This statement was written by CHPHE faculty members, Akilah Dulin, Katie Biello, Diana Grigsby-Toussaint, Deborah N. Pearlman and Shira Dunsiger, and ODI staff member, Jai-Me Potter Rutledge

Acknowledgement: We would like to thank the Behavioral and Social Health Sciences doctoral students for bringing the need for this statement to the forefront.

As we are all aware, the COVID-19 pandemic has hit the United States (US) especially hard. As of May 6, 2020, there are 1,193,813 total cases and 70,802 deaths in the US, DC and US territories (1). Closer to home, the number of COVID-19 cases in Rhode Island is 10,205 confirmed cases and 370 deaths (2). 

Recent physical distancing and other COVID-19 transmission prevention strategies have helped states “flatten the curve” and lower worst case disease transmission estimates (3, 4); however, the pandemic has laid bare existing racial/ethnic health disparities (5). Although more than half (i.e., 54.2%) of total COVID-19 cases do not include racial data, where race is collected, 28.2% of COVID-19 cases are among Black Americans. When ethnicity data are reported (i.e., 41.6% of total cases), Hispanics account for 26.1% of COVID-19 cases. These rates are excessive relative to the population sizes of these racial/ethnic minority groups (1). In Rhode Island, Hispanic and Black Americans are impacted disproportionately by COVID-19 as well (44% and 13%, of confirmed cases, respectively) (2). 

Although some may attribute this disparate impact to individual choices and “non-compliance” to COVID-19 transmission prevention behaviors, we know that social determinants of health (e.g., racism, discrimination, poverty), and the intersections of these determinants, are the primary drivers of these disparities. For example, racial/ethnic minorities disproportionately make up those who are low-wage essential workers and thus are not afforded opportunities to stay home and shelter in place during this pandemic (6). Also, due to social determinants of health, racial/ethnic minorities experience other health disparities like obesity and hypertension, which are risk factors for greater COVID-19 symptom severity and mortality (6). Once ill, racial/ethnic minorities also do not have the same access to high-quality health care. Barriers to this access are due in part to lower levels of health insurance coverage, less access to top-tier medical services, and the “racial empathy gap,” where racial/ethnic minorities are less likely to be believed or given less medical intervention when they present with symptoms.

COVID-19 also leads to other health disparities for racial/ethnic minorities impacted disproportionately by COVID-19 morbidity and mortality. The disruptions caused by COVID-19 for people’s livelihoods, learning environments, and social networks are resulting in severe emotional, financial and mental health tolls, which may be particularly pronounced for Black and Hispanic communities. These challenges are especially deserving of recognition, understanding, support and action. 

We understand that there will be long-standing implications that will overwhelmingly affect these communities, inclusive of our own students, faculty, and staff. We know that these are difficult times that have created unprecedented struggles that we are trying to figure out how to work within. We recognize these challenges and understand that we are impacted differently given many facets of our identities. 

Although we have and are developing human capital and the capacity to improve population health within the School, the COVID-19 pandemic may still lead to feelings of helplessness and anxiety. We want to let you know that you are not alone in feeling this way. We want to highlight some of the things that we are doing in the interim to try to alleviate these feelings and contribute in some way to the discourse around COVID-19 health disparities. We are committed to continued conversations and efforts to address these ongoing needs. 

The Office of Diversity and Inclusion (ODI) is leading the charge by hosting discussions and convening steering committees around COVID-19. For example, just in the last few weeks, ODI hosted or co-hosted:

1. a Black maternal health event where they discussed COVID-19 health disparities;
2. a Learn and Engage around Diversity (LEAD) discussion on COVID-19 health disparities;
3. a conversation between the Dean and the School of Public Health Graduate Students of Color organization; and
4. a Diversity and Inclusion Action Plan steering committee meeting to discuss COVID-19.

More details about the work of the ODI are available at https://www.brown.edu/academics/public-health/diversity/home.

Within the Center for Health Promotion and Health Equity (CHPHE), faculty are working to address the health disparities surrounding this pandemic. For example, Dr. Grigsby-Toussaint is collaborating with other faculty within and outside of Brown to archive COVID-19 web data. Dr. Grigsby-Toussaint also launched several sites to track and disseminate information about COVID-19 health disparities; this information is available at https://www.socialimpactcovid19.com/ and @impactcovid_19. In her role as Health Policy Committee Chair in the Society of Behavioral Medicine, Dr. Dulin collaborated on The Society of Behavioral Medicine (Position Statement on Health Equity and the COVID-19 Pandemic). In this role, Dr. Dulin also oversees development of several other COVID-19 health disparity policy briefs and collaborates with other organizations (e.g., Physicians for Human Rights) to address COVID-19 disparities. Many of the Center faculty have been adding COVID-related measures to their ongoing research projects to rapidly and efficiently further the research on how COVID-19 is differentially impacting certain populations, including racial/ethnic minorities. More broadly, the Center faculty continue their critical work centered on addressing health disparities and social determinants of health, including many of the health conditions that put racial/ethnic minorities at higher risk of COVID-19 (e.g., obesity, healthcare access). Additional information about CHPHE is available at The CHPHE website and on the webpage of CHPHE affiliated faculty.

In addition to our roles as faculty and staff members, on a personal level, many of us have donated our time, skills, expertise and resources to our neighbors and communities and will continue to do so in the coming months. 

We will close out this statement by asking all of you to continue to support your fellow students, faculty and staff and commit to address racial/ethnic health disparities and/or social determinants of health in your own work, in a thoughtful manner that does not exacerbate health disparities or exploit vulnerable communities. By doing this, we hope to affect change so that we can mitigate substantially, racial/ethnic disparities today and in future pandemics.

References

1. Centers for Disease Control and Prevention (2020, May 6). Cases of Coronavirus Disease (COVID-19) in the US. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
2. Rhode Island Department of Health (2020, May 6). COVID-19 Data Tracker. https://ri-department-of-health-covid-19-data-rihealth.hub.arcgis.com/
3. Johns Hopkins University (2020, April 25). New Cases of COVID-19 in World Countries. https://coronavirus.jhu.edu/data/new-cases
4. National Public Radio (NPR) (2020, April 25). Are We Flattening the Curve? States Keep Watch on Coronavirus ‘Doubling Times’. https://www.npr.org/sections/health-shots/2020/04/10/829167659/are-we-flattening-the-curve-states-keep-watch-on-coronavirus-doubling-times
5. Sen-Crowe B; McKenney M and Elkbuli A. 2020. Social distancing during the COVID-19 pandemic: Staying home saves lives. American Journal of Emergency Medicine [ePub ahead of print]
6. Centers for Disease Control and Prevention (2020 April, 25). COVID-19 in Racial and Ethnic Minority Groups. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html