New Hope for Reducing Inequities in Health and Beyond

DIRECTOR’S MESSAGE

Welcome to the Winter 2021 edition of Health Equity Happenings, the Center for Health Equity’s digital newsletter.

Dr. Lisa A. Cooper, MD, MPH. Director of the Johns Hopkins Center for Health Equity and the Urban Health Institute, June 2020. Photo Credit: Johns Hopkins University.

The first year of the Biden administration has been an emotional rollercoaster for those of us working in the health equity world. I felt profoundly optimistic last January, when the newly inaugurated president acknowledged the existence of systemic racism and the persistence of white supremacy in American society. These acknowledgements seemed like an important first step toward addressing the health (and many other) inequities that burden people of color in America. An ambitious vaccination campaign was about to be launched. It seemed like COVID might finally be in the rearview mirror. 

Then came  the Delta variant, which disrupted everything, causing new spikes that persist and are driving new highs for hospitalizations. And now, we have yet another new variant. Omicron, which may be even more transmissible than Delta, and it is unclear whether this will lead to higher hospitalization rates and deaths here and around the world.

One bit of good news, however, is that the disparities that characterized the infection and fatalities in 2020 narrowed considerably in 2021, with deaths among Black and Hispanic persons tracking more closely with their share of the population. This improvement can largely be attributed to the uptake of vaccines in the US, where about 70% of the population has received at least one dose.  And strangely enough, it is in the white population where vaccinations are lagging—and in many cases, by choice.  CDC data indicates that of the people who are not vaccinated, 63% are white. Now unvaccinated persons, regardless of race, are being hospitalized and dying at higher rates than those who have been vaccinated. 

And the virus continues to kill, with 789,000 dead in the US, and nearly 5.3 million dead across the globe, including a great many in low and middle-income countries. 

Although disparities in the impact of COVID in the US have improved somewhat, we cannot forget that communities of color and those with low income across the globe have seen, and continue to see, disproportionate impacts compared to wealthier communities with a higher percentage of White persons.  

Well before the COVID-19 pandemic raised questions about the disproportionate burden of the virus on communities of color, the Johns Hopkins University Center for Health Equity had recognized that cultural, structural and individual-level racism made people of color more susceptible to chronic disease, and more likely to have worse outcomes, than their White counterparts. Racial and ethnic disparities in deaths caused by COVID mirror similar inequities in the impact of obesity, high blood pressure, diabetes, heart disease, and cancer. Correcting these kinds of inequities is precisely why the Center for Health Equity exists.

The Johns Hopkins University Center for Health Equity is at the center of the effort to build trust in scientists and health professionals among minority, poor and underserved populations here in the US and globally. Our researchers are working on innovative ways to provide health care to patients from underserved communities, ways that consider patients’ particular circumstances and experiences. CHE researchers are developing strategies to help patients overcome the limited food choices in their neighborhoods and improve their diets. We are testing whether home based blood pressure monitoring, aided by nurses and community health workers who understand the community context, is as effective as clinic-based care. By taking into consideration the unique circumstances of the patient, and by providing caregivers who look like the people they serve, we are learning that the trust of the Black, Latino and other disenfranchised populations can be gained and that we can support people in gaining power and control over their lives to improve health outcomes.

Thankfully, biomedical science has provided life-saving vaccines, and community-engaged public health research and  practice have yielded success with respect to vaccinations among minoritized populations. The possibilities of reluctance among Black, Latino, and Indigenous communities to get vaccinated were anticipated and answered with proactive interventions and education. We must use many of these same successful strategies, along with sound health and social policy, to address fallouts of the pandemic -- worsening health and social inequities and the related crises of mental illness, substance use, and violence.

Our work remains important. People--all people--deserve vaccines and other medical treatments that are safe and available to them. They also deserve opportunities to be healthy –housing, healthful food, education, gainful employment, and peaceful and safe neighborhoods . Inequities in our society have existed for over 400 years --but I believe that our collective consciousness has been raised over the past two years and that solutions will come as we continue to work together towards a common vision of health equity – one in which every person is valued and has the opportunity to attain their best possible health.

Lisa Cooper, MD, MPH

Director, Johns Hopkins Center for Health Equity
Director, Johns Hopkins Urban Health Institute
Bloomberg Distinguished Professor, Equity in Health and Healthcare, Johns Hopkins University Schools of Medicine, Nursing, and Public Health
James F. Fries Professor of Medicine, Johns Hopkins School of Medicine

CommunityLisa Cooper