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As the disparate impact of COVID-19 on NH minorities worsens, advocates call for solutions

​​​​​​​Granite State News Collaborative
Published: 5/19/2020 8:46:39 AM

It’s been over three weeks since the state first began to release data on the race and ethnicity of patients infected by COVID-19. Since then, the disproportionate impact on minority communities has apparently worsened and the state has expanded its monitoring to include statistics on hospitalizations and deaths.

But little has been done to mitigate the causes or effects of this disparity.

“It’s not that we don’t know about it. It’s ‘what do we do about it?’” said Rogers Johnson, chair of the Governor’s Council on Diversity and Inclusion.

On May 4, Johnson penned a letter to the governor on behalf of the council, expressing concern about the tale the existing data tells, as well as some gaps in what we know, such as the impact of the virus on American Indians in New Hampshire.

The council called for the formation of a state team “grounded in cross-cultural research methods” that would be charged with analyzing the data and coming up with a plan of action for addressing the disparate impact COVID-19 is having on minorities.

Days later, Gov. Chris Sununu addressed the matter at a daily press conference, saying he plans to set up a task force through the state Department of Health and Human Services to look at what the numbers are, how they compare to other states and what actions may be possible to remedy the situation.

“The Diversity and Inclusion committee, the council that we set up, have kind of looked at that and said ‘you know, we should really dig into it,’ and I said ‘absolutely,’” Sununu said at the May 8 press conference.

Solutions

According to the latest weekly summary, white people, who make up 90% of the statewide population, are a shrinking part of the COVID-19 patient population; weeks ago, they were 81%, and they now make up 73.7%.

Meanwhile, the share of cases among black, Latinx, and “other” ethnicities has grown, especially among Latinx (8.5%) and other races (9%), a group that includes American Indians and Pacific Islanders. People who identify as black or African American represent 5.7% of cases, while they make up only 1.4% of the state population.

All minority groups have experienced outsized hospitalizations and, so far, there have been three recorded deaths of Hispanic people and three deaths of other non-white people.

So, what can be done?

As was previously reported, the underlying reasons for the disparities are nothing new. They are the result of generations of systemic racism and socioeconomic barriers which have contributed to comorbidity factors among minorities, all of which predictably set them up at a disadvantage in any public health crisis.

In the long-term, Johnson, who also has a background in public health, said the solutions must revolve around providing better economic opportunity to minorities. Better pay and benefits means better educational opportunities for the next generation, which means even better jobs and so on. Those kinds of solutions take two to three generations to come to fruition, Johnson said.

“Those things take time, but we can start that process now,” he said.

But he said there are still things we can do in the short-term to help minorities during this pandemic. And those steps, Johnson said, can potentially put a dent in the overall impact statewide.

Right now, the state is providing priority testing and personal protective equipment (PPE) to certain at-risk populations like elderly people, first responders and frontline healthcare workers.

“But they need to go the step further to provide these services to the minority communities who are adversely affected by the disease,” Johnson said.

He said minorities are also an at-risk population, and the state should “surge” its capabilities in those sectors of the state where minorities are severely impacted. The more minorities who test positive and are quarantined, the more masks that become available in those communities (where some low-income individuals may not have easy access to masks), the slower the overall spread of the disease among minority communities will be, Johnson said.

He also said expanded outreach and education among minorities is key. The issue of the disparate impacts is not widely known within the black community, Johnson said. The more minorities in the state know about their risks and the steps they need to take to be healthy, the better.

Johnson said that effort should be part of a long-term campaign to educate low-income minorities on how to eat healthier and how to access healthcare resources available to them. The same is true for members of the LGBTQ community, he said.

Johnson noted in the council’s letter to the governor that they have heard reports of increased “extreme social isolation” among LGBTQ youth. He said LGBTQ individuals, who sometimes feel like outcasts of society, experience higher levels of physical abuse and have higher rates of addiction and suicide.

“They don’t view themselves as having any value,” Johnson said. “That’s one of the bigger problems, period. It doesn’t matter if it’s COVID or not COVID.”

He said the immediate solution is more communication; LGBTQ individuals need to be told they are valued and accepted as part of society. They need to feel they have access to resources.

Finally, Johnson said he supports a re-opening of the economy, with the necessary safeguards, in order to get vulnerable populations back to work.

People of color are far more likely than their white counterparts to have no choice but to work outside of their homes. As such, Johnson said employers should take steps to sufficiently protect their workers, which they already appear to be doing, he added.

Sen. Melanie Levesque, who represents Nashua, said she agreed with Johnson’s recommendations, and that testing, in particular, needs to become more widely available.

“I just think it’s important that there needs to be more widespread testing. For people of color yes, but for all people,” Levesque said. “And I think that we are working towards that. We just need to get there faster.”

Still, one of the biggest challenges the state faces is finding minorities who require resources, Johnson said. Unlike larger cities, or places like Chelsea or Lawrence, Massachusetts, which have a majority of Hispanic residents, New Hampshire has very few minorities and they’re spread throughout the state.

While some examples of urban congregation in the country are the unfortunate result of historical redlining and segregation, he said, they can be useful for public health engagement efforts.

“It’s easier for larger cities because the areas are more easily identified,” he said.

