Few events better illustrate the gap that exists between the wealthiest and most vulnerable Americans than the coronavirus pandemic that hit the United States in early 2020.
That’s what a panel of experts said at St. John’s University’s 12th Biennial Poverty Conference. The Oct. 29 Pandemic and Poverty Symposium examined the ways in which underserved populations experienced additional crisis points in the early stages of the pandemic.
Experts agreed that economic and social disparities reveal inequities in the health care system that burden marginalized communities to near breaking point. Although COVID-19 has abated, the social circumstances it exacerbated remain.
“This exposed what we already knew, that inequities exist in our society,” said Dave A. Chokshi, MD, former commissioner of the New York City Department of Health and the symposium’s keynote speaker. “They are avoidable and unfair. These are choices we make as a society, and they have led to the results we’ve seen: low-income people have borne the brunt of the COVID pandemic.”
The three-hour symposium, held in the D’Angelo Center Ballroom, brought together Dr. Chokshi, who led New York’s medical response to COVID-19, and six faculty members of the St. John, whose sectors were affected by the pandemic.
The panel includes Jennifer S. Bhuyan, Pharm.D., College of Pharmacy and Health Sciences; Fred P. Cocozelli, Ph.D., Associate Professor, Government and Politics, St. John’s College of Liberal Arts and Sciences; Cdr. (left) Harlem Gunness, MD, MPH, Associate Professor, College of Pharmacy and Health Sciences; Alia E. Holmes, PhD, Associate Professor, Curriculum and Instruction, School of Education; Raphael Art. Javier, Ph.D., ABPP, Professor of Psychology, College of Liberal Arts and Sciences St. John; and Ansel Schiavone, Ph.D., Assistant Professor of Economics and Finance, The Peter J. Tobin College of Business.
A collaboration between the Vincentian Center for Church and Society and the Faculty Research Consortium of the Vincentian Institute for Social Action, the conference was attended by members of the community of St. John and the public at large. Others watched live.
Dr Chokshi’s hour-long speech touched on the need to learn lessons from the response to the coronavirus, with the expectation that another future pandemic is almost certain. Asking tough questions about access to health care, he said, is the best way to protect the most vulnerable.
“Why, in the richest nation in the history of nations, do we have so many New Yorkers struggling to make ends meet?” asked Dr. Chokshi. “I see this in my clinical practice — people who have to live paycheck to paycheck just to cover their insulin costs.”
“The fundamental issue we must grapple with starts with putting health equity at the center of the conversation,” he continued. “When we talk about equity, it’s often a side event, not the main event.”
This was especially evident in the earliest days of the pandemic, Dr. Chokshi said, when the virus tore through the city’s less affluent neighborhoods. Unable to retreat to less populated areas, the urban poor were easy targets for the virus. Once infected, preexisting medical conditions, often untreated, left them more likely to experience serious illness.
Even when vaccinations became available in early 2021, the poor were often unable to travel to a vaccination center.
“There is a reason that people in certain groups are more likely to be infected by the virus,” Dr. Chokshi said. “Our task is to ask why. And why are some people more prone to serious illness? Certain groups are more likely to suffer from obesity, heart disease and diabetes, but the conversation cannot end there.
“We have to have the courage to keep unpacking the layers and asking why after successive why,” added Dr. Chokshi.
The answer to these questions, he said, will come from an honest assessment of the systemic inequities in health care delivery that include racism.
“Why, for example, are some groups more likely to have diabetes? The answer is not primarily in biology,” said Dr. Chokshi. “It’s in structural factors. It’s in the way that certain people have access to food or to physical activity in a neighborhood where they can exercise safely, or from the stress of how racism gets under the skin and makes people more susceptible to certain medical conditions.
As officials ask why, Dr. Chokshi said, they should also ask Vincent’s question, “What needs to be done?” How can systemic inequities in health care delivery be addressed?
The start, he said, was his department’s October 2021 declaration of racism as a public health crisis. This was followed a month later by the creation of the city’s first-ever Coalition to Oppose Racism in Medical Algorithms. The city even offered financial incentives to those willing to get vaccinated and restricted indoor dining to vaccinated guests.
“Too often, a conversation about justice remains just a conversation,” said Dr. Chokshi. “But it has to be about moving to action. I draw inspiration from Vincent’s philosophy.”
Fittingly, he was joined by members of the St. John’s faculty who added their own observations. Dr. Bhuiyan, who runs a mobile health care delivery service, noted how the poor often lack the means to purchase COVID-19 deterrents such as hand sanitizer or masks.
Dr. Holmes, a curriculum specialist, noted how the rapid shift to online learning upset many families who were unable to afford technology needs. “Some homes didn’t have internet access and some families only had one device and had to share it with all the children,” she said.
And as the pandemic continues, Dr Javier said psychologists are seeing increases in alcohol and substance abuse, domestic violence and child abuse. “We’ve lost the sense of safety and security that used to guide us,” he said.