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COVID-19 and inequity — public health needs a third revolution

COVID-19 and inequity — public health needs a third revolution
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For many Americans, George Floyd’s murder ignited a new level of momentum to confront police violence against people of color. The COVID-19 pandemic — which is killing black Americans at nearly two and a half times the rate of whites — has put a spotlight on our nation’s shameful racial divide in public health. 

While the first and second public health revolutions vastly extended life expectancy by making strides against communicable disease (cholera, typhoid and dysentery) and chronic illness (heart disease and diabetes), racial gaps remain a persistent contributor to negative health outcomes.

In a nation with growing economic disparities, scarred by centuries of systemic racism, the third revolution in public health must address the root causes of our remaining pervasive health inequities — poverty, pollution, housing, food security and other basic needs. Also, because our systems have resulted in these issues disproportionately impacting communities of color, we need to conceive, develop and implement solutions that prioritize the wellbeing of people and communities that have been overlooked for far too long. 

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It’s a daunting task, to be sure. But, with an approach I call precision community health, we can target our limited resources to be effective at addressing the most urgent public health inequities, while also supporting the eradication of racism throughout our society. 

Investment is needed in public health systems, including state-of-the-art data collection and communications tools. With these we can collect granular data on everything from asthma rates to housing conditions and police violence, broken down by race and income. That data can then be transformed into knowledge to guide decision-making. 

We can leverage social media and other communications strategies to deliver precisely targeted messages to ensure people have information they need, when and where they need it, to make informed decisions for themselves and their loved ones.

We can also invest in people by creating a national Public Health Corps, similar to AmeriCorps. Recruitment could start with our country’s community health workers, our invaluable set of frontline public health workers who are already trusted members of the communities we serve today.

But importantly, these workers’ expertise and training can also build equity in communities today, by linking people to resources on housing, food security, employment and more.

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Community health workers are also uniquely positioned to have an immediate impact on the spread of COVID-19 by performing the critical task of contact tracing — reaching out to those who test positive for COVID-19, helping them identify others they may have been exposed, then supporting them through quarantine and testing. 

For any of our efforts to succeed, we must account for and honestly confront the distrust many people feel in our public institutions. In this time of massive societal upheaval, we have a tremendous opportunity to shift our focus and resources to fully embrace public health solutions. But our field will need to reckon with our own painful history of systemic racism to realize our full potential.

If we are to continue making the breakthroughs that improve and extend lives as public health has done for decades, we must embrace the moment we are in. It’s time to rethink public health by understanding the inequities that are making people sick and targeting resources where they are needed most. 

Bechara Choucair, a family physician by training, was commissioner of the Chicago Department of Public Health from 2009 to 2014. He is currently senior vice president and chief health officer at Kaiser Permanente and author of “Precision Community Health: Four Innovations for Well-being.”