April 7 marked one month since the first case of COVID-19 was confirmed in Missouri. As the initial phase of the pandemic response ramped up and hospital systems announced testing in some parts of St. Louis County, many black elected officials, clergy and community leaders were left to justly question the availability of testing in North St. Louis City and County. As tests and data have become more readily accessible, the distribution of COVID-19 cases and deaths show what many calling for more equitable testing likely did not need a map to know: COVID-19 has and will hit the black community hard.
Decades of policies, practices, politics and legal precedent have laid the foundation for much of the institutionalized inequity many observe and experience in St. Louis today. Like many places in America, where one lives in St. Louis is one of the most important indicators of one’s health and life expectancy. Disparities in health and life expectancy are undeniably correlated with inequities in criminal justice, education, employment, housing, income, transportation, and other social determinants of health.
COVID-19’s impact on the black community in St. Louis will be both reflective of and exacerbated by these disparities. While COVID-19 may not discriminate, the systems, structures, processes, resources, and power dynamics that influence health and life outcomes do. Coined as the “political determinants of health,” these are “the instigators of the causes of inequities, the determinants of the determinants.” Along with addressing the social determinants of health, true health equity requires managing these political determinants as well.
With the current public health crisis comes an opportunity to use the political process to advance health equity in all communities, and ample research highlights the possibilities of achieving health equity through policy actions. Equity has been at the center of the COVID-19 response in St. Louis County, not only in policy outputs, but also in the process of policymaking itself. Empowering me to serve as an incident commander primarily focused on the public health response, engaging Jason Purnell and Andrea Jennings-Jackson to lead the human and social services response, and working with a diverse range of stakeholders to help inform economic recovery policies are just a few examples of St. Louis County Executive Dr. Sam Page’s leadership in advancing health equity both in policies and through policymaking.
However, the work does not end once a particular policy outcome is realized. Centering health equity in and advancing equity through policy and politics is a continual process that will require stakeholders to remain engaged, to continue to advocate for change, and to hold decision makers accountable.
History tells us that once the fight against COVID-19 is won, the impact on the black community will be disproportionately devastating. But history also tells us that by listening to the black community, St. Louis has the potential to emerge from the COVID-19 pandemic as a more equitable region. As noted in an important piece recently authored by former U.S. Congressman William “Bill” Clay about one of the most significant health, social and economic achievements for blacks in St. Louis history, “Homer G. Phillips Hospital came into being as the result of a 23-year struggle” and “from the time (the) hospital was dedicated in 1937 until it closed in 1979, the black community was preoccupied with the fight to keep the doors open.”
Achieving health equity in St. Louis will require a willingness from political and civic leaders to engage in what may be difficult conversations about inequities rooted in race, as well as age, gender, sexual-orientation and socioeconomic status, to develop more meaningful and effective coalitions, to eliminate systemic fragmentation and silos, and to invest the resources necessary to dismantle institutionalized inequities.
COVID-19 has placed St. Louis at a tipping point. We must all decide if we will allow inequities in St. Louis to persist and undermine our region’s full potential, or if we will work together toward a more equitable St. Louis that is as good as its promise.
Cora Faith Walker, Esq., MPH, is the director of Policy for St. Louis County Executive Dr. Sam Page and is a member of the Delta Omega Honorary Public Health Society.