COVID-19: A Fair and Just Recovery

A note from our director

two girls illustration photo

The COVID-19 pandemic is heaping untold suffering across communities and exposing the longstanding structures, policies and systems that have produced unfair differences in how long and well people live.

We must not look away. Rather, we must marshal our collective resources to create a future that leverages existing knowledge, accelerates implementation and catalyzes necessary innovations.  UWPHI pledges to “use what we have to do what we can” in this time of upheaval, uncertainty and loss.

Sheri Johnson

COVID-19: A Fair and Just Recovery

The UWPHI team is creating and curating must-read COVID-19 resources that focus on the social determinants of health and equity.

Our goal is to shape response and recovery strategies that lead to better health for all.  We hope to present diverse viewpoints on a balance of problems and solutions on issues aligned with our mission.  Our resources help clearly identify the root causes of the impacts of the pandemic on our communities.

We have organized these resources in the seven tabs below. The UWPHI Insights tab presents original material developed by members of the UWPHI team. We also share information from other sources about the Impact of COVID, various Responses to COVID, and Recovery steps.  We link to helpful sources for Data & Visualizations as well as General Information.  Finally, we describe our work with the Department of Health Services and the State Emergency Operations Center’s Community Resilience and Response Task Force (CRRTF).

Original discourse on COVID-19 created by the UWPHI team

Proposed LHIs are intended to reflect a balanced set of factors that contribute to overall health and drive equity. (Added 6/17/20)

UWPHI submitted written testimony to the U.S. House of Representatives Ways & Means Committee for a hearing titled “The Disproportionate Impact of COVID-19 on Communities of Color.”  The COVID-19 pandemic is heaping untold suffering across communities, especially communities of color. We cannot thrive as a nation when the factors that contribute to good health are available to some and denied to others. COVID-19 exploits structural racism, leading to a disproportionate impact on communities of color. We must marshal our collective resources to alleviate the disproportionate burden of COVID-19. (Added 6/11/20)

We must know who is being most impacted by COVID-19, but data must be released with context and explanation to help us understand inequity. (Added 6/3/20)

In the face of the COVID-19 pandemic, Milwaukee residents faced an imminent threat and cruel quandary: Vote in person and risk our lives. Don’t vote and lose our right to shape the future.

Public health pandemic responses should include automatic economic protection and swift relief for people already experiencing injustice.

Research by the UWPHI team

COVID-19 widens existing disparities that are deeply rooted within our social and economic systems. Even though anyone can be affected by COVID-19, it does not impact everyone in the same way. These resources ​acknowledge ​and describe that disproportionate impact.

By race and ethnicity

Data is preliminary, but points to coronavirus infection and death rates disproportionately effecting black people across the U.S.

One reason why coronavirus hits black people the hardest (Racial equity, environmental justice and COVID) (Added 6/17/20)

The over-representation of Black death reported in Detroit, Michigan is a case study for this argument. Racism and capitalism mutually construct harmful social conditions that fundamentally shape COVID-19 disease inequities. (Added 6/18/20)

In documenting Covid-19 racial disparities, it is important to contextualize such data with adequate analysis. Disparity figures without explanatory context can perpetuate harmful myths and misunderstandings that actually undermine the goal of eliminating health inequities. (Added 6/23/20)

Audio story (with transcript) featuring two Fellows from UWPHI’s Population Health Service Fellowship program (Added 6/23/20)

Rates of coronavirus infection among Latinos have risen rapidly across the United States. (Added 7/6/20)

Racial disparities across all age groups in COVID-19 cases and deaths can be linked to many factors, including non-remote workplaces, less space in the home, and access to testing and treatment. (Added 7/15/20)

This collection documents the experience of COVID-19 on Black communities in America. Its intention is to create a collective conversation of material for teaching and learning about the contemporary effects of COVID-19 among Black communities as it is tied to the historical legacy of race in America. Topics range from data, health, criminalization, housing, protest, gender and sexuality, labor, music, poetry, and diaspora. (Added 7/15/20)

Racism, not race, is the cause of many health disparities. Racist medical and public health practices persist today, leading to worse health outcomes for Black people. (Added 7/20/20)

By income

Income is a potent force along with race in determining who among the nation’s vulnerable, older population has been infected with the novel coronavirus, according to findings based for people on Medicare. (Added 7/6/20)

By gender

The COVID-19 outbreak, as well as Zika and Ebola outbreaks, disproportionately impacts females. Two-thirds of the global health workforce is female, females are the largest group of workers at risk to be laid off, and during isolation, women and children are at a greater risk of domestic violence. Post-crisis support needs to be multi-level and include women in decision making.

