Dr. Fredrick Echols

By now, you’ve heard the news: In the City of St. Louis, the first 13 COVID-19 associated deaths were African Americans. Now, African Americans account for more than 70% of the coronavirus deaths. This mirrors what’s happening across the nation as the pandemic is killing more African Americans than any other racial group. 

On April 16 we released detailed COVID-19 data stratified by race, examining where the disease is striking the hardest. COVID-19 has impacted every ZIP code in the City of St. Louis and continues to sweep across the city, devastating areas with high concentrations of poverty. 

In order to slow the spread of COVID-19, the City of St. Louis will continue to implement evidence-informed community mitigation strategies and data-driven decision making. This is necessary to prevent more unnecessary deaths in St. Louis. 

While COVID-19 has the capacity to strike anyone, higher rates of underlying health conditions in the African-American community – such as diabetes and hypertension – coupled with less access to health care and a longstanding distrust of the medical community make African Americans particularly vulnerable. 

When we think about the long-term health of our community, we have to think about long-term change. To do that, we must call upon all sectors of St. Louis to come together in a new way.

Nontraditional partners have already come to the City of St. Louis Department of Health to ask what they can do to help keep the city’s residents healthy. We’ve had discussions with clergy, churches, academic institutions and venues that employ thousands of workers. This is a big step toward making St. Louis a place for all to not just merely live, but thrive. This effort must continue after the pandemic ends.

To address where we need to go in the future, we need to reflect and understand where we’ve been. In the age of COVID-19, we can’t talk about today’s racial disparities in health without talking about our history.

In 2013, Washington University published “For the Sake of All,” a landmark report which found that if we reduced the racial disparity in treatments for chronic diseases like heart disease, cancer and diabetes, St. Louis could save $65 million a year in inpatient hospital charges. In our COVID-19 world, we can see that a reduction of those disparities before 2020 would have saved even more lives.

That same study also found residents of St. Louis ZIP codes separated by only a few miles have up to an 18-year difference in life expectancy. History is repeating itself as we see that disparity play out again with COVID-19. 

There was a time when it was different in the City of St. Louis. During the 1990s, the City of St. Louis Department of Health had several hundred employees, providing direct health care and essential public health services to St. Louisans. Residents also once had Homer G. Phillips Hospital, a 728-bed hospital in the Ville neighborhood built at the height of segregation in the region, that served African-American patients in North St. Louis until it closed in 1979. 

Our communities still feel this void. We know that after this pandemic fades, some of our neighborhoods will be left more ravaged than others. We must start thinking about what long-term recovery needs to look like in St. Louis. 

In the public health world, we talk about social determinants of health. Social determinants of health are the environmental conditions where people are born, live, learn, work and play. It includes things like access to jobs, education, health care and emergency and social services, safe and affordable housing, healthy food and green spaces. 

For people to live fully, our communities need equitable placement of and access to quality health care, social services, and economic opportunities – these are long-term, effective prevention resources to slow the disease of health disparities. 

To make that happen, we need to expand working across all sectors to address the social determinants of health in St. Louis. We need businesses thinking about how they can support a healthy St. Louis. We need nonprofits and places of worship tuned in to how they can help residents and organizations thrive. Also, we all need to recognize how the health of one community affects every community. 

We are only as strong as our region’s most vulnerable. 

Dr. Fredrick Echols is the director of the City of St. Louis Department of Health. Visit stlouismo.gov for updates on the City of St. Louis’ response to COVID-19.

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