Building a New Normal: Strategic Actions for Health Equity in a Post Pandemic World

People walking in a city with masks on.

 

Southeast Michigan has been hard hit by COVID-19, with Detroit and surrounding Wayne County experiencing the greatest number of cases and high mortality rates. Michigan's African American residents account for 32 percent of COVID-19 cases and 41 percent of deaths despite being only 11 percent of Michigan’s population. These disproportionate impacts result from long standing policies that increase risk of exposure and negative health outcomes.

African American, Latinx, and low-income Michigan residents are more likely to live and work under conditions that place them at greater risk of exposure. This includes “essential,” often low-wage jobs impossible to perform from home, limiting the ability to practice social distancing and other protective actions. African American and Latinx households are also disproportionately likely to have incomes below the poverty line. Racial inequity and poverty are linked to multiple chronic conditions such as hypertension and asthma associated with worse COVID-19 outcomes. This double jeopardy—a greater likelihood of infection combined with increased lethality of the infection—contributes to the emerging health inequities reflected in Michigan's COVID-19 numbers.

COVID-19 mortality has long-term negative effects on families and social networks. The death of family members alters family structures and the quality of relationships for surviving network members and increases social, economic, and physical and mental health risks that add to health disadvantages. Due to COVID-19, families and friends are unable to come together to mourn lost loved ones and comfort one another, compounding the grieving process.

Short-term measures enacted by local and state officials in Michigan, including moratoria on evictions and mandates to resume water service, saved lives and offered critical protections to vulnerable households. Extending and expanding such protections should become part of a longer term public health strategy to address racial, ethnic, and socioeconomic health inequities. Below we detail selected occupational, housing, and environmental protections toward that end.

Occupational Protections

  • Assure protections, including personal protective equipment and social distancing guidelines, for health care and other essential service workers.
  • Provide unemployment benefits, health insurance, and paid sick time for those unable to return to work. 
  • Assure financial respite and job protections for workers with caregiving responsibilities (for example, for children, elderly, those with disabilities).
  • When hotspots are identified (for example, meat packing industries), ensure that workers are able to remain out of harm’s way until protections are guaranteed.

Housing Protections

  • Provide rental assistance or emergency financial assistance to stabilize housing. 
  • Extend current moratoriums on evictions and foreclosures.
  • Assure housing for workers who become ill and must isolate themselves from family members.
  • Provide safe alternative housing for those living in crowded conditions.  
  • Once moratoriums are removed, allow a minimum of 60-day period for rent to be paid with no additional interest.

Environmental Protections

  • Ensure access to clean water for all, including those unable to pay and those reliant on well water. 
  • Require that the health impacts of industrial emissions be systematically assessed and considered in the permitting process.
  • Monitor emissions and enforce regulations for air pollutants with scientifically established adverse health effects, particularly in communities that experience disproportionate exposure. 
  • Provide incentives for more rapid conversion to clean energy, such as solar energy. 

In the post COVID-19 pandemic world, we understand in very fundamental ways that low-wage workers, once considered marginal, are “essential” to the continued functioning of critical infrastructure, health, and social care systems. Sustained protections for low wage workers can protect them from adverse health effects. The pandemic has also crystallized the critical role of housing and clean air to protect against the spread of the infection. Consistent with the reality of our "new normal," these protections are essential components of a public health strategy that values people as critical societal assets, recognizes the interdependence of all our communities, promotes racial, ethnic, and socioeconomic equity and is well-positioned to protect and sustain the health and well-being of Michigan communities.

About the Authors

Amy J. Schulz is professor of Health Behavior and Health Education at the University of Michigan School of Public Health

Roshanak Mehdipanah is assistant professor of Health Behavior and Health Education at the University of Michigan School of Public Health

Angela Reyes is the executive director of the Detroit Hispanic Development Corporation

Linda Chatters is professor of Health Behavior and Health Education at the University of Michigan School of Public Health and professor at the University of Michigan School of Social Work

Barbara Israel is professor of Health Behavior and Health Education at the University of Michigan School of Public Health

Enrique Neblett is professor of Health Behavior and Health Education at the University of Michigan School of Public Health


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