Credit: City of New York photo

Before I began leading the health departments in Baltimore and New York City, I was a young pediatrician at a Federally Qualified Health Center in Washington D.C., where most of the families I served were either longstanding low-income residents or newly arrived immigrants.

The social contexts of my patients’ lives affected what was happening in my exam room every day; I learned quickly that prescriptions and vaccinations were inadequate remedies for health issues caused by the chronic stressors of racial discrimination, trauma and poverty. What led me to clinical medicine in the first place—a commitment to applying social justice to science—ultimately led me out of it.

Now, as a public health leader, I strive to serve more people than I ever could as an individual clinical provider by acknowledging the underlying causes for illness and creating human-centered, science-based solutions.

The COVID-19 pandemic is a fervent reminder that justice and equity must undergird public health practices.

Even before it reached the U.S., many of my public health colleagues and I prepared for another public health emergency that would devastate communities of color, especially those in our most under-resourced neighborhoods. Our prediction came tragically true, at a devastating scale.

Fifty percent of New Yorkers who have died of confirmed or probable COVID-19 are Black and Latino, distressing data that mirrors the national trend. When we account for the excess deaths that otherwise would not have happened, we expect the number to be even greater.

The community-centered approaches to promoting public health that New York City has developed have provided blueprints for the kind of collaborative interventions our country will need to massively expand if we hope to combat injustices, reshape public health and prevent the poor outcomes in future health emergencies.

Unfortunately, some prominent national health experts have inaccurately weighed in on who is most likely to experience COVID-19 complications and what can be done about it. Their analyses often conflate causation with correlation for the root causes of health disparities, attributing COVID-19 deaths wholly to individuals’ drug misuse or unhealthy eating habits and using that to justify ending shelter-in-place in states with large populations of Black, Latino, and Indigenous residents. 

These conclusions propagate the pervasive, racist myth that people of color are overly susceptible to disease due to substandard hygiene, faulty DNA and hazardous lifestyle choices. This myth gains even more traction during times of national distress and has shaped the pandemic’s narrative and emergency response in some parts of this country.

I’m saddened, but I’m not surprised. Blaming people of color for their poor health is an age-old smoke screen used to prevent investing in environments wherein healthy choices would be the default. While historic oppression contextualizes the root causes of COVID-19 health disparities (along with other causes of death), public health cannot rest after tabulating data or acknowledging that disparities exist.

New York City unveiled a plan that actualizes equity by concentrating more resources where they are needed the most—in low-income communities of color and the public hospitals that anchor them.

We’re offering free hotel rooms for those who believe they’ve been exposed and can’t physically distance safely at home. We’re also manufacturing and disseminating personal protective equipment (PPE) and expanding testing to those who have been ignored by our pay-to-play healthcare system. In collaboration with community partners, we are identifying local issues, and ensuring linkages to resources and services. Our state-of-the art public awareness campaign aims to meet people wherever they are—on the phone, at home, online or in the streets—in the languages New Yorkers speak most. I’m most excited to break through the literal and metaphorical walls within our healthcare delivery system by expanding culturally appropriate, community-based care via tele-medicine.

America needs a COVID-19 equity action plan. Other jurisdictions like Louisiana, Massachusetts, Washington and Virginia have all joined in creating task forces or plans focused on equity, but those efforts won’t be enough to prevent the mass devastation that faces the nation as some states rush to reopen.

In the absence of leadership from the federal government, it’s imperative that every jurisdiction creates public-facing equity action plans that center their most marginalized residents. Community accountability is one tool to ensure we are doing the right thing in the right places at the right time for the right people.

As we move from the acute pandemic response to long-term recovery, racial equity must remain our most steadfast core value. Public health and medicine must remain committed to acknowledging, preventing and mitigating racism and other intersecting spheres of oppression—particularly xenophobia and poverty—lest the next pandemic have the exact same results. 

Dr. Oxiris Barbot is a pediatrician who serves as the commissioner of the New York City Department of Health and Mental Hygiene.