Black people continue to be a group with one of the highest risks of COVID infection in the U.S. But from city to city, this disparity has emerged at different times in the pandemic and has taken on different forms.
Take Allegheny County, Pa., where Pittsburgh is located. Early in the pandemic, the overall number of infections and hospitalizations, including racial differences, were modest—until they weren’t. Hospitalizations of Black people eventually rose and stayed high, even as the racial disparity in infection rates between Black and white populations across the U.S. slowly decreased from three times as many infections to 1.3 times.
Like many American cities, Pittsburgh is racially and economically segregated, and it has been referred to as “America’s apartheid city.” Systemic disinvestment by all levels of government has created conditions that exacerbate disparities in health, employment, access to transportation, food, affordable housing and quality education. For example, in the city, the average life expectancy in the neighborhood with the lowest life expectancy (which is predominantly Black) is 62 years, compared with 84 years in the neighborhood with the highest life expectancy (which is predominantly white).
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Much of the area’s Black population holds many of the highest COVID exposure risks, including hourly jobs that require constant contact with people. It was inevitable that the disease would strike, and strike hard, among this population particularly in economically disadvantaged neighborhoods.
A group of us, including the authors of this article, recognized that Pittsburgh’s institutions—among them its public health, health care, academic, governmental and philanthropic institutions—have rarely addressed the city’s challenges through a lens of racial equity. We had little faith that the COVID pandemic would be any different. So we established the Black Equity Coalition (BEC), a Black-led coalition of community advocates, funders, public health scientists and physicians from multiple sectors in Pittsburgh. Our goal was to build a socially just and equitable response to the pandemic.
While our work is ongoing, our early successes make us hopeful that our community-wide effort can serve as a blueprint for a local, racially-sensitive and equity-minded action in preventing not just the spread of communicable diseases but reducing other health disparities.
Since it first convened in the spring of 2020, the BEC has developed public information and communication strategies for traditional media and social media outlets. We have spoken directly to residents and made sure that the messages, stories and people in our public service ads were genuine and provided unscripted concerns. We have ensured that our communications were respectful of the legitimate fear and mistrust that Black people have of public health and government institutions while also conveying the seriousness and threat of the deadly virus.
We took data on COVID from local sources in Pennsylvania, such as the Allegheny County Health Department and the Pennsylvania Department of Health, and determined the accuracy and utility of those data. We then looked at zip code, race, gender and age-specific data, rather than county-wide aggregate data, to provide information to Black residents and underserved communities in Pittsburgh. This way, residents could make the best choices for themselves and their families based on the most up-to-date place- and population-specific information rather than on fear and misinformation.
To do this, we received financial support from local philanthropic organizations and have become one of the only Black-led nonprofit organizations to receive a major contract from the Pennsylvania Department of Health to continue to work on community outreach regarding COVID and COVID vaccines, as well as on data analysis. We organized regular meetings with local philanthropic organizations and representatives from both of the major regional health care systems based in Pittsburgh, the University of Pittsburgh Medical Center and Allegheny Health Network, who attended some of our working group meetings.
Through this effort, we have established relationships in cities and municipalities across the state and have made allies and connections in other social and service sectors. These relationships were critical in helping us to communicate to people in health, public health, and in different communities that the Black population was vulnerable to COVID not because of anything specific about the virus but because of persistent social inequities in labor, housing, health, education, and exposure to environmental and climate hazards.
In our core model, which we describe as “hub and spoke,” the BEC places organizations such as the federally qualified health centers as a primary health and human development community hub, responsible for sharing information with communities and reporting out to the spokes of the network of resources and support organizations. The hub organization remains connected to other service organizations that operate outside of its area of specialty.
In our functioning hub and spoke, when a clinician at one of the health centers sees a patient, they note how and when they can connect that patient to necessary services based on social determinants of health. The health centers then make referrals via spokes in the network, which correspond to services in housing, jobs, education, and the like. Similarly, a job or workforce development center can serve as a hub for improving access to livelihoods and may recognize the worker’s childcare, health, housing, and other needs and make appropriate referrals and connections.
In its first year or so of operation, the BEC has demonstrated how community, nonprofit, academic, philanthropic, political and medical professionals can use their expertise and assets to create pathways to preventive health access and social equity. Virtual meetings flattened social hierarchies. There was no dais. There was no leader. We were accountable to the work, to whichever group that we were representing and, more importantly, to the Black residents of Pittsburgh.
While COVID was the reason for such an unprecedented effort, health disparities will not end with the pandemic—this public service infrastructure that we established can open pathways to social equity across the board. As COVID rates ebb and flow, not to mention new policies and public responses, the BEC wants to work with Pennsylvania’s Department of Health, Department of Community and Economic Development and Department of Education to change social determinants of health such as racism, education, public safety, livelihoods, neighborhoods and housing.
COVID uncovered long-standing, broad and pervasive inequities in Pittsburgh that need to be addressed over the long term through policy change and institutional transformation. One initiative or community-based vaccine plan during an unprecedented pandemic will not change that. The long-standing and pervasive healthy equity challenges facing urban and rural municipalities across our nation require a responsive, systemic “equity in all policies” strategy, and we believe it must move from a medical-curative approach to a preventive socioecological one that addresses determinants of health. Specifically, new policies and practices to address disparities should lean on and learn from people experiencing and working with underserved communities. They should focus on intersectional problem-solving, recognizing that housing, environment, workforce, transportation, education and health are interrelated.
Our effort in Pittsburgh has disseminated information and population-specific data, elevated COVID awareness and become a source for trustworthiness in advancing equity. We believe other cities can make similar strides if equity in health and well-being is part of their just community promise.
This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.