>> Hello, and thank you for inviting me to join you today.
I'm Leandris Liburd, the Chief Health Equity Officer for CDC's COVID-19 response.
Today I will speak about the importance of addressing social determinants of health
and COVID-19 Related Racial and Ethnic Disparities and how policymakers
and healthcare organizations can leverage data to advance health equity.
CDC is working hard to address increasing COVID-19 health disparities,
and these considerations expand beyond the context of the COVID-19 pandemic.
These are the sections we will cover today.
I'd like to ensure we are grounded by key definitions
of health disparities and health equity.
We define health disparities as a particular type of health difference that is closely linked
with social, economic and/or environmental disadvantage.
Health disparities adversely affect groups of people
who have systematically experienced greater obstacles to health.
Before I begin, I want to give a little background
on CDC's Chief Health Equity Officer Unit.
To accelerate progress toward reducing COVID-19 disparities,
CDC established the Chief Health Equity Officer Unit in the COVID-19 response.
This is the first time in the agency's history that a senior leader was placed
on the Response Leadership Team with the sole focus of ensuring an all of response approach
to identifying and addressing health disparities.
The Chief Health Equity Officer's efforts align with the Department of Health
and Human Services strategy for racial and ethnic minority populations.
Efforts also emphasize CDC's long-term plan for recovery and resilience of social, behavioral
and community health to help CDC achieve its public health mission.
CDC is implementing four strategic priorities to reduce the disproportionate burden
of COVID-19 among populations at increased risk for infection, severe illness and death
and to broadly address health disparities and inequities related to COVID-19
with the holistic, all of response approach.
The CDC COVID-19 Health Equity Strategy is focused on immediate actions that can be taken
to respond to the COVID-19 pandemic and track intended outcomes.
For the duration of the pandemic, we will work to expand the evidence base
to increase our understanding of the impact of COVID-19 and the factors that led
to the disproportionate burden of COVID-19 in certain population groups.
We will provide resources and technical expertise to expand testing, contact tracing,
isolation or quarantine options and healthcare, reaching populations
that have been put at increased risk.
We are expanding intervention activities to support essential and frontline workers
to prevent transmission of COVID-19.
And we are increasing an inclusive workforce that is equipped to assess
and address the unique needs of an increasingly diverse population.
In order to achieve these priorities and objectives, we must apply a health equity lens.
What does this mean?
When framing health disparities and discussing public health implications,
it's important to use a health equity lens such that, when information is disseminated,
decisions are made about what to emphasize, how to explain it and what might be left unsaid.
When communicating about disparities, be sure to emphasize the value of ensuring
that everyone has an equal opportunity to be safe and healthy
and that reducing disparities contributes to the common good and benefits all.
Explain that disparities can be prevented by equitable programs, policies and services,
and recommend solutions or the need to develop innovative solutions.
Also consider the three bullets on this slide as you disseminate information.
Number one, consider systemic health and social inequities,
including some that have been introduced by federal, state and local policies
and have put some population groups at increased risk of getting sick from some illnesses,
having overall poor health and having worse outcomes when they do get sick.
Secondly, health equity is intersectional, meaning that individuals may belong
to several groups that have historically experienced discrimination and, therefore,
may have layered health and social inequities.
Such intersections must be further examined to better understand,
interpret and communicate health outcomes.
Thirdly, public health programs, policies and practices must recognize
and respect the diversity of the community they are trying to reach.
It's also important to distinguish between equality and equity.
Generally, equality is considered to exist when all individuals and groups
of people are given equal treatment regardless of need or outcome.
An equitable approach, on the other hand, focuses on more equal outcomes,
and recognizes that more disadvantaged groups may need more support or resources
to achieve the same health outcomes as disadvantaged groups.
In the picture on the slide, even though a stand has been equally made available
to each individual in the group on the left,
the outcome of watching the ballgame is not equitable
because not everyone can see over the fence.
For the group on the right, resources, in this case,
the stands have been allocated differently based on need
so that each person has an equitable outcome of having the same view of the ballfield.
It is well-established that some racial
and ethnic minority groups are more affected by COVID-19.
Factors that may contribute to this increased risk of getting sick and dying
from COVID-19 include discrimination, which includes racism, and can lead to chronic
and toxic stress and shapes social and economic factors that put some people from racial
and ethnic minority groups at increased risk for COVID-19.
Healthcare access and use refers to the fact that people from some racial
and ethnic minority groups are more likely to be uninsured than non-Hispanic whites.
Healthcare access can also be limited for some people due to other factors such as lack
of transportation, not having childcare or the ability to take time off from work.
There are communication and language barriers, cultural differences between patients
and providers and past as well as current practices
and healthcare systems that are discriminatory.
Occupation plays a significant role in this epidemic.
