Experts talk solutions to racial health disparities in Utah and beyond
Medicaid expansion and fixing pre-existing structural inequities are crucial to implementing effective solutions to health disparities, according to a panel of subject area experts at the Utah Health Policy Project’s Health Care Solutions for Utahns conference.
On this panel, Jamila Michener, Ph.D., Associate Professor of Government at Cornell University, Ciriac Alvarez, policy analyst at Voices for Utah Children, Christina Adeleke, policy and communications manager at the North Carolina AIDS Action Network and Christine Madrid Espinel, health program specialist at the Utah Department of Health’s Office of Health Disparities, spoke about solutions to the racial health inequities COVID-19 has illuminated.
Michener said disparities in health care are more obvious now than they have ever been. Pacific Islander, Latinx, Black, Indigenous and Asian communities are experiencing a larger amount of death and mortality rates from COVID-19, she said.
“Many of us who were working in the space of health policy and health care and thinking about race and racism and equity prior to COVID-19 already understood that racism in health care and beyond, in terms of social determinants of health and in a wide variety of institutional aspects of our society, had implications for health outcomes,” she said.
One of the most effective policies for advancing racial equity is Medicaid, she said. According to her, the makeup of the Medicaid-enrolled population in 25 states is over 50 percent racial minority. She said Medicaid expansion has decreased uninsured rates and high medical care costs, which often significantly benefits black and brown communities.
“It’s important to realize that policies like Medicaid expansion have ripple effects,” she said. “They reduce hospitals’ uncompensated care burdens and, importantly, the hospitals that have the highest uncompensated care burden are the hospitals that are disproportionately serving populations of color.”
These “ripple effects” include evictions and unpaid medical bills, which are indirectly impacted by health equity, she said.
She said Medicaid can additionally increase the amount of community health workers. This is beneficial because not only are community health care workers able to provide needed care to communities of color, but the health care workforce is often made up of people of color.
Alvarez said work can be particularly difficult for these health workers of color, given that it is their own community who is struggling with COVID-19 the most.
Espinel said her department is implementing the COVID Community Partnership Project, which embeds community health workers into Utah’s COVID-19 response. These community health workers operate at the department’s sixteen locations throughout Utah.
Michener added that Medicaid expansion augments the political capabilities of its beneficiaries.
“We should also think about building power among Medicaid beneficiaries because, as that power is built, beneficiaries can use that power to protect programs like Medicaid, to advance calls to grow and develop our public health care workforce and to advance other kinds of policy prerogatives that ultimately support and sustain healthy lives in communities of color and that reduce health disparities in those communities as well.”
Adeleke talked about the polarizing nature of Medicaid expansion and how this can impede the pursuit of health equity solutions.
“It has provided a lot of contention between folks when it comes to policy, but when it comes to actual practice, we find that there isn’t a disagreement — folks want health care,” she said.
On top of fearing COVID-19, communities of color are afraid of engaging with the system that enforces the structural racism in the first place, Espinel said.
“In reality, communities’ social status and conditions make them susceptible to structural discrimination, and this is the real underlying risk factor of COVID-19,” she said.
She points out that although data shows COVID-19 originally entered Utah through its affluent communities, by June, low-income communities had more than double the COVID-19 infection rates than other areas.
“So we know that the virus came into Utah from those who could travel and do business, but it stayed in communities where people couldn’t even take a day off,” she said.
Alvarez spoke about her organization’s Invest in Utah Kids campaign. This program aims to direct investments toward children struggling with health issues in Utah. 8 percent of Utahn children are uninsured, one of the lowest rates in the country, she said. She added that 13 percent of Latinx children in Utah are uninsured.
She emphasized the importance of pursuing policies that will continue to address health inequities after the pandemic, not one that solely respond to COVID-19-related inequities.
“During the pandemic, we have seen so much light on inequities, but we know that those have existed in the past, and those will continue to exist unless we use some of the solutions that we’ve created, like the CCP Project that Christina talked about,” Alvarez said.
Adeleke explained that the face of the AIDS epidemic became predominantly white, which greatly boosted its public support. She cautions against letting the same thing happen with COVID-19 vaccine distribution, saying all racial groups need to have equal access to the vaccine.