{"id":43904,"date":"2020-07-22T18:51:31","date_gmt":"2020-07-22T22:51:31","guid":{"rendered":"https:\/\/www.med.unc.edu\/medicine\/?p=43904"},"modified":"2023-06-06T17:56:43","modified_gmt":"2023-06-06T21:56:43","slug":"covid-19-and-health-equity-time-to-think-big","status":"publish","type":"post","link":"https:\/\/www.med.unc.edu\/medicine\/news\/covid-19-and-health-equity-time-to-think-big\/","title":{"rendered":"COVID-19 and Health Equity: Time to Think Big"},"content":{"rendered":"<figure id=\"attachment_43994\" class=\"thumbnail wp-caption alignright\" style=\"width: 310px\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-43994\" src=\"https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2020\/07\/cene-berkowitz-photo-300x251.png\" alt=\"\" width=\"300\" height=\"251\" srcset=\"https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2020\/07\/cene-berkowitz-photo-300x251.png 300w, https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2020\/07\/cene-berkowitz-photo-768x644.png 768w, https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2020\/07\/cene-berkowitz-photo-600x503.png 600w, https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2020\/07\/cene-berkowitz-photo-301x252.png 301w, https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2020\/07\/cene-berkowitz-photo.png 804w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption class=\"caption wp-caption-text\"><span class=\"discreet\">Crystal Wiley Cen\u00e9, MD, MPH, and Seth A. Berkowitz, MD, MPH<\/span><\/figcaption><\/figure>\n<p><a href=\"https:\/\/www.med.unc.edu\/medicine\/directory\/seth-berkowitz-md-mph\/\">Seth A. Berkowitz<\/a>, MD, MPH and <a href=\"https:\/\/www.med.unc.edu\/medicine\/directory\/crystal-wiley-cene-md-mph\/\">Crystal Wiley Cen\u00e9<\/a>, MD, MPH, from the division of general medicine and clinical epidemiology, and the Cecil G. Sheps Center for Health Services Research, are authors of a new perspective on health inequities, published today in the New England Journal of Medicine with <a href=\"https:\/\/www.bumc.bu.edu\/busm\/profile\/avik-chatterjee\/\">Avik Chatterjee<\/a>, MD, MPH, from the division of general medicine at Boston Medical Center, Boston University School of Medicine and Boston Health Care for the Homeless Program.<\/p>\n<p>The article recognizes that, in addition to health policy and individual-level efforts, social policy solutions are needed to advance health equity.<\/p>\n<p>\u201cThere have been terrible racial\/ethnic and socioeconomic disparities in outcomes related to COVID-19,\u201d Berkowitz said. \u201cWhile much discussion rightfully focused on how clinical care might improve these outcomes, we think it is also important to study, and improve, the forces that shape who is most vulnerable to COVID-19. This perspective is important because it focuses on public policy changes that could both improve COVID-19 outcomes and advance health equity.\u201d<\/p>\n<p>The authors emphasize how the pandemic has exposed structural racism, the social context (institution, practices, mores, and policies) that influence actions that result in different allocations of resources that increase inequities across racial groups. They identify two key lessons from the pandemic: public policy enables public health, and health equity requires big investments in public policy.<\/p>\n<p>\u201cTo address the 400+ years of structural racism in the US, we must move beyond implicit bias and cultural competency trainings to address the structures, policies, and practices that drive disparities,\u201d Cen\u00e9 said.<\/p>\n<p>In response, the authors advocate for thinking big, to reach beyond healthcare systems, and they suggest three actionable policy targets that can help to advance health equity and the response to COVID-19.<\/p>\n<p>First, food insecurity is known to be a health equity issue that disproportionately affects racial\/ethnic minorities and those with lower incomes and rural communities. Berkowitz has conducted a number of studies on health-related social needs and their effect on health outcomes, published in\u00a0<a href=\"https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/fullarticle\/2730768\">JAMA Internal Medicine<\/a>, the\u00a0<a href=\"https:\/\/www.med.unc.edu\/medicine\/berkowitz-study-recognized-in-washington-post\/\">Washington Post<\/a>, and the\u00a0<a href=\"https:\/\/www.nytimes.com\/2019\/12\/31\/upshot\/food-stamps-lower-health-care-costs.html\">New York Times<\/a>.<\/p>\n<p>Second, working conditions are patterned by race\/ethnicity, and precarious employment, low wages and lack of benefits undermine efforts to control the pandemic. The CARES Act (Coronavirus Aid, Relief, and Economic Security) has helped many of these issues; however, unemployment insurance expires in July, 2020.<\/p>\n<p>Third, community development is needed to provide quality affordable housing and advance health equity long-term by improving living conditions. The authors identify the Low-Income Housing Tax Credit and Community Reinvestment Act as key pieces of legislation that can address these issues.<\/p>\n<p>\u201cCOVID-19 has exposed the failures in our health care system, but also in our approach to public policy, in a tragic way,\u201d said Chatterjee. \u201cBut, we hope this tragedy provides an opportunity to reflect on our values as a society, and to re-envision public policy such that we can support resilience and promote equity even among the most marginalized communities in America.\u201d<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Seth A. Berkowitz, MD, MPH and Crystal Wiley Cen\u00e9, MD, MPH, from the division of general medicine and clinical epidemiology, and the Cecil G. Sheps Center for Health Services Research, are authors of a new perspective on health inequities, published today in the New England Journal of Medicine with Avik Chatterjee, MD, MPH, from the &hellip; <a href=\"https:\/\/www.med.unc.edu\/medicine\/news\/covid-19-and-health-equity-time-to-think-big\/\" aria-label=\"Read more about COVID-19 and Health Equity: Time to Think Big\">Read more<\/a><\/p>\n","protected":false},"author":69419,"featured_media":43994,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"layout":"","cellInformation":"","apiCallInformation":"","footnotes":"","_links_to":"","_links_to_target":""},"categories":[98,2],"tags":[629],"class_list":["post-43904","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-general-medicine","category-news","tag-629","odd"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>COVID-19 and Health Equity: Time to Think Big | Department of Medicine<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.med.unc.edu\/medicine\/news\/covid-19-and-health-equity-time-to-think-big\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"COVID-19 and Health Equity: Time to Think Big | Department of Medicine\" \/>\n<meta property=\"og:description\" content=\"Seth A. Berkowitz, MD, MPH and Crystal Wiley Cen\u00e9, MD, MPH, from the division of general medicine and clinical epidemiology, and the Cecil G. 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