Health Disparities Close to Home

Here in Massachusetts, we are fortunate to have top university researchers, some of the finest medical schools and teaching hospitals in the world, and a robust state system of public health.

But even a state like ours has faced an unprecedented challenge from COVID-19.

We had our first confirmed case of COVID-19 on Feb 1. Since then we have been working nonstop to address the local impacts of this pandemic across several key areas: increasing testing capacity; developing surge capacity in our health care system; doing disease surveillance, case identification, and contact tracing; and communicating and sharing information as we learn more about this new and evolving disease.

This pandemic is like none other any of us have seen in our lifetimes. Unfortunately, many of us now know someone who is sick or has lost someone to this illness. As of this writing, we have reported more than 90,000 cases and unfortunately more than 6,000 deaths since this pandemic began. It is difficult to comprehend this loss of life, and individual and family suffering that this virus is causing.

But we have been fighting back together. We took an early lead on testing and are working to expand the 10,000 to 14,000 tests we are conducting every day. We are the first state to put into place a statewide contact tracing initiative, reaching out to those who test positive and their close contacts to make sure they are following isolation and quarantine steps so as not to infect others. We worked hard with our healthcare partners to expand capacity in our health care system. Thankfully, we have started to see hospitalizations level off and a drop in the percentage of COVID-positive tests.

The progress we are making is reflected in the roughly 30-page daily dashboard the Department of Public Health posts online, reporting on cases by county, gender, age, race/ethnicity, hospitalizations, and trends over time. This dashboard is an example of a tool that can help inform and protect communities.

We have long known that data must drive public policy and response — whether to a contagious virus like COVID-19 or to any other disease. We know that smart actions stem from accurate, reliable data.

As we continue to dig into our data, we are beginning to see some trends that are at once alarming and yet not surprising.

We see clear disparities by race and ethnicity where Hispanic and black residents are bearing a higher burden of COVID-19 cases and deaths relative to their populations. In fact, here in the Commonwealth, eight of the top 10 cities or towns with the highest rates of COVID-19 have majority or near-majority non-white residents.

We see that black residents represent just under 9 percent of our state population, yet account for 15 percent of COVID-19 cases. We see that Hispanics represent 12 percent of the population yet account for 27 percent of cases. The highest rates of positive cases are among black and Hispanic people which are 3 times higher than the rate for white non-Hispanics.

Finally, when looking at COVID-19 deaths, where about half of race/ethnicities are known, we see the COVID-19 death rate is highest for black non-Hispanics.

Massachusetts communities which are already over-represented when it comes to the opioid epidemic, childhood asthma, heart disease, and hypertension are now among those bearing the brunt of this deadly virus. It’s disheartening that people most impacted are again our priority populations: communities of color, people who are housing insecure or experiencing homelessness, and people who are incarcerated. It should not be surprising that, like other diseases, a deadly pandemic highlights health disparities.

To help us put equity at the forefront of our COVID-19 response, we’ve assembled a Health Equity Advisory Group to inform our Department’s actions and initiatives. This group includes members of communities disproportionately impacted who are deeply committed to health and racial equity, and many who have a perspective of both content expertise and lived experience.

We are working hard every day to understand this pandemic and its effect on our Commonwealth and we intend to use this moment to redouble our efforts to address inequities in our healthcare system. We must ensure that marginalized communities are not denied the attention, care, and support all communities deserve.

From smallpox and cholera, to HIV and the opioid epidemic, and other public health issues such as tobacco and e-cigarette use, our state has always led the way when it comes to prevention, improving healthcare, and keeping people healthy.

In our response to a new disease, an unprecedented pandemic, we need to continue to come together as one medical, public health, and scientific community, not only to respond to the moment – but to pay attention to what we are learning and be ready for what comes next.

Monica Bharel is the Commissioner of the Massachusetts Department of Public Health.