Pie in the sky?

There are myriad ideas on how to address the disparate impacts on minorities being floated in public health circles, not all of which will work in New Hampshire, Johnson said.

During a recent public webinar hosted by the American Public Health Association, experts from across the country presented a number of ideas on how to address the social and economic determinants of public health among vulnerable minority communities.

Jeanette Kowalik, commissioner of public health in Milwaukee, Wisconsin, said short-term and long-term supports are necessary, such as providing PPE to essential workers, hazard pay, reparations and free, high-quality healthcare.

She also suggested some safety nets would help such as suspending rents or mortgages, utility payments, providing food and monthly stipends and providing free or low-cost college education.

Johnson was skeptical that such steps would be feasible in a state like New Hampshire, especially considering what it would cost taxpayers.

“You’re just spreading the problem down the line,” he said.

Johnson supports creating more subsidized low-income housing, which would, in turn, help to prevent the overcrowding situation that many Latinx communities are now faced with. Those overcrowded living situations can contribute to the spread of coronavirus. Still, he said the issue has historically been a non-starter in the Granite State, because the state has always valued small government and increasing taxes to pay for affordable housing is unpopular among voters.

Cities

When you put some urban centers like Nashua under a microscope, the racial disparities during the pandemic become more pronounced.

While white people make up nearly 83% of the city’s population, they represent only 62% of COVID cases in the city, according to data recently posted on the Nashua Division of Public Health and Community Services website.

Latinx individuals are about 12% of city residents, and 3.9% of the state population, but they represent over 30% of the cases in Nashua.

Likewise, more than 25% of positive patients in Nashua identify as an “other” race, while only 7.8% of the Gate City population. And 8.7% of patients in the city are black, while only 3.7% of the city population.

Statewide, people who identify as Asian are still testing positive proportionate to their population of about 3%. In Nashua, they represent 7.8% of the population, but are only about 3.3% of positive cases.

The percentages for race and ethnicity data in the city adds up to more than 100% because some individuals identify as multiple races.

Manchester Health Department Director Anna Thomas said the department has requested city-wide data from the state to get a better picture of the situation on the ground, but has not received it as of May 15 and it may be delayed as the state transitions to a new database system.

Minorities living in Manchester who are symptomatic or part of a high-risk population have a number of opportunities to get access to free testing offered by companies like Rite Aid or by the Manchester Health Department at its permanent testing site at the National Guard Armory and at various mobile testing sites, Thomas said.

Thomas said the department is selecting locations for mobile testing where there are concentrations of at-risk individuals, including minorities, low-income people or seniors. In the coming days, the department will be setting up testing at low-income and subsidized public housing areas like Kelley Falls and Elmwood Gardens.

“We know that ... the health of the community is only as strong as the health of its most vulnerable residents,” Thomas said.

Thomas said the department is offering the mobile testing in part because some folks don’t have access to transportation.

Anyone, even uninsured individuals, can pre-register for the free testing (pre-registering is required to control crowd sizes and allocate sufficient resources). A culturally-sensitive and compassionate staff will be able to accommodate multiple languages and religious beliefs, Thomas said.

Ultimately, Thomas believes testing rates by race and ethnicity will provide a clearer picture of how well a community is reaching its minority constituents than just infection rates by race.

While they don’t yet know how well the testing has penetrated minority communities so far, Thomas said there are some anecdotal indications that ethnic minorities make up a significant portion of the people they’re serving during the coronavirus outbreak. For example, the department’s expenses for translation services has increased four-fold since the start of the pandemic, she said.

“Naturally, the city of Manchester is the most diverse community in the state,” Thomas said.

Still, Thomas said race and ethnicity are just a part of the bigger picture of the risk factors for COVID-19, which range from work and living conditions, other socioeconomic factors, age, pre-existing medical conditions and proximity to others who have tested positive.

While Thomas said she is casting a wide net to serve as many people as she can in the city, public health officials are also trying to provide a tailored approach to certain at-risk communities, including minorities. Having access to more stratified data that combines many of these factors would make it easier to target resources where they’re needed, Thomas said.

“It’s not just about race, it’s about people who are living in crisis,” she said.

Thomas emphasized that no one should skip testing because they are fearful of immigration enforcement.

“We are not asking anyone for their citizenship status or legal status,” she said.

Response

Johnson said the state was slow to collect race and ethnicity data in the early days of the epidemic, in part because leaders just didn’t think of it.

“In New Hampshire, it’s not something that comes to the forefront. The reason is, primarily, we’re not a diverse state,” Johnson said.

Now that a light has been shown on the issue, Johnson said he is optimistic Gov. Sununu will respond to it, though he recognizes the governor’s attention is being pulled in multiple directions every day.

“We will get there,” Johnson says. “It just takes time.”

The data the state has is still incomplete. When it first released numbers, it was only for 80% of the known COVID-19 cases.

As of the week of May 11, the latest statistics have race and ethnicity data on 72% of infections, 86% of hospitalizations and 61% of deaths. In other words, we know the ethnicity of 2,285 of 3,160 positive cases, 275 of 318 hospitalizations and 79 of 133 deaths.

These articles are being shared by partners in The Granite State News Collaborative. For more information visit collaborativenh.org.


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