Health Inequities – a Further Review

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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.

  1. 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.

 LatinxNative American/ Alaska NativeBlack/African AmericanWhite
Adult Uninsured Rate in Washington19%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  


A Call to Action – Racism and Health Inequities

Reading Time: 2 minutes

Skagit County Public Health is repulsed and outraged by the senseless killing of George Floyd. We wholly stand with the nationwide demand that those involved be called to justice. Systemic biases are prevalent in our society and harm people of color in numerous areas of their lives. Public Health is acutely aware structural racism impacts the health of many Skagitonians. Although health inequities often do not receive the same attention as violence against people of color, such disparities are just as deadly.

COVID-19 has laid bare the socio-economic disadvantages that people of color in our community face due to racism and inequity. Nationwide, Black Americans are dying from COVID-19 at three times the rate of white Americans. Last month in Skagit County, 75 percent of identified COVID-19 cases were members of the Latinx community.  These are just a few of many stark examples of how COVID-19 is disproportionately impacting communities of color and highlight the existing inequities in our systems.  Further, although the Centers for Disease Control and Prevention’s existing data does not indicate a disproportionate level of COVID-19 among Native Americans countrywide, there is undeniable evidence demonstrating racism severely affects the health of Native Americans. This reality is crucially important given that Samish Indian Nation, Sauk-Suiattle Indian Tribe, Swinomish Tribal Community and Upper Skagit Tribe are among the Skagit community.

Racism is a public health threat that cannot be ignored. These unacceptable injustices require action and real solutions.  We recognize and know that Skagit Public Health must intentionally strive to do better. Our mission is to serve all Skagit County residents and create positive health outcomes and living conditions for everyone.

We are making a commitment to equality, justice, and inclusion. We realize the answers to these issues are found from the wisdom and experience among our local Black, Latinx and Tribal communities.

With the support of our County Commissioners and Board of Health, we will establish an Equity Task Force lead by leaders within Skagit’s Black, Latinx and Tribal communities. Given the immediate threat of COVID-19, we will continue to focus coronavirus response efforts on assisting communities disproportionately impacted by the pandemic.

As we continue to move forward in service, we welcome guidance on ways we can do better. We ask for community feedback. You can reach us at 360-416-1500 or by email at health@co.skagit.wa.us