Advancing health equity has been a consistent theme in the life and work of Dr. Lauren Powell, PhD, MPA. The first head of TIME’S UP’s Foundation’s health care industry work and de Beaumont Foundation 40 Under 40 honoree most recently served as the director of the office of health equity in the Virginia Department of Health. Amid the COVID-19 pandemic, Dr. Powell is also working as a consultant to help the Commonwealth of Virginia address the public health crisis through a health equity lens. 

“[The COVID-19 pandemic] has illuminated the cracks in the foundation of our society that have been there for a very long time that some people have the privilege to just walk over and breeze past, but many others knew…[were] there,” Dr. Powell told de Beaumont staff during a recent talk spanning her education, career, and response to the COVID-19 pandemic.

How can health equity be centered across COVID-19 response efforts when it tends to fall to the wayside even in non-emergency times? Dr. Powell shared the following insights: 

Embed Health Equity in Policy and Decision-Making

Public health emergency response efforts must be framed with health equity, not as an afterthought, Dr. Powell explained. Health equity “has to be embedded as a part of structure. It has to be an embedded part of decision-making, an embedded part of how we address these issues moving forward.”

She pointed to the COVID-19 Health Equity Working Group, which falls under the Virginia Department of Health’s unified command structure. For a health equity task force to carry so much influence in emergency response efforts is “unprecedented, because when it comes to emergency preparedness in the emergency management sense, not in the public health sense, health equity is nowhere to be found,” she said. 

Her hope is that this approach can be scaled up for future emergency response efforts. For example, she said, federal health equity emergency response funds could be allocated to states that establish health equity task forces, with money put aside for target populations. 

Consider Potential Harms of Interventions

At the time of her discussion, all of the reported cases of COVID-19 in Richmond, Virginia, were among African Americans, who are already at increased risk of chronic disease due to systemic racism, she said. 

Despite the urgency of finding a vaccine that could help marginalized populations, it is crucial to remember past abuses by the medical field against groups such as African Americans. Dr. Powell said she is wary of a challenge trial that would speed the development of a COVID-19 vaccine aimed at African American populations, considering how they have been exploited in cases in the past. For example, a syphilis study at Tuskegee specifically targeted Black men and caused irreparable generational mistrust and harm to the African American community, which is still felt today. 

“Because we still have not dealt with race and racism in this country, there will be many examples of how attempted solutions to address COVID-19 completely backfire on entire populations of people, if we don’t prioritize equity,” Dr. Powell said. “And we have to be much more outspoken, much more clairvoyant about future manifestations of inequity. At the same time as we’re thinking ahead of those problems, we must work to tackle many of the structural issues we can see right in front of us.”

Meet People Where They Are

Dr. Powell recognizes that many populations at increased risk of COVID-19 infection are understandably skeptical of governmental institutions based on historic and ongoing abuses. However, governmental public health can help overcome distrust. “The only way to counteract that narrative is for the government to step out and step up,” she said. “The government has to step out and take action that is supportive of the community and have the humility to recognize that they don’t have to be in the limelight to do it.”

She discussed a pilot in Richmond involving the local health and fire departments. The agencies are mapping neighborhoods most at risk and projected to be at risk of COVID-19 infection. Members of the fire department — as opposed to members of the police department — are going into the most under resourced communities because they have traditionally been more accepted among populations who have been harmed by abusive policing practices. 

Dr. Powell also wants to see governmental public health be more creative about messaging, leveraging the voices of community health workers to get important information out. “Their community trusts them more than they would ever trust me as a government official, and I’m OK with knowing that and with understanding that,” she said. “And I think more of our public health officials and leaders need to think like that.”

Discern Between Equity and Equality

Equity and equality are two terms that are often conflated, but have important distinctions, she explained. “We have to constantly remind people, that there’s a difference between equality and equity,” she said. “Equality is giving everyone the same thing. But equity is giving people what they actually need. So if I put it in another way, equality is giving everyone a pair of shoes. Equity is giving people shoes that fit.” 

She pointed to the conflation of equity and equality in the stipends provided through the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act. The $1,200 stipends going out to Americans will go into savings for some people but will be a lifeline for others. “They’re trying to equalize the playing field. But what we actually need is equity,” she said.

Remember That Health Goes Beyond the Individual

The COVID-19 pandemic is far from the “great equalizer” that some have claimed it to be, Dr. Powell said. However, it has underscored just how much health is interconnected. “I think that what this moment has done more than anything is show us just how much we depend on each other, whether we know it or not,” she said. “My health literally depends on yours at this very moment. I’m so dismayed and disturbed when I see people who exist within a cloud of privilege walking around without a mask as if nothing’s happening, when your privileged exposure could literally kill me.” 

With so much at stake, understanding the importance of structural policy change is essential to advancing health equity, she said. “If we don’t focus on that, we run the risk of creating a society where we’re going to have even wider margins of inequity, and that’s not going to help any of us.” 

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