Community Health Survey

COVID, COVID, COVID

COVID, COVID, COVID

COVID, COVID, COVID

So much has been written about the COVID-19 pandemic that it would seem that there is little left to say that has not been said already more than once. Prevention of transmission of the virus (face masks, social distancing, frequent handwashing, and careful cleaning of touched surfaces), frequent testing (rapid and PCR-based, at least in part to reduce the chances of virus transmission in persons with symptoms of the illness), and vaccination (Pfizer or Moderna versions presently available) are all part of the overall U.S. approach to controlling and then stopping the pandemic.

Despite the present efforts to stop the pandemic, the fact remains that, as of the first wave of the pandemic, Black Americans in New York City, while representing roughly only 13% of the U.S. population, represented one-third of all COVID-19 positive cases and were twice as likely to die from the disease than whites. Across the United States, COVID-19 infections were three times greater, and mortality rates six times higher, in predominantly Black counties compared with those with predominantly White populations. According to other data, COVID-19 has been killing one in 800 Black Americans, with Black people ages 35-44 being hit the hardest – at a rate nine times that of their White counterparts (ProPublica). The hardest hit of all are young Black men. The experience in East New York and central Brooklyn more generally has been similar to what has been experienced elsewhere. More terrible details could be provided, especially as the second wave of infection has hit the community even harder, but that is not the point. This situation is unacceptable!

As bad as the COVID-19 situation is, its greater significance has highlighted the even broader and even more disturbing inadequacies, inequalities, and injustices in the U.S. healthcare system, which, in reality is more of a “non-system” with many, often competing vested interests, that block meaningful reform. There are many reasons one can give as to why the Black communities, and East New York specifically, have been hit so hard. Wilkins et al in the New England Journal of Medicine Catalyst publication (January 2021) have summarized the situation very well:

The causes of these inequities are likely multifold and involve differences in exposure,
susceptibility, testing, and treatment.11 Groups socially disadvantaged because of race/ethnicity,
social position, and/or economic status may have greater exposure to the virus because of jobs that
prevent work from home, dependence on childcare outside the home, reliance on public
transportation, and household size. Poverty and experiences with discrimination and racism lead to
chronic psychosocial stress, causing prolonged secretion of stress hormones, which leads to
physiological dysregulation and inflammation. The resulting maladaptation increases
susceptibility both acutely, through impaired immune response to the virus, and chronically,
through predisposition to diabetes, obesity, and cardiovascular disease,17 which are linked to worse
COVID-19 outcomes. Disadvantaged groups are less likely to have a primary care provider, medical home, or regular access to care and may have limited access to Covid-19 testing and treatment.

When you put all of this together, the situation seems overwhelming. COVID-19 is only the tip of a threatening iceberg or perhaps, put a better way, a dim flashlight highlighting just a bit of a massive health and quality-of-life “ecosystem” disaster that, at its base, concerns the dysfunction of our society and not simply that of our healthcare system. Since true health, good or bad in the sense of physical, emotional and social well-being and not merely the absence of physical infirmity (as per the World Health Organization definition of health in 1948), is a product of all the elements of our society, it seems clear that roots of the present situation are both broad and deep.

What can be done to change the situation? One option is to undertake the arduous and slow work toward getting state and national legislation changes and the accompanying regulatory authority to address both the current, acute situation and the underlying long-term issues concerning the structure of our society as a whole. That certainly must be done. However, it is clear that there is a need for immediate action to address the inequities/injustices, especially as they relate to “true” health in our system. The practical issues here are stopping the disability and death associated with the COVID-19 pandemic, but also beginning to deal with the underlying issues of unsatisfactory employment, education, housing, physical activity, nutrition, transportation, and so forth, that, as far as health is concerned, manifest their dysfunction in conditions such as chronic stress, hypertension, obesity, diabetes, and chronic kidney disease that contribute to what we have seen with the COVID-19 pandemic in communities like East New York. These are results that never should have been seen. In addition, they rob such communities of their community-wide and individual resistance, as well as their resilience. In other words, they will not be any better prepared for the next pandemic health and quality-of-life threat than they were for COVID-19’s assault. That is not acceptable – and it does not have to be that way!

Addressing the issues now is what Rise Up East New York (an East New York-based and conducted program) is all about. It is a locally-led and -driven multisectoral attack on the problems faced by the community as a “ecosystem” in its totality and not simply some pieces here and there. It involves the health issues listed above directly, but it also works to correct the underlying conditions and/or dysfunctionalities that lead to the health and quality-of-life problems that we have described above in outline form only, but are well-documented and detailed by a wide variety of sources and by the residents of the community themselves. Most importantly, it is community led- and -driven.

Accordingly, it needs you (and every other community resident) to make it successful in having maximal impact on health and quality of life. It demands immediate, concerted, and persistent action until the goals that the community has set are realized. Partners, with a capital “P” Hospital system (One Brooklyn, for example), Borough President, political leaders, city, State and Federal agencies, non-profits, for-profit businesses large and small, schools, faith-based institutions, you name it, must pitch in to support the community efforts with the special expertise that only they can be, but they are not the “drivers.” Rather, the community, with its tremendous pool of untapped talent, will be the “drivers”. The goal is an East New York that is the healthiest, longest-lived, and truly equitable community in New York City and State. It is also to have East New York become a model for urban improvement across the country. In so doing, it can be the template for legislation and regulation that will make American society, the just and equitable society it should and can be.

None of the above will happen without you! The health and quality of life of East New Yorkers will not improve unless we do it! American society will not change without the example that can be set by the multifaceted radical transformation that must first take place, and be successful, in East New York.

You can do it, but you have to join the fight to create the positive change that is needed. Sign up today by calling 347-417-5368 or visiting the Rise Up East York website: www.riseupeny.org

Be a FELLOW WARRIOR for what is good and right for everyone!!

Fight for what’s right and accept nothing less!!!

We must be the CHANGE we want to see!!!

Barry H. Smith MD, PhD

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