This article was written by Judy Bankman and published by the Hood River News and The Dalles Chronicle on July 15th. Click here for the original article.
Health is not just about what happens at the doctor’s office. All health outcomes, from birth weight to blood pressure, are impacted by what are called structural determinants of health (SDoH). These are factors like income level, housing, food access, immigration status, race, ethnicity, sexual orientation and gender identity.
Structural determinants of health are the reason why the infant mortality rate among African Americans is more than twice as high as the infant mortality rate for white Americans. Because of this country’s history of racism, race actually determines health outcomes. Structural determinants are also the reason why communities without access to healthy, affordable food are more likely to suffer from diabetes, high blood pressure, or heart disease. Geography and food access can determine health.
As COVID cases continue to mount in Oregon, Washington, and throughout the country, we are seeing certain groups of people hit harder than others, largely because of structural determinants of health. The New York Times recently reported that Latinos and African Americans are three times as likely to become infected as white Americans.
Throughout Oregon, the Latino community has been disproportionately affected by COVID. According to the Oregon Health Authority, 36 percent of COVID cases are identified as Hispanic, while only 12 percent of the Oregon population identify as Hispanic. The data paints a similar picture in Washington.
The reasons behind this inequity are many, but not hard to understand. Hispanic (or Latino) individuals often have jobs where they are less likely to have paid sick leave or be able to self isolate. Many Latinos work in the food and agriculture sector, which is considered essential, and may have employers who do not provide appropriate protective gear or the ability to safely distance. What’s more, understanding the frequently changing COVID guidelines is difficult without plain-language translation.
The unequal impact of COVID is also influenced by immigration status and access to health care. For community members who are undocumented, going to the doctor or the emergency room can feel unsafe. For community members without health insurance, or with minimal coverage, accessing health care is cost prohibitive. Some of us simply cannot afford it, which means we don’t get it. A long history of housing segregation has also exacerbated COVID disparities, because people of color are more likely to live farther from hospitals.
Further, underlying health conditions have been shown to exacerbate COVID symptoms. Individuals who have diabetes, asthma, and obesity are more likely to have severe symptoms. Low income people and people of color are generally more likely to have underlying health conditions, making them more vulnerable to COVID. Even more disturbingly, people of color experience discrimination in the health care system more frequently than white people. This has cost lives.
So what do these health inequities mean? They mean the impact of COVID affects groups of people differently, and it is no accident. They mean that policymakers on the local and national levels need to understand the burden of COVID on vulnerable communities, including communities impacted by racism, and take action to support them. These inequities also mean that we in the Gorge can work with local policymakers and employers to make sure our community is safe. This might look like providing paid sick leave in industries that didn’t previously provide it, making sure social distancing is possible in the workplace, and ensuring everyone, regardless of race, feels welcome in the health care system.
Community leaders in the Gorge have been working to eliminate health inequities for a long time. For more than 30 years, One Community Health has advocated for social justice and provided health care to anyone who walks through the door. One Community Health makes the Gorge unique among rural areas, whose populations often experience lower access to health care.
Right now, local health departments, The Next Door, Inc., One Community Health, and other community partners, are all working to protect vulnerable communities, including the region’s seasonal farmworkers, through COVID testing, messaging in English and Spanish, and educating employers. As COVID cases rise and amplify existing health inequities, the work of our local nonprofits, medical providers, and public health officials is more important than ever.
Check out Esencial, a local campaign that recognizes and celebrates the hard and often unacknowledged work of our farmworker community members, on Facebook at www.facebook.com/esencialgorge.