On rural communities

Rural communities throughout the U.S. have limited healthcare resources compared to urban areas. Many rural residents felt a sense of security that the virus would not reach their remote communities and were shocked when it did; feeling the impact much more intimately given the close knit, small town populations.

Rural populations are older and have higher rates of several chronic health conditions, and rural areas have a less robust health care infrastructure to deal with coronavirus cases. Rural economies may also be affected in different ways than their urban counterparts, which has implications for long-term rural population health outcomes.

On Native American communities

Strict regulations put in place as COVID-19 cases spike throughout the Navajo reservation including check-points, curfew, and patrols. Factors like limited running water, pre-existing health conditions, indoor pollution, and multiple generations living in the home are thought to have impacted the spike in cases. Frustration over barriers to federal emergency funding and resources for tribal nations is being echoed across the U.S.

Nearly 500 tribal casinos remain shut down during the pandemic, causing job losses to spike. The economic damage is spreading quickly, wreaking havoc on fragile tribal finances.

On other types of communities

For the poor and disenfranchised, many social determinants of health are expected to worsen during the COVID-19 pandemic and in its aftermath, namely, employment, housing, food, education, and health care. Public health professionals and policy makers need to proactively work with community partners to influence policies and other relevant sectors to ensure that health inequities do not intensify for the most vulnerable in our communities. (Added 6/18/20)

This is a critique of white urbanist discussions that are very prevalent in media. (Added 6/23/20)

For more than two decades, Roberto Valdez has harvested crops in California’s eastern Coachella Valley… An undocumented immigrant, he is not eligible for federal relief during the Covid-19 pandemic, but while millions of people shelter in place, he continues to work in the fields with his wife. Here he tells about his life as an essential worker. (Added 6/23/20)

On different types of facilities

Huge turnover in jails, which are not designed to support social distancing and are nearly impossible to limit person to person contact, are seeing growing infection rates inside the jails and in the neighboring communities. Call for jails to take steps to mitigate infection, some have, many haven’t.

Meat processing plants throughout the Midwest and Wisconsin have become hotspots for outbreaks of COVID-19. A safety expert talks about why these workplaces are seeing an uptick in cases and what could be done to mitigate the spread of the disease.

On those with disabilities

Richard Besser (President of the Robert Wood Johnson Foundation) and Rebecca Cokley (Director of the Disability Justice Initiative at the Center for American Progress) discuss oversights in paid family leave policies, services, and prescription drug support are putting strain on people with disabilities and caretakers. Concerns grow over “othering” and discussions over the rationing of care. Call for better planning and protocols for people with disabilities in emergency response.

On patients without COVID-19

Lisa Rosenbaum, MD, writes about changes in medical protocols have led to treatment modifications, especially those undergoing treatments resulting in immunosuppression, ex: cancer treatments. Shift in health priority has stalled other clinical trials and strained resources for non-COVID-19 patients.

On other considerations

Outlines key considerations for ongoing need to push for affordable, quality health care coverage; well-trained, diverse health care and medical research workforce; and accessible sources of care for all. Provides recommendations for immediately addressing needs of those who are most vulnerable.

COVID-19 and policy responses/ protocols are bringing to light new vulnerabilities for people/groups who were not considered vulnerable before COVID-19 and exacerbating already existing inequalities. A one-size-fits-all model is not appropriate for all members of society.

  • Beyond sex and gender analysis: an intersectional view of the COVID-19 pandemic outbreak and response (from the University of London Global Policy Institute).

A UK policy brief brings attention to the multiple intersecting factors that underpin the impact of the outbreak, encouraging us to go beyond analysis along single dimensions, such as gender and race and to incorporate other axes of disadvantages and inequalities.

The coronavirus has created new tensions. Staying at home has worsened abusive situations. Shelters worry about the spread of the virus.

It is impossible to ignore the obscenely and grotesquely disproportionate impact that the virus has on the health of some of us… But no geneticist is suggesting that genetic differences are an important part of the explanation for why the virus impacts different social groups differently. Rather, it is a truism that those different impacts are due to the different social conditions to which different groups are exposed. [Genetic medicine] will not reduce, much less eliminate, the health disparities that are produced by the unjust social conditions that are so excruciatingly obvious in our current crisis. (Added 6/23/20)

Learn how Wisconsin and others across the nation have responded to the COVID-19 pandemic with strategies and solutions that focus on promoting health equity.

Data reporting:

There is a call for more transparent data on the impacts of COVID-19 on vulnerable populations. Article provides interactive maps that explore the extent to which all 50 states and DC are reporting data breakdown by age, gender, race, ethnicity, and health care workers for both case of and deaths from COVID-19.

