The New York Times ran an important report earlier this week about the challenges that low income communities will face in the event of a more widespread coronavirus outbreak. Federal, state, and local policymakers and program leaders have to pay closer attention to this because most negative social trends find themselves amplified in poor communities.
The country catches a cold and the poor come down with pneumonia, which might be sadly precise in the case of coronavirus. The underlying health conditions of the type that turn coronavirus from several days of misery into a life threatening illness are more present among the poor. Asthma, heart disease, kidney disease, lung problems related to smoking, and other chronic conditions are all far more prevalent in these kinds of individuals. Health services are also less accessible, for reasons of cost or location, leading low income families to postpone necessary treatment.
As the New York Times points out, an even more troubling aspect of this challenge is the high level of mistrust that some minority communities, in particular African Americans, have for the health system itself. A troubling history of racism and exploitation has sometimes led minorities to avoid doctors and distrust medical treatment. Past infamies like the Tuskegee syphilis study embedded suspicion among African Americans that they might be used as “guinea pigs” for testing vaccines and treatments.
Given the risk to minority communities and the challenges to delivery of services and treatment, how should federal, state, and local policymakers respond? To start, they should ensure that the human services side of the Department of Health and Human Services, which oversees many major welfare programs, and other domestic agencies are fully engaged in the messaging for coronavirus prevention, testing, and treatment strategy.
While coronavirus resources are featured on the Department of Health and Human Services website, a search of “coronavirus” on the homepage of the Administration for Children and Families, which oversees programs like Head Start, yields zero hits now. Even the homepage for the Office of Human Services Emergency Preparedness and Response is silent on it.
Some individual Administration for Children and Families offices have issued guidance to partners and grantees, but more must be done. The matrix of coronavirus challenges facing poor communities, including chronic health problems, barriers to access, and mistrust of the health system, means federal policymakers should be building a true “whole of government” outreach and education strategy targeted to disadvantaged communities. The vast networks of state agency partners and thousands of nonprofits that receive federal funding through the Administration for Children and Families programs are strong channels for disseminating timely information and helping low income communities access care.
If they have not already, regional administrators and staff headquartered in major cities across the country must be brought into communication, public education, planning, and outreach to reinforce hygiene technique, social distancing, response planning, and treatment messaging. If such widespread outbreaks in low income communities occur, these regional networks, which often include trusted faith and local groups, would be critical channels of communication, access to services, and treatment.
As a senior appointee under President Bush, I saw this movie once before in the aftermath of Hurricane Katrina. The health agencies of the federal government swung into action to meet critical urgent needs for those injured in the storm. Unfortunately, for many of the neediest individuals and communities, medical treatment for acute injuries was a relatively small part of the equation. Confusion combined with a dearth of reliable information added to and prolonged the suffering of tens of thousands.
President Bush and President Obama both invested significant resources in preparing human services for the next big disaster, and it may be upon us now. We need to remember the lessons of the recent past and leverage all the great capacities of the government to assist our most exposed and vulnerable populations navigate this unfolding public health emergency.
Brent Orrell is a resident fellow with the American Enterprise Institute. He served as the deputy assistant secretary for policy and external relations with the Administration for Children and Families under President Bush.