People who work in settings such as healthcare facilities, farms, factories, grocery stores
and public transportation are essential workers and, consequently,
have more chances to be exposed to the virus.
Educational, income and wealth gaps, inequities in access to high-quality education
for some racial and ethnic minority groups can lead to lower high school completion rates
and barriers to college entrance.
This may limit future job options and lead to lower paying or less stable jobs.
People with limited job options in many instances have less flexibility to leave jobs
that may put them at a higher risk of exposure to COVID-19.
And lastly, housing.
Some families live in crowded conditions
that may make it more challenging to follow prevention strategies.
It is also common in some cultural communities
for multiple generations to live in one household.
In addition, growing unemployment rates from the pandemic has led to greater risk of eviction
and homelessness and more sharing of housing.
Other health equity considerations include factors that influence access to or quality
of medical care during the pandemic.
And for many, these barriers existed prior to COVID-19.
Inadequate health insurance coverage is a major barrier to medical care,
and the unequal distribution of coverage directly affects health disparities.
Unreliable transportation also impacts the ability to access healthcare.
A lack of transportation contributes to patients, especially people at increased risk
of severe illness from COVID-19, missing medical appointments
and possibly disrupting their ability to purchase or refill medications.
When healthcare providers and other staff use language that is stigmatizing,
people are less willing to use even needed healthcare,
as the experience is alienating and not caring.
It is essential to be able to provide culturally and linguistically appropriate care
to all patients and their families.
What about data in health equity and the social determinants of health?
Data is needed to inform decisions related to the efficiency of services provided,
to identify areas that need improvement, to identify gaps and lessons learned.
CDC is aware of many of the challenges associated with effectively collecting data,
especially getting complete data or required elements such as race and ethnicity.
This is a big challenge for us but one we are committed to overcome.
We are studying this issue closely and coming up with strategies to address it.
One potential strategy to address completeness would be to provide training
for persons responsible for collecting demographic data that helps them know how
to probe for this information, how to explain the different racial and ethnic categories
and how to assure patients that sharing this information will not be used against them.
Other ways to measure and understand health disparities are to use a variety of data sources
and analytic methods and engage communities in the process.
Community engagement can help providers interpret findings in their analyses.
We can avoid perpetuating negative stereotypes or blaming people
for their own life circumstances or health status when reporting data
or information about health disparities.
The Chief Health Equity Officer Unit has been holding a series of listening sessions
since September 2020 with groups that serve historically marginalized communities.
The goal of these listening sessions is to collect qualitative data
to expand CDC's communication, outreach and partnership efforts
to ensure minority groups and rural populations receive accurate,
timely and culturally responsive COVID-19 outreach messages
and resources for prevention and control.
Based on these listening sessions, CDC is now working to create tools and resources
in response to these important community concerns
and feedback to build vaccine confidence.
We've shared a list of some key considerations provided by community members on this slide.
The Health Equity in Action web page showcases CDC's collaborative efforts
to address health disparities among populations at higher risk
for COVID-19 and advance health equity.
It identifies the populations of focus for CDC health equity activities.
It serves as a resource for partners, the media, policymakers and others interested
in CDC's health equity efforts during the COVID-19 response.
CDC is building more and more partnerships to accelerate vaccinations across the country.
CDC has already funded hundreds of organizations beyond the 31 Reach Programs currently funded.
We have established partnerships with national organizations
to address health disparities including but not limited to the National Urban League, the NAACP,
the National Minority Quality Forum, Unidos US and the National Medical Association.
We have partnered with pharmacies such as CVS, Walgreens and Walmart
to tailor messaging and outreach efforts.
We've developed an active social media presence to combat disinformation
and improve trust and confidence in vaccines.
And we've stood up a robust forum to share best practices and provide grantees
with community level data analytics.
We can achieve health equity working together.
Partnerships between trusted community based organizations and public health is essential
to effectively reach communities.
Review and put into practice CDC's guidance.
This includes promoting preventive measures such as social distancing, use of mask,
frequent hand washing and staying home when appropriate.
Share COVID-19 prevention information with communities using ways you know are effective
to connect with community members.
Connect people to healthcare providers and resources
to help them get the treatment and medicines they may need.
And hire people from the community to share COVID-19 prevention messages;
and link people to resources and free or low-cost services, including testing.
Reach out to the local public health department to offer to be a community testing site.
Provide a platform for information sharing, or share community insights.
Continue to work with area federally qualified health centers
to ensure community members receive seasonal flu as well as COVID-19 vaccinations.
A few additional things you can do right now include know where to go
for the latest accurate information on the COVID-19 vaccines.
Understand your organization's plan for vaccination.
Connect with your local public health department and ask how you can help.
And help carry the message.
You are a trusted source who understands your community best.
Engage with community partners to address vaccine hesitancy.
Here are a few resources I'd like to point you toward.
Thank you for the opportunity to talk with you today.