{"id":2892,"date":"2021-03-24T10:00:53","date_gmt":"2021-03-24T09:00:53","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-humanities\/?p=2892"},"modified":"2021-07-23T09:41:23","modified_gmt":"2021-07-23T08:41:23","slug":"prioritizing-justice-in-the-u-s-response-to-the-covid-19-pandemic","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-humanities\/2021\/03\/24\/prioritizing-justice-in-the-u-s-response-to-the-covid-19-pandemic\/","title":{"rendered":"Prioritizing Justice in the U.S. Response to the COVID-19 Pandemic"},"content":{"rendered":"

Blog by Sarah E. Rowan, Michelle Haas, Lilia Cervantes, Kellie Hawkins, Lilian Barahona Vargas, David Duarte-Corado, Alonzo Ryan and Carlos Franco-Paredes<\/strong><\/p>\n

Days ago, a clinician in Denver looked with anger at a patient who laid dying in the ICU. \u201cWhy didn\u2019t she access care earlier? There are resources available and now she\u2019s dying!\u201d<\/em> The patient was the mother of two young children, and, as it turned out, undocumented. The risk of engaging with any type of program and being separated from her kids was likely too great for her.<\/p>\n

The Covid-19 pandemic wrenches our fault lines wide open and exposes our inequities to the open air. In nearly every case with full hospitals, student learning loss<\/a>, shuttered businesses<\/a>, and overextended frontline workers,<\/a> the harm of the pandemic exacts the greatest toll on communities of color and lower-income individuals. Federal, state, and local governments initially appeared helpless. In many cases where disparate impacts went unchecked, it was not for lack of good and willing officials on the ground, but rather for want of a clearly articulated and conspicuously stated vision of their roles\u2014a north star.<\/p>\n

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Justice as our true north<\/strong><\/p>\n

We need guiding principles to drive our actions. As we tread through our emergency responses and tackle rebuilding, the identification of our communities\u2019 \u201ctrue north\u201d will lead to activities that are more thoughtful, coordinated, focused, meaningful, and durable. Equity is a pillar of social justice that we must uphold; equity elevates fairness. Thus, equity is the most effective way to remediate unfair social arrangements, seeking to eliminate disparities and start repairing damage done. Equality alone perpetuates the system that upholds white supremacy and will prolong the pandemic by shunting resources away from communities with the highest COVID-19 burdens.<\/p>\n

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\u201cThe fierce urgency of now\u201d<\/strong><\/p>\n

Dr. Martin Luther King, Jr. spoke of \u201cthe fierce urgency of now\u201d as a rebuke to the \u201ctranquilizing drug of gradualism\u201d that had permeated the changes driven by the civil rights movement. In particular, school desegregation was progressing slowly under the clause of \u201call deliberate speed\u201d in the second Brown v. Board of Education<\/em> ruling.<\/p>\n

In the spring of 2020, communities struggled to devise emergency response plans. In many cases, approaches were \u201cwell-intentioned, well-designed, but with a sense of moral equivocation at a crucial moment,\u201d to apply Charles Ogletree\u2019s observation<\/a> of the post-Brown<\/em> era. When healthcare resources became scarce, our systems\u2014and the policymakers acting within them\u2014acted without an equity framework, a north star, leading to disparities in Covid-19 testing, hospitalizations, and death<\/a>. It is not too late to act with fierce urgency toward vaccine distribution. Before more lives are damaged, our society must agree that social justice is our true north and work quickly to ensure that Covid-19 vaccine distribution is equity-focused.<\/p>\n

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Defining an equity framework<\/strong><\/p>\n

Leading with equity means sending resources where they\u2019re needed<\/em> rather than giving everyone equal slices of pie, regardless of how much pie they already have. A better analogy is that of a firetruck going to where the fire is rather than spending equal time on every city block. Vaccines, testing, and support services need to be in neighborhoods where Covid-19 has caused the most harm.<\/p>\n

Leading with equity also means prioritizing those who are least able to advocate for themselves<\/em>. This includes those experiencing homelessness or incarceration, or children, and intentionally reaching out to politically disenfranchised communities. These may be immigrant or those communities still reeling from the lingering toll left by redlining<\/a>.<\/p>\n

\"Rowan,<\/p>\n

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Social marginalization versus individual risk<\/strong><\/p>\n

Societal imbalances rooted in policies that reinforce inequitable access to power, opportunities, and resources are being magnified during the deployment of COVID-19 vaccines nationwide. Age-based vaccination policies ignore the social radiograph driving COVID-19 morbidity. Disparate prevalence is the result of food and housing insecurity, discrimination, multigenerational households, and insufficient information. Vaccination strategies that target socioeconomically disadvantaged individuals will reduce social inequity and interrupt community transmission. It is clear that prioritizing racial justice will help all communities to prosper<\/a>.<\/p>\n

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A call to action<\/strong><\/p>\n

The following actions would improve equity in the Covid-19 response, ultimately leading to better outcomes for everyone.<\/p>\n