In his daily briefing, when noting the disproportional impact that the COVID-19 has delivered to communities of color, Governor Andrew Cuomo stated, “It always seems the poorest people pay the highest price?”[1]  He restated this same question more than once, as if to ask this question to this world, not necessarily seeking an immediate answer, but to challenge all of us to seek answers. 

Many of us who constantly think about health equity for most of our waking hours are not surprised by the data that have emerged in Louisiana, Michigan, and Illinois in the last 48 hours.  The numbers are staggering, in Michigan, 33% of the COVID-19 cases are African Americans; in Illinois, the percentages are as disturbing, 29% of the cases and 42% of the deaths are African American.  What is most disheartening, are the growing numbers in Louisiana, my home state, with 70% of COVID-19 deaths among self-reported African Americans.[2]  This staggering statistic magnifies the inequities in access, income and wealth, and care, among other determinants, and in fact, Louisiana and specifically New Orleans, exemplifies the challenges that vulnerable populations face in many parts of the country.

Let us consider pertinent data.  The health expenditures per capita is significantly greater than health expenditures in other industrialized countries, measuring $10,581 per capita in the United States versus $7,316.6 in Switzerland, $6,186.9 in Norway, and $5,986.4 in Germany.[3]  Yet, our outcomes do not represent what one would expect from such an extraordinary investment.  Currently, the average life expectancy at birth is 76.1 years in the U.S., which is 5.5 years lower than Switzerland;  within the same ranking, the U.S. is listed well below other countries such as, Slovenia and Costa Rica.[4]  Moreover, when one considers the previous work by Murray et al.,[5]  there is actually a difference in life expectancy as great as 20.7 years within the United States based on access to important resources such as fresh produce and quality education.  As far back as the observations of W.E. DuBois in the early 1900s, disparities in health were observed to be based on inequities in social measures such as housing and education.[6]  Fast forward to the 1980s when the Secretary of Health and Human Services brought forward data regarding disparities in health among Black and Latino populations.  This report noted six primary diseases and injuries that account for the majority of the disparities: infant mortality, cancer, cardiovascular diseases, cirrhosis, diabetes, and homicide and unintentional injuries.[7]  These disparities continue today despite the evidence presented decades ago. 

Fast forward to today, my own home state of Louisiana ranks 49th in the United States according to the United Health Foundation.  On specific measures such as diabetes, cardiovascular diseases, and obesity, this state ranks 47^th, 46^th, and 47^th.  Diabetes and hypertension have been noted to be risk factors for complications related to COVID-19.  Although public health funding in Louisiana ranks 25^th in the country, given the low ranking of this critical indicators pertinent to COVID-19, greater investment is needed to secure the public health of the citizens of the state.[8]  It is time to take the politics out of healthcare and invest in the health of every citizen regardless of socioeconomic status or ancestry.  The expansion of Medicaid under Affordable Care Act with the inclusion of essential benefits was a first step in this direction, but even this historic legislation is under siege. 

Growing up in New Orleans there are several sayings that we learn growing up, one of them is the “City that Care Forgot.” Usually one hears this phrase around the time of Mardi Gras, referencing the last time one has to enjoy great food and a joyous, festive time with friends and family before Lent. However now I consider this phrase in the context of COVID-19.  It is time that state and federal policymakers should care and proactively address inequities in care.  We have known about these brewing disparities for more than a century.  It is time to take meaningful action.

[1] . Governor Andrew Cuomo Daily Briefing, April 8, 2020, CCN Broadcast News.
[2] . https://www.usnews.com/news/healthiest-communities/articles/2020-04-07/black-people-are-disproportionately-dying-from-coronavirus. Accessed 4/9/2020
[3] . OECD Data. https://data.oecd.org/healthres/health-spending.htm Accessed 3/1/20
[4] . OECD Data. https://data.oecd.org/healthstat/life-expectancy-at-birth.htm. Accessed, 2/29/20
[5] . Murray, C. J., Kulkarni, S.C., Michaud C., Tomijima N., Bulzacchelli, M.T, Landiorio T. J., and Ezzati, M. 2012. Eight Americas: Investigating mortality disparities across races, counties, and race-counties in the United States. PLoS Medicine 3(9):e260.
[6] W. E. B. Du Bois, The Health and Physique of the Negro American (Publ. no. 11, Atlanta Univ. Publications, Atlanta, GA, 1906).
[7] . HHS (U.S. Department of Health and Human Services). 1985. Report of the Secretary’s Task Force on Black and Minority Health, vol. 1, executive summary. Washington, DC: HHS.
[8] . https://assets.americashealthrankings.org/app/uploads/louisiana-health-summary-2019.pdf Accessed, 4/9/20