Social Distancing, Stay At Home Orders, and Re-opening

Learning from the great Chicago heat wave of 1995, this article discusses how social connections can be the difference between life and death in times of health crisis.

Social distancing and staying at home are not privileges that everyone has. This article calls to attention disparities between race and income when it comes to COVID-19 infection and death rates, as well as peoples’ ability to work from home, or social distance.

Reopening economies is a dynamic process. This article provides updated information on what steps each region of the U.S. is taking to reopen economies while also protecting public health.

This is the full email by Dr. Gregory Gelembuik (a UW-Madison scientist) to city and county elected officials showing why reopening now is not a good idea. The letter contains four main topic areas. 1. Reopening now is very ill advised. 2. The reopening criteria for the Forward Dane plan are severely flawed and lack an adequate basis in science. 3. The types of sites allowed to reopen and the types of events permitted under the Forward Dane plan are very problematic. 4. There is a way to reopen safely. (Added 6/23/20)

Contact Tracing

Experts say disease contact tracing is needed in order to lift coronavirus lockdowns. Here’s what that is and what it will look like.

Cloth Masks

Published on Streets Blog in response to aggressive enforcement of social distancing and mask rules.

From the Conversation, written by a scientist from the University of San Francisco. Discusses the evidence and likely results from mask-wearing.

Business

Commentary from US News and World Report. By investing in efforts to address inequity, business leaders can make a lasting difference on community well-being.

From Fast Company. “The fact that we have this enormous fraction of the population, which is living pretty much right at the edge, and now threatens to go right over it, is no longer something that [companies] don’t have to worry about. It’s right here.”

Other Strategies:

Blog series about policies that can be enacted right away to help communities and local governments strengthen their response to COVID-19 and advance health equity. This article covers equitable enforcement of physical/social distancing measures.

A public health approach to preventing violence is ever more important: we need to examine the data, put community members in the lead, and work across sectors.

Where one lives, race, and income have implications for a person’s opportunity for a healthy life and the coronavirus will continue to illuminate inequities. This article provides recommendations for ways to address historic inequities, and urges us to use this time as an opportunity to protect communities.

Rural communities receive a disproportionately small share of foundation grants, only five to six percent. This lack of capital and associated business development capacity outside of urban areas contributes to widening income inequality.

COVID-Local and the Frontline Guide are a joint project of the Global Biological Policy Program at the Nuclear Threat Initiative (NTI), the Center for Global Development, and the Georgetown University Center for Global Health Science and Security, in collaboration with Talus Analytics. Developed by a team of experts and former public health officials, in consultation with current state and local officials about the key issues they face. Its focus is on providing information for both slowing and suppressing the spread of the virus, and also on supporting community needs.

The Wisconsin Federation of Nurses and Health Professionals calls for employers to keep employees safe, and this matters to all of Milwaukee.

From Untokening. Untokening curated the Principles of Mobility Justice from the experiences of advocates, practitioners and community members from marginalized identities across the country to outline recommendations for mobility justice that are rooted in the liberation of our communities. In response to the current pandemic, their network convened a virtual conversation to share reflections and recommendations for mobility justice in the COVID-19 world.

Editorial from JAMA, by David Williams and Lisa Cooper. The striking racial/ethnic disparities reported for COVID-19 infection, testing, and disease burden are a clear reminder that failure to protect the most vulnerable members of society not only harms them but also increases the risk of spread of the virus, with devastating health and economic consequences for all.

From The Atlantic. What’s happening is not one crisis, but many interconnected ones. The historical legacies that have shaped today’s patchwork will play out in these crises — and in our responses — in ways that could unite or divide us. (Added 6/17/20)

From the Journal for Health Politics, Policy and Law. This piece (by Alberti, Lantz et al) proposes a health equity framework for pandemic preparedness and response that recognizes the fundamental causes of social and health inequity while focusing on the upstream, midstream, and downstream effects of policy. (Added 6/23/20)

From the Guardian. “Already one lesson of the pandemic is clear: America’s deep and brutal fault lines – of race, partisanship, gender, poverty and misinformation – rendered the country ill-prepared to meet the challenges of this disease.” (Added 6/23/20)

From Stat News. Had U.S. leaders taken the decisive, early measures comparable to S. Korea, Australia, Germany, and Singapore, between 70%-99% of COVID-19 deaths in the U.S. would have been prevented. (Added 6/23/20)

