Health Advocacy and COVID-19

Goal: Assess how your understanding of health advocacy, social determinants of health, and

structural inequity has changed as a result of your experience working at your HAP community site

and as a result of living through the current pandemic.

Tasks:

Read through all 3 parts of the assignment.

Answer questions and upload this assignment to BB by Sunday, April 26th @ 11:59 pm.

BRING A COPY of your answers to our final TBL the following week. During the TBL,

members of each Core Group will share answers in order to identify themes and report back

to the larger group.

PART I

(A) Read: Failing another national stress test on health disparities.

(B) Review the IL and TBL learning we did in HAP this year:

IL: This IL presented evidence on how healthcare determines only a small percentage of health
outcomes. By far the greatest determinant of health and lifespan is access to health resources such

as food, safe housing, living wage, freedom from discrimination, and education.

Presentation on stigma (by Bill Kunkle). Using the example of the opioid epidemic, we explored
how social stigma causes injury and drives poor health outcomes. We defined specific forms of

stigma: (1) blaming the person; (2) criminalizing the action; (3) pathologizing the person--

something is damaged inside of them; (4) patronizing society knows better, society knows what

they really need; the person isn really capable of exercising autonomy or doesn deser e

autonomy; (5) marginalizing and isolating people by generating fear, hatred, or disgust.

TBL: Bias and the Ethics of Care. We discussed the health consequences of: othering (withdrawal of

empathy); data on implicit bias in medicine being associated with poorer treatment and poorer

outcomes; differences between personal bias and structural racism/discrimination.

TBL: Trauma Responsive Care: effects of traumatization; ACEs; positive childhood experiences;

essentials of trauma responsive care; harm reduction; vicarious trauma and vicarious resilience.

Review also any population-specific learning you were assigned through Blackboard or by your

site.

Answer the following questions in order to help your peers better understand the health

issues of your population:

(a) Describe the specific population that was served at your HAP site.

I was volunteering at Wissahickon Charter School

I was working with Kindergarteners (aged 5-6)

The majority of the students (about 95%) were African American

I did not learn a lot about their backgrounds, but I got the impression of number of

them were from low SES households

(b) What are 2-3 ways that the material we covered in HAP this year relates to how your
population will be affected by the pandemic? What are your greatest worries about the

health of your population right now?

1. The kindergarteners I was working with are no longer able to attend school due to the

pandemic. Since education is such a large determinant of health, this could have a negative

impact on their health in the long-term.

2. Going through something like this could be traumatizing for many children. They suddenly

aren’t able to see their friends at all and engage in many activities that could be considered

positive childhood experience. ACEs, such as this, can have long lasting impacts on health.

3. Many of the children I worked with were African American. Historically, African Americans

have been discriminated against by the health system. The quality of their health care or

access to care could be affected during this pandemic.

4. Many of the children I worked with had family members who worked in retail or blue collar

jobs. I am worried that the children who have parents doing essential work may have

exposure to the virus and that those children who have parents that can’t work right now
might have inadequate access to money to provide safe shelter, food, and health insurance.

PART II

CORONAVIRUS EQUITY CONSIDERATIONS (Source: NAACP)

[The NAACP is an advocacy group working on behalf of People and Communities

of Color. Most of the impacts and recommendations below are also relevant to

vulnerable white populations. We also keep in mind how intersectionality of

race/ethnicity and some other social vulnerability is associated with even worse

health outcomes. SR]

The coronavirus outbreak is officially a pandemic, according to the World Health Organization.

Beca e of he acial and economic ineq i ie embedded in o co n em , he effects

of the coronavirus could be compounded for Black, Brown, Asian, and indigenous communities,
as well as other population groups. Our policy experts have outlined key considerations and

recommendations in containing the spread of the coronavirus.

10 Impacts of the Coronavirus COVID-19 Outbreak on Communities of Color

1. Racism and stigmatization have increased, particularly towards the Asian and Asian

American populations.

2. Certain populations including immigrants, incarcerated people, people over 60 years old,

people with disabilities, people with special health needs, and others are at an added risk of

exposure and other implications.

