Setting an Opportunity Agenda for Multisectoral Partnerships: Building on Learnings from COVID-19.

Abstract

Setting an Opportunity Agenda for Multisectoral Partnerships:Building on Learnings from COVID-19 Marcella Nunez-Smith, MD, MHS (bio) The burden of COVID-19 falls disproportionately on those who are minoritized, marginalized, and medically underserved in the United States.1,2 Despite incomplete and inadequate data, a clear pattern emerged early in the pandemic. Rates of COVID-19 infection, hospitalization, and death were higher among those identifying as Black, Latino(a), or Indigenous than among Whites; rural communities also experienced substantial COVID-19-related challenges.3 Many affected groups, such as people with disabilities and queer-identifying people and those involved in the carceral system, were invisible in public health data. Structural and systemic realities kept people who needed them the most separated from life-preserving COVID-19 resources—personal protective equipment, testing, therapies, and vaccines. The threat COVID-19 posed extended beyond physical health and included educational loss, economic instability, and assaults on mental health such as stress, depression, anxiety, and loneliness. In the U.S., 250,200 children lost one or more caregivers; these so-called pandemic orphans were predominantly children of color.4 Between April 2020 and June 2021, Black children were twice as likely as White children to have lost a parent or caregiver.5 Additionally, a record high of 19 rural hospitals closed in 2020.6 COVID-19-related illness also remains a significant problem, with at least 7.5% of Americans or nearly 25 million people navigating post-acute sequelae of SARS-CoV-2 infection or long COVID.7 Many of these people are disbelieved by medical providers and are unable to access high-quality care. We witnessed a decline in life expectancy in the United States in 2020 that was the largest since World War II.8 We now understand the impact of COVID-19 will be felt for generations. Most importantly, the outline of these trends predates the pandemic and their appearance was predictable. The social and structural drivers of health have been brought to the forefront of health equity discourse once again. Equitable access to basic needs is necessary for achieving health. Longstanding intentional disinvestment in particular communities manifests through differential access to basic needs. For example, Black, Latino(a), Native American, and Alaska Native communities already had the highest rates of food insecurity prior to COVID-19, and this only worsened during the pandemic. Specifically, it is estimated that 24% of Black Americans, compared with 7.6% of White Americans, [End Page vii] were food insecure during 2020.9 This was an increase from the already high 19.2% prevalence of food insecurity in Black communities in 2019.9 Additionally, Latino(a) communities faced high rates of food insecurity, with 11.8% being food-insecure in 2020.9 A study conducted to evaluate food insecurity in Indigenous communities found that half of the 500 individuals surveyed experienced food insecurity during COVID-19.10 Disparities in food insecurity are not a local, but a national problem; the Map the Meal Gap 2022 Report found that in 99% of U.S. counties with comparable data Black or Latino(a) individuals have higher rates of food insecurity than White individuals.9 Historical and contemporary discriminatory practices such as redlining have led to decreased access to and affordability of housing for people of color and those living on the margins of the economy.11,12 Prior to COVID-19, Black and Latino(a) individuals faced much higher rates of eviction than White people.13 A study based in Washington State found that Black renters faced 60% higher eviction rates than Whites.14 Much like food insecurity, these disparities in housing stability worsened during COVID-19. While before the pandemic an average of 3.6 million people faced eviction annually, at the end of 2020 a startling 40 million renters faced eviction, with Latino(a) and Black people making up 80% of those at risk.15 During the pandemic, historic federal investments were deployed to stabilize housing, nutrition, and health care access for tens of millions of Americans while providing economic relief to families.16–19 Yet, as these interventions come to a close, we are already witnessing a reversal of key gains that resulted...