From Project Syndicate by Jeff Sachs. High inequality undermines social cohesion, erodes public trust, and deepens political polarization, all of which negatively affect governments’ ability and readiness to respond to crises. This explains why the United States, Brazil, and Mexico account for nearly half of the world’s reported deaths since the start of the pandemic. (Added 7/6/20)

Trust for America’s Health (TFAH), reviews steps the federal and state governments have taken to ensure students’ access to healthy meals when schools are closed and what needs to be done to ensure continued meal access as all school systems face uncertainties about how to safely reopen for the 2020-2021 school year. (Added 7/27/20)

From the Harvard Kennedy School’s Ash Center. (Added 8/3/20)

From the Harvard Kennedy School’s Ash Center. (Added 8/3/20)

As we recover from the pandemic, let’s come together and learn from one another: how can we restructure our world into a better place, one that is more just and equitable? Here’s what recovery can look like.

Historically, recovery efforts have not deliberately tried to solve for issues facing low-income communities and communities of color. To navigate through COVID-19, the nation should follow the Common-Sense, Street-Smart Recovery principles of center racial equity, put people first, invest in community infrastructure, build equitable economy, and protect and expand community voice and power.

The outbreak is revealing compounding inequities, but also providing an opportunity in that policymakers are frantically willing to try new solutions that were seemingly unachievable before, in order to protect our most vulnerable populations. This article discusses relief measures being preserved and improved for systemic changes beyond the crisis period.

Article outlines considerations for employment, education, and the racial wealth gap that policymakers should take into account as they prepare to for recovery from COVID-19. Considerations are meant to help the country recover in a more resilient way that reduces racial disparities.

The pandemic presents many challenges, but there is also an opportunity to galvanize Americans for change – similar to the New Deal during the Great Depression. However, in the current political climate and upcoming elections make imagining and drafting a “New New Deal” difficult.

UN Secretary-General warns of the approaching “point of no return” for the climate crisis and proposes climate-related actions to shape COVID-19 recovery.

From StatNews. As epidemiologists attempt to scope out what Covid-19 has in store for the U.S. this summer and beyond, they see several potential futures, differing by how often and how severely the no-longer-new coronavirus continues to wallop humankind.

Opinion by Todd May. Our obligations to one another won’t end when this crisis does.

From the Robert Wood Johnson Foundation. Health equity principles for communities to consider in designing and implementing their responses so they can recover fully. These principles provide a compass that points leaders toward an equitable and lasting recovery. (Added 6/17/20)

From Center for Health Equity Action for System Transformation at Families USA. Along with recommendations for changes in Medicaid and health insurance, this report also addresses some social determinants of health. (Added 6/17/20)

From the Fast Company. From postal banking to Medicare for All to baby bonds, this series of proposals to build our way out of the recession would also help build generational wealth in communities that have been shut out of opportunities. (Added 7/6/20)

From the Black to the Future Action Fund. COVID-19 has exposed the connection between rigged rules and their impacts: Black people are infected at higher rates, and comprise the majority of deaths from the disease in many cities across America. We need a plan for Black communities that protects families, provides access to needed care, and that builds new infrastructure to address current crises. The Black Agenda 2020 is a roadmap for making Black people powerful in all aspects of their lives. (Added 7/6/20)

From the Atlantic. Public health seeks to maximize health and equity across many domains — supporting racial justice and anti-police-brutality protests in a pandemic is aligned with public health ethics and science. (Added 7/6/20)

 

 

Find helpful local, regional and national sources for data, dashboards, and visualizations on COVID-19.

From the University of Chicago and partners (including the County Health Rankings). The U.S. COVID-19 Atlas is a county-level clustering surveillance tool to provide quick access to county-level COVID-19 estimates, longitudinal exploration, and cluster detection.

From the Johns Hopkins Bloomberg School of Public Health. The COVID-19 pandemic is a complex phenomenon but models can be useful. Here are tips for making sense of COVID-19 models for decision-making.

From FiveThirtyEight. A laypersons guide to how epidemiologists construct COVID-19 models

From the New England Journal of Medicine. Some models with apparently conflicting conclusions have received substantial press coverage, giving the impression that mathematical models are in general unreliable or inherently flawed. But infectious disease modeling is an expansive field with a long history, encompassing a range of methods and assumptions that are not necessarily directly comparable, or even designed for the same purpose.

From the US Census Bureau

From ColorLines published by Race Forward. In addition to wildly differing protocols at all levels of government, the fact remains: Science and data collection are anything but neutral.

From the Vox Video Lab. This video shows how to read a popular chart of coronavirus cases by country.

