021, February 1). Demogrphaic Charateristics of Persons Vaccinated During the First Month of the COVID-19 Vaccination Program. Retrieved from Morbidity and Mortality Weekly Report: https://www.cdc.gov/mmwr/volumes/70/wr/mm7005e1.htm#:~:text=During%20the%20first%20month%20of%20the%20U.S.%20COVID%2D19%20vaccination,%25%20were%20non%2DHispanic%20White.
Pereira S, D. J. (2021, January 31). City Reveals White New Yorkers Have Received Lion’s Share of COVID-19 Vaccine Doses. Retrieved from Gothamist.com: https://gothamist.com/news/white-new-yorkers-triple-nyc-covid-19-vaccine-doses
Tenpas, K. (2021, January 13). Just How Diverse is President Biden’s Prospective Cabinet. Retrieved from Brookings: https://www.brookings.edu/blog/fixgov/2021/01/13/just-how-diverse-is-presidents-biden-prospective-cabinet/
U.S. Bureau of Labor Statistics. (2021, February 1). The Employment Situation – December 2020. Retrieved from Bureau of Labor Statistics: https://www.bls.gov/news.release/pdf/empsit.pdf
U.S. Bureau of Labor Statistics. (2021, January 21). Unemployment Rate – Black or African American. Retrieved from FRED – Federal Reserve Bank of St. Louis: https://fred.stlouisfed.org/series/LNS14000006
U.S. Census Bureau. (2019). ACS Demographic and Housing Estimates, Race Alone or In Combination With One or More Other Races – Total Population – Black or African American. Retrieved from United Stats Census Bureau: https://www2.census.gov/programs-surveys/acs/summary_file/2019/data/1_year_ranking/R0202.xlsx