Sec. 2. Findings

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Congress makes the following findings: The World Health Organization

(WHO)declared COVID–19 a Public Health Emergency of International Concern on January 30, 2020. By late January 2021, there have been over 22,000,000 confirmed cases of, and 383,351 deaths associated with, COVID–19 in the United States. From the beginning of this pandemic, Black, Brown, and American Indian/Alaska Native (in this section referred to as AI/AN ) people in the United States have suffered the largest burden of illness, hospitalization, and death from COVID–19. The Centers for Disease Control and Prevention

(CDC)reports that AI/AN people are 4 times as likely as White people to be hospitalized for COVID–19, and that Black and Hispanic/Latino people are 2.8 times as likely to die of COVID–19 as White people. Historically, structures and systems such as racism, ableism, and class oppression have rendered affected Black and Brown communities more vulnerable to inequities and have prevented people from achieving optimal health even when there is not a crisis of pandemic proportions, highlighting that racism and not race presents as a risk factor driving inequities in illness and death. Significant differences in access to health care, specifically to primary health care providers, health care information, and greater perceived discrimination in health care place Black, Brown, and AI/AN communities, individuals with disabilities, and Limited English Proficient individuals at greater risk of receiving delayed, and perhaps poorer, health care. Stark racial inequities across the United States, including unequal access to stable housing, quality education, and decent employment, significantly impact the ability of Black, Hispanic/Latinx, and AI/AN individuals to take care of their most basic health needs. Black and Brown communities are more likely to experience homelessness and struggle with low-paying jobs or unemployment. An analysis by the University of New Hampshire found that in every month between March and August 2020, Black and Latino workers had significantly higher unemployment rates than White workers, even after adjusting for age and education status. Black, Hispanic/Latinx, and AI/AN communities experience higher rates of chronic disease and disabilities, such as diabetes, hypertension, and asthma, than non-Hispanic White communities, which predisposes them to greater risk of complications and mortality should they contract COVID–19. Research experts recognize that there are underlying differences in illness and death when each of these factors is examined through socioeconomic and racial or ethnic lenses. These socially determinant factors of health accelerate disease and degradation. Language barriers are highly correlated with medication noncompliance and inconsistent engagement with health systems. Without language accessibility data and research around COVID–19, communities with limited English proficiency are less likely to receive critical testing and preventive health services. Yet, to date, the Centers for Disease Control and Prevention does not disseminate COVID–19 messaging in critical languages, including Mandarin Chinese, Spanish, and Korean within the same timeframe as information in English despite requirements to ensure limited English proficient populations are not discriminated against under title VI of the Civil Rights Act of 1964 and subsequent laws and Federal policies. Further, it is critical to disaggregate data further by ancestry to address disparities among Asian American, Native Hawaiian, and Pacific Islander groups. According to the National Equity Atlas, while 13 percent of the Asian population overall lived in poverty in 2015, 39 percent of Burmese people, 29 percent of Hmong people, and 21 percent of Pacific Islanders lived in poverty. Utilizing disaggregation of enrollment in Affordable Care Act-sponsored health insurance, the Asian and Pacific Islander American Health Forum found that prior to the passage of the Patient Protection and Affordable Care Act ( Public Law 111–148 ), Korean Americans had a high uninsured rate of 23 percent, compared to just 12 percent for all Asian Americans. Developing targeted outreach efforts assisted 1,000,000 people and resulted in a 56 percent decrease in the uninsured among the Asian, Native Hawaiian, and Pacific Islander population. Such efforts show that disaggregated data is essential to public health mobilizations efforts. Without clear understanding of how COVID–19 impacts marginalized racial and ethnic communities, there will be exacerbated risk of endangering the most historically vulnerable of our Nation. A recent national study found that American Indian/Alaska Natives were 3.5 times more likely to be infected with COVID–19, however that data excluded 27 States as they had reported less than 70 percent of race/ethnicity data to the Centers for Disease Control and Prevention making it impossible to include them in the analysis thus creating a significant data gap for understanding the impact of COVID–19 on this vulnerable population. The consequences of misunderstanding the racial and ethnic impact of COVID–19 expound beyond communities of color such that it would impact all. Race and ethnicity are valuable research and practice variables when used and interpreted appropriately. Health data collected on patients by race and ethnicity will boost and more efficiently direct critical resources and inform risk communication development in languages and at appropriate health literacy levels, which resonate with historically vulnerable communities of color. To date, race and ethnicity data on COVID–19 cases, test, hospitalizations, deaths, and vaccinations is incomplete and lacking. The inconsistency of data collection by Federal, State, and local health authorities poses a threat to analysis and synthesis of the pandemic impact on Black, Hispanic/Latinx, and AI/AN communities. However, research and medical experts of Historically Black Colleges and Universities and Tribal Colleges and Universities, academic health care institutions which are historically and geographically embedded in minoritized and marginalized communities, generally also possess rapport with the communities they serve. They are well-positioned, as trusted thought leaders and health care service providers, to collect data and conduct research toward creating holistic solutions to remedy the inequitable impact of this and future public health crises. Well-designed, ethically sound research aligns with the goals of medicine, addresses questions relevant to the population among whom the study will be carried out, balances the potential for benefit against the potential for harm, employs study designs that will yield scientifically valid and significant data, and generates useful knowledge. The dearth of racially and ethnically disaggregated data reflecting the health of Black, Hispanic/Latinx, and AI/AN communities underlies the challenges of a fully informed public health response. Without collecting race and ethnicity data associated with COVID–19 vaccinations, testing, hospitalizations, morbidities, and mortalities, as well as publicly disclosing it, Black, Hispanic/Latinx, and AI/AN communities will remain at greater risk of disease and death.

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Pub. L. 111-148

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Sec. 2

Findings

Pub. L.Pub. L. 111-148

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