3. Frontline workers face tough choices between abstaining from work or risking exposure.
4. Census and voting may be jeopardized as public outings continue to dwindle.

5. Coronavirus remediation will result in increased exposure to toxic cleaning chemicals.

6. Children and college students risk exposure in schools. If schools close, students may

experience food or housing insecurities.

7. There is a lack of accessibility to testing kits.

8. Quarantine policies and practices are unfolding with a risk to human and civil rights.
9. The coronavirus has already been used to justify increased militarization and more restrictive

immigration policies and practices.

10. Denial and misinformation on the crisis can worsen the outbreak.

Open the NAACP document.

(A) Key Considerations Parts I-III.

Look at PDF pages 1-7 (report pp 1-6). Yo ll see here a list of links to news stories. Find 2

of these that are relevant to your HAP site. Sections I and II address specific populations. Section

III addresses front-line workers, this includes the staff and service providers at many of your sites.
If none of the above 3 Sections seem relevant to your population, then look to other sections as well.

Generate bullet points based on the article(s) to share with your peers.

Social Distancing Is a Privilege - NYT

• African Americans are dying at higher rates from COVID-19 than other ethnic groups

• Many states are not releasing race-specific data

• Must kill the idea that this virus is an equal opportunity killer

• Less than 1 in 5 black workers are able to work from home

• Must make decisions: stay home and risk starvation or go to work and risk contagion

• Low wage workers must use crowded mass transportation if they do go to work

• Ability to panic is privilege among those who rarely have to do it

Black Businesses Left Behind in COVID-19 Relief - City Lab

• Kennedy Center received $25 million in relief, but indigenous black art and cultural institutions

are collapsing

• Authors believe if well-endowed institutions can get a bailout then black institutions and

businesses that have survived legacy of legal discrimination should too

• Only 1% black business owners able to obtain loans in founding year as compared to 7% for

white

• Black businesses often receive less revenue due to negative perception of black

neighborhoods

(B) Specific advocacy recommendations

Look at the advocacy recommendations beginning PDF page 11 (report p. 10). What

recommendations, if any, seem most relevant to your HAP site population?

School Policies

• Advocate for equal standards of sanitation, safety, and health in all schools

• Train all school personnel and students on healthy practices

• Policies for execution of appropriate containment processes if infection is discovered

• Advocate for provision of food assistance to families enrolled in free meal program

• Advocate for education continuity to the highest standard possible in the event of the need for

school closure due to infection or risk

• Establishment of alternative means of education that are accessible to all and of comparable

quality to in-classroom experience

Vulnerable Populations and low income communities

• Advocate that as testing kits become available, vulnerable groups/populations are prioritized

for testing and care

• Prioritize under-resourced facilities to ensure limited hospital supplies are equitably distributed

• Mobile basic needs delivery, including food and sanitation supplies

• Moratorium on water shut offs, energy shut offs and evictions

• Long term: establish a universal basic income

PART III

How has living through this pandemic affected your understanding of how medical students

and physicians need to serve as health advocates for patients and their communities?
When disasters happen, such as this pandemic, vulnerable populations are the most affected
and often have no one to advocate for them. I think this pandemic is making it clear how the
health system often fails minority groups such as African Americans (who are dying at alarming
rates). It is important that Physicians use their position of power to advocate for these vulnerable
populations. Physicians have had to take it upon themselves to try and secure enough PPE and
other resources to adequately care for their patients. I think it is physicians’ responsibility to
ensure that legislators know about these issues to ensure they do not happen again.

Physicians also need to ensure they have measures in place for disseminating information to their
patients as quickly as possible. Recently, we’ve seen multiple instances in which those in power,
including the President, have advocated for the use of unproven drugs or household cleaning
supplies in fighting this pandemic. Many of our patients might hear this advice coming from the
president and assume it is good advice. Physicians have a responsibility to their patients to try
and get correct information out there and dispel these dangerous falsehoods.

Please Upload this Assignment to Blackboard

by Sunday, April 26th @ 11:59 pm