June 15, 2020, Skagit County Public Health issued a press release and a call to action on racism and health inequities. We wanted to provide some additional information and context about that call to action. Examining health disparities and inequities is not new to Skagit County Public Health or the Population Health Trust, which is the community advisory committee that guides the department’s health assessment and planning. The Population Health Trust adopted a vision for health equity that guides this work:
“Health Equity means that everyone in our community has a fair and just opportunity for healthy living. This requires that we address and remove barriers to individual and community health that arise from poverty and discrimination (whether based on race, education, gender identity, sexual orientation, job status, housing status, or disability) that result in compromised health and powerlessness, and are often derived from lack of access to: good jobs with fair pay, quality of education, healthy housing, nutritious food, safe environments and active lifestyles, and quality health care.”
The COVID-19 pandemic has highlighted deep-seated inequities that are impossible to ignore. We are still learning about these impacts, but four immediate examples include: a disproportionate share of COVID-19 disease burden among communities of color, unequal healthcare access, employment circumstances that disadvantage some groups compared to others, and an unequal social safety net.
- Disproportionate COVID-19 Disease Burden
In May, 75% of identified Skagit County COVID-19 cases were from members of the Latinx community, even though the group represents only 18% of the county’s population. We know that there are consistently higher rates of infection in communities of color throughout Washington State and nationally. According to the Washington State Department of Health, 37% of the people diagnosed with COVID-19 are White, while 68% of our population as a whole is White. Statewide, members of the Latinx community make up 13% of the population but represent 43% of the people diagnosed with COVID-19. This is a clear and indisputable health inequity. As is noted below, primary reasons for this inequity include unequal healthcare access, differences in employment circumstances and an unequal social safety net.
- Unequal Healthcare Access
Sadly, although communities of color are most impacted by COVID-19, those same communities are less likely to have health insurance and access to medical care. As the table below illustrates, the uninsured rate for Latinx adults in Washington State is nearly four times the rate of White residents. Native Americans and African Americans also are less likely to have health insurance compared to White residents.
| Latinx | Native American/ Alaska Native | Black/African American | White | |
| Adult Uninsured Rate in Washington | 19% | 17% | 11% | 5% |
- Differences in Employment Circumstances
In Skagit County, workplaces are a major source of COVID-19 spread. Many people take for granted that their jobs offer them the ability to work from home or take time off when they are sick. Frontline workers face tough economic and health choices, and there are stark racial differences in employment situations. Many of these workers were laid off while others continued in essential services that involve a high degree of interaction with others and consequently place them at greater risk for COVID-19 infection.
Nationally, nearly a quarter of employed Latinx and African American workers are employed in service industry jobs compared to only 16% of White workers. Also, Latinx workers account for 17% of total employment but 53% of agricultural workers. In Skagit County, where agriculture is such an important part of the economy, Public Health is working with the farming community to foster safe working conditions for farmworkers.
4. Unequal Social Safety Net
The coronavirus crisis is not just a pandemic; it is also an economic crisis. Unfortunately, we do not have a social safety net that helps everyone equally. Many non-citizens did not qualify for the federal stimulus checks. Even citizens married to non-citizens were locked out of these payments. Children who live in mixed immigration-status households were also penalized and no one in their family received a stimulus payment.
Millions of people lost their jobs, including people whose presence in the US is based on a temporary visa, and some workers find themselves in limbo where they do not qualify for unemployment payments and cannot seek new work. The process to receive unemployment benefits is confusing for people with limited English skills, who work non-traditional or ‘gig economy’ jobs, or for people who are self-employed.
These are just a few of the health equity issues that have become more apparent during the COVID-19 pandemic, and this just scratches the surface of health equity issues in our community. We know there are similar inequities in chronic disease rates, educational outcomes, housing, and other economic segments of our community.
Skagit County Public Health and the Population Health Trust will continue proactively exploring these and other health equity topics. In response to the current crisis, this process will start with listening sessions where Public Health will reach out in consultation with the communities that are most impacted.
Sources
Skagit County Race & Ethnicity Data from US Census 2018 American Community Survey 5 Year Estimates, https://data.census.gov
Kaiser Family Foundation estimates for uninsured (nonelderly) adults based on the Census Bureau’s American Community Survey, 2008-2018: https://www.kff.org/statedata/
Viruses don’t discriminate, But We Do, Washington State Department of Health, June 19, 2020: https://medium.com/wadepthealth/viruses-dont-discriminate-but-we-do-fcec9758c18f
Labor Force Characteristics by Race & Ethnicity, 2018: https://www.bls.gov/opub/reports/race-and-ethnicity/2018/home.htm