Despite being home to premiere academic medical institutions and a thriving biotech hub, Massachusetts has not achieved health equity across race and ethnicity. Never mind that we were the first state in the nation to offer true health care reform. Boston alone is saturated with Level 1 trauma centers and a plethora of physicians. Yet the experience for many poor communities of color has been anything but ideal. The devastation that COVID-19 has unleashed in our communities of color requires bold and immediate action.
The Boston Public Health Commission recently released a color-coded map of the most heavily infected neighborhoods. It should come as no surprise that certain areas — Dorchester, Mattapan, Hyde Park, and East Boston — are disproportionately affected. The Globe reported that Chelsea, which is 66 percent Latinx, “has by far the highest incidence rate of COVID-19 cases in the state.” Black and Latinx communities are often outliers when maps are defined by socioeconomic indexes. Foreclosures, pollution, medical comorbidities, low-performing schools, gun violence, food insecurity . . . the list goes on and on. It’s as if one could place the maps on top of one another and be assured the contours of the neighborhoods would remain intact.
We cannot allow the status quo to prevail while COVID-19 infections, hospitalizations, and deaths rise in Black and Latinx communities. Similar to hard-hit clusters such as our veterans facilities, nursing homes, homeless shelters, and prisons, we must intervene quickly and robustly to stave off an impending but avoidable loss of life. Applying a mandatory racial equity lens when it comes to testing, treatment, access, and empowerment in communities of color must be at the center of any strategy. That begins with access to statewide racial and ethnic COVID-19 data. We undermine our ability to act on hot spots if the collection and reporting of data are not prioritized. The subsequent monitoring and evaluation that will be necessary as the crisis evolves heavily depends on it.
And our efforts should not stop with data collection. Making sure that any Crisis Standards of Care guidelines do not incorporate comorbidities that disproportionately impact patients of color is imperative. If triage teams are to make decisions about which patients get care, communities of color need adequate representation. Enlisting the expertise of culturally competent providers who look like and speak the languages of those communities most impacted is paramount. We cannot push back against the belief that the “coronavirus doesn’t infect Black people” or similarly ensure that our Spanish-speaking and other multilingual neighbors have access to appropriate information if there is little public trust or there are barriers to health care access. Supporting decarceration efforts to decrease virus transmission in jails and prisons long defined by their over-representation of Black and Latinx people must also move forward. And yes, that includes ICE detainees. Recent litigation before the Massachusetts Supreme Judicial Court revealed that over 300 incarcerated people had been approved for release by the Parole Board but were awaiting law enforcement discharge orders.
We must realize that today’s COVID-19 pandemic will shape Massachusetts’ future. We have a chance to redraw those maps, to tackle the inequities and disparities made plain by this crisis. The reasons why some of these communities are denser and why poor people do not have the privilege to work from home — both factors probably contributing to disproportionate infection rates — should empower elected officials and community leaders to strive for more equitable policy-making as we enter a post-COVID-19 economy. Let us allow this public health emergency to be a rallying cry as we redress the health disparity that has defined our country since its founding.
Our experiences in government, legal circles, and medicine have been defined by trying to stamp out the inequity made so clear by these maps. And as elected officials of color, we stand ready to partner and act boldly with our colleagues in federal, state, and local government. No doubt, challenges exist. The data are imperfect, outreach to communities of color has been historically lacking, and resources are scarce. But similar to the health care workforce putting themselves at risk with limited personal protective equipment, we have a duty to serve our communities in their greatest time of need. We stand ready to do so.
Jon Santiago is the state representative for the Ninth Suffolk District and an emergency room doctor at Boston Medical Center. Rachael Rollins is the district attorney for Suffolk County. Ayanna Pressley serves as US representative for the Massachusetts Seventh Congressional District.
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