2020 made visible what many BIPOC (Black, indigenous, people of color) and other historically and systemically marginalized communities have had to experience for centuries. Being healthy and having reasonable access to quality healthcare is impacted by privilege. The identities you embody (either by birth or those acquired through life) have a direct impact on how much healthcare costs you, how easily or difficult it is for you to access proper healthcare, and how you are educated about options available.
Now, enter a pandemic like most of us currently alive have never seen. What has received rising coverage since talk of a COVID-19 vaccination rollout began is how public agencies still have not learned from the lessons highlighted in 2020. The same cycles, underlying dynamics, and systemic issues in health care and public health management exposed last year (and lived by some of us for centuries) keep replaying themselves. Healthcare, most importantly public health in the United States, has been and remains heavily centered around privilege.
While we will focus on the current dynamics and inequities of the current vaccination rollout, let’s briefly review the theme of privilege since the beginning of this pandemic.
COVID-19 Tests Sites
If you surveyed South or West side Chicagoans at any time last year, most would tell you that it was difficult to know where any accessible testing sites were and whether one had to have health insurance or what the out-of-pocket costs would be. The amount of vague and misleading information generated or disseminated by public entities was mind-boggling. And the privilege of socio-economic status became very apparent when the main communication method was online, missing entire segments of the community. Improvement fell on community organizations, activists, and public officials who acknowledged a system “gap,” organizing “pop up” sites to make access in health care desserts more possible.
Initially, public site required a “doctor’s note” in order to even ask to be tested. Privilege, my old friend. Many BIPOC community members who have never or have rarely been in a position to have health insurance were now put in a position to have to go to a clinic or find a doctor. The cost, the time (including having to take time off to get a note), and other factors did not seem to have been considered by those in charge of responding to the pandemic.
Even though some of this phenomenon was addressed by offering free testing and more sites in Black and Brown neighborhoods, it was disappointing to see how non-inclusive the public health mechanism is.
Who, Where, and Prioritizing To Vaccinate
When news of a vaccine broke, there was a global sigh of relief and excited anticipation. But for some of us, myself included, it was quickly followed by a wave of anxiety and deep concern of how this would be rolled out in an inclusive and equitable way. Inclusion and anti-racism/racial justice should have been the main considerations in constructing the rollout, especially after the statistics showed which communities were the hardest hit with COVID-19 related cases and deaths, even after the slow-down. But, as anticipated, the very locations that were first to have testing sites, were the locations that had the most people vaccinated, were the locations where COVID cases and deaths were the lowest. News outlets from NPR to the Chicago Tribune, community groups, and educational institutions showed heat maps telling the same old story: if you are privileged (have a job, have income, live in a non-BIPOC neighborhood, have reliable internet and/or devices, have the income to pay for extra/contactless services, etc.), you could get tested, you could sign up for the vaccine.
“For instance, the zip code containing Streeterville, a neighbourhood that is home to a Gucci boutique and Chicago’s Museum of Contemporary Art, has one of the highest vaccination rates in the city. The area is more than 70 per cent white, with a median household income of almost $107,000. Just 40 per 100,000 residents have died of Covid-19, while about 24 per cent of them have received a first dose of the vaccine. Sixteen miles south, the zip code containing Roseland is more than 90 per cent black with a median household income of $41,000. Covid-19 has killed 279 people out of every 100,000; just 6 per cent of residents have received a first dose of the vaccine,” notes Financial Times. The article conducts the same analysis for Washington, D.C., Baltimore, and NYC. Same script, different state.
It bears pointing out that another aspect of privilege when it comes to healthcare is being able to seek out care without fear or suspicion. News of vaccination was met by the Black community with mixed emotion, and it is important to note why. With a long documented record of unethical experiments on Black bodies, the community’s lack of trust in the healthcare system is legitimate. Just last year, in an article posted in January 2020, entitled How We Fail Black Patients In Pain, the American Association of Medical College noted that “half of white medical trainees believe such myths as black people have thicker skin or less sensitive nerve endings than white people…as recently as 2016” . We have also seen in recent years that Black women are the most likely to die giving birth and are less likely to be believed by their healthcare professionals and experience incredible amounts of pain and even death because their concerns are delegitimized. That historical context must be centered when public health officials respond to any health crisis, and certainly this pandemic. The ability to trust healthcare is heavily rooted in privilege.
But, that is just but one barrier to the vaccine by BIPOC communities. Even if a Black or Brown individual would want to get the vaccine, as was the issue with testing sites, most of the scheduling “to get in line” was made available online. So, again, if you do not have access to internet, or a device, you had to rely on word of mouth. And, as was the issue with the testing sites, locations to get the vaccine were more sparse in Black and Brown neighborhoods than in non-BIPOC neighborhoods. Accessing sites, like the United Center here in Chicago, is not always easy, especially if you do not have access to a vehicle (especially a vehicle that can accommodate a wheelchair).
One cannot help but walk away from these response efforts thinking that decisions like where testing sites are located, how they are accessed, and who is prioritized were all made from a privileged world view. It just seems that a lot of the decision-making in responding to this pandemic from who ought to be considered an “essential worker,” to where testing sites are to be erected and paid for, from who and what geographical areas should be prioritized and how accessibility ought to be ensured, are all made from a very privileged world view. The public health and healthcare systems in this country can no longer claim ignorance to privilege (or racism or discrimination) after 2020, yet any adjustments public officials may have undertaken between the different COVID spikes and phases on response and recovery do not seem to reflect inclusion and anti-racism in the updated heat maps.
Responding to this pandemic inclusively and equitably is not hard: rather, responding with awareness, honoring different lived experiences and the respective systemic barriers that impact the intersectionality of those identities is required. A Tweet from Dr. Ali Khan was a welcomed illustration of how to understand equity and implement anti-racist framework to the COVID response. He beings his thread with “…#HealthEquity isn’t hard, but it does take intentional work to overcome the inequitable inertia of the status quo” and then goes on to show how the Oak Street Health team vaccinated 2,000 Latinx people in Belmin-Cragin.
What stood out and what I have observed public officials really having neglected to consider or center were these points:
Utilization of “trusted messengers known by their communities”
Accessibility barriers: “We know website wasn’t going to cut it. To sign up our community, we needed multichannel action - web, text, phone + shoe leather”
Combination of outreach methods: “Texting, calling and knocking on doors”
I will close with Dr. Khan’s words: “Intentional, deliberate work is needed to do it right. Brown people want this vaccine. Brown + Black communities want to come together safely. We owe it to each other, then, to do the legwork to find those ready to be vaccinated fast + those till wanting to move slow. The scar tissue of structural racism and structural policy violence isn’t undone in a day. But when the right teams come together w intentionality, intensity and ingenuity, we can start to move mountains.”
About the Author
Carla Madeleine Kupe is the CEO of The Impact Alliance LLC, a diversity, equity, inclusion, and anti-racism consulting enterprise. Additionally, Carla is the Director of the Professional Identity Formation program at Loyola University Chicago School of Law. Carla created Speak Truth Summit, a platform giving voice and visibility to the particular and unique experiences of women of color.
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