Opportunity Insights is based at Harvard University, where a team of researchers and policy analysts work together to analyze new data and create a platform for local stakeholders to make more informed decisions. Combines anonymized data from private companies to provide a real-time picture of indicators tracking the impact of COVID-19, such as employment rates, consumer spending, and job postings across counties, industries, and income groups.

Published in Medium by the Pew Research Center. This post walks through some of the differences in the data available from three widely used sources of information related to the geographic progression of the coronavirus outbreak.

From the Harvard School of Public Health. This describes how to use the methods of the Public Health Disparities Geocoding Project to Monitor COVID-19 Inequities and Guide Action for Health Justice

Comparing recent totals of deaths from all causes can provide a more complete picture of the pandemic’s impact than tracking only deaths of people with confirmed diagnoses. In nearly every state with an unusual number of deaths in recent weeks, that number is higher than the state’s reported number of deaths from Covid-19. Epidemiologists refer the gap between the observed and normal numbers of deaths as “excess deaths.”

From the Harvard Business Review. Incomplete or incorrect data can muddy the waters, obscuring important nuances within communities, ignoring important factors such as socioeconomic realities, and creating false senses of panic or safety.

From the Urban Institute. These data track losses of low-income jobs, defined here as jobs with annual earnings below $40,000, but exclude some workers, such as independent contractors and those working in the gig economy.

From a scientist with UW-Madison’s Applied Population Lab. COVID and physical distancing explained through gaming (Added 6/17/20)

From the Atlantic. A regularly refreshed dashboard offering disaggregated COVID data alongside corresponding population data for each racial or ethnic group and flagging where racial disparities are likely, given data limitations. (Added 6/23/20)

This is a collection of over 100 COVID-19 policy trackers and datasets in the areas of non-pharmaceutical interventions, economic and social policy responses, public attitudes, politics and media coverage (compiled by Lucas Lehner of University of Oxford). (Added 6/23/20)

From Emory University. Interactive map with every county in US depicted. Can compare your county to state and to nation based on COVID-19 cases, deaths, and risk factors (obesity, diabetes). Includes % of population that is African-American. (Added 6/23/20)

From Our World In Data (University of Oxford). Country-by-country data on confirmed COVID-19 cases. (Added 6/23/20)

From NPR. Researchers at the Harvard Global Health Institute are leading a collaboration of top scientists at institutions around the country who have joined forces to create a unified set of metrics, including a shared definition of risk levels — and tools for communities to fight the coronavirus. (Added 7/6/20)

The Household Pulse Survey is designed to deploy quickly and efficiently, collecting data on a range of ways in which people’s lives have been impacted by the pandemic. Data will be disseminated in near real-time to inform federal and state response and recovery planning. (Added 7/6/20)

The Community Resilience and Response Task Force (CRRTF) is a partnership between the Wisconsin State Emergency Operations Center – Future Operations Branch and the UW Population Health Institute. In partnership with Resilient WI (DHS), UW Extension, and Governor’s Office Staff, the Task Force aims to integrate concepts of community resilience, equity, and mental health across the COVID 19 pandemic response and set the stage for changes to policy and systems that ensure every Wisconsin community reaches its full health potential. The objective is to strengthen individual and community resilience of groups vulnerable to disproportionate harm by the pandemic. The Task Force’s work is done by enhancing diverse partnerships and connecting groups to public health expertise, resources, and support.

Resilient Wisconsin

Trauma and adversity can make it difficult to take care of yourself and the people around you. Learning ways to cope with, and recover from, tough times in healthy ways is the heart of building resilience. Resilience matters to COVID-19 response and recovery efforts. Building resilience in communities is a complex challenge; there is no one-size-fits-all approach.

In April, DHS launched Resilient Wisconsin, a statewide initiative designed to provide Wisconsinites with tools to build resiliency. When we build resilience and find ways to cope with life’s challenges, we take a step closer to a healthier future for us all.

The CRRTF is working with a wide range of community partners, advocates, and health practitioners to identify and promote changes to policies and systems to ensure everyone in Wisconsin can reach their full health potential. The team is currently prioritizing sectors that are working on strategies to protect vulnerable groups, including people in jails and prisons, people living with a disability, older adults, people  with language barriers, and people with housing and food security issues. This team is also working on strategies to support the needs of health care workers and other essential workers during this pandemic.

CRRTF has focused on building relationships with and addressing concerns from spiritual advisors, law enforcement and first responders, community health care workers, incarcerated populations, mental and behavioral health professionals, domestic and interpersonal violence advocates, migrant workers, rural residents, communities of color, and long-term care providers.

Tools and resources developed or supported by partnership with CRRTF