Responding to COVID-19 in Georgia: Recommendations to Advance Racial Equity

Responding to COVID-19 in Georgia RECOMMENDATIONS TO ADVANCE RACIAL EQUITY Robert A. Hahn, Ph.D., MPH Abigail Cohen C.T. Stafford, MD Preface by Nathaniel Q. Smith Founder and Chief Equity Officer, Partnership for Southern Equity

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Contents PREFACE

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COVID-19 AND RACE IN GEORGIA

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ECONOMIC IMPACTS OF COVID-19

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ECONOMIC EQUITY RECOMMENDATIONS

INCREASE APPRENTICESHIP OPPORTUNITIES

MINORITY SMALL BUSINESS SUPPORT

EXPAND ACCESS TO RESPONSIBLE CREDIT AND CAPITAL

ADVOCATING FOR FEDERAL MINIMUM WAGE INCREASE

IMPACTS OF COVID-19 ON THE EDUCATIONAL SYSTEM

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EDUCATION RECOMMENDATIONS

PROVIDE UNIVERSAL CENTER-BASED EARLY CHILDHOOD EDUCATION

IMPLEMENT HIGH SCHOOL COMPLETION PROGRAMS

DEVELOP SCHOOL-BASED HEALTH CENTERS

PROVIDE CATCH UP PROGRAMS

FILL TECHNOLOGY GAPS HEALTH CARE ACCESS AND RACE

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HEALTH RECOMMENDATIONS

EXPAND ACCESS TO COVID-19 TESTING

IMPLEMENT VACCINES: AWARENESS CAMPAIGNS AND ACCESS

EXPANDED HEALTH CARE COVERAGE

THE AMERICAN RESCUE PLAN: A STEP IN THE RIGHT DIRECTION

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APPENDICES

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APPENDIX A: MAPS OF SOCIO-DEMOGRAPHIC CHARACTERISTICS IN GEORGIA COUNTIES APPENDIX B: C ASES AND DEATHS OF COVID-19 IN GEORGIA AS OF NOVEMBER 7, 2020

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This document was commissioned by the Partnership for Southern Equity and produced through the generous in-kind support of our Just Health Circle members, including its authorship by members of the Just Health Circle.

About the Partnership for Southern Equity Since 2008, the Partnership for Southern Equity (PSE), an Atlantabased nonprofit, has been advancing the cause of equity through a ecosystem-based model for multi-demographic engagement in the City of Atlanta and the surrounding metropolitan region – a bustling area emblematic of many Southern communities riven by racial, economic and class disparities.

Using its ability to connect, educate, and empower diverse individuals and organizations to encourage just, sustainable practices for shared prosperity, PSE has stood at the forefront of promoting balanced growth and shared prosperity throughout metropolitan Atlanta and the American South.

Focusing on four key areas – energy, growth, health and opportunity – PSE has developed strong partnerships, resulting in a series of successful policy initiatives that help elevate and enable the communities we serve.

About the Just Health Circle PSE believes we can advance health equity through collaboration and partnership, both with policy and decision-makers and people who live in communities most affected by health inequities.The Just Health Circle represents an organized group of key regional health equity leaders from the private, nonprofit, and government sectors.

What is Health Equity?

PSE’s Just Health issue area defines health equity as achieving the highest level of health for all people. It requires valuing everyone equally, with ongoing efforts to address avoidable inequities, historical and other injustices, and the elimination of health and health care disparities.

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Preface

This policy brief aims to articulate the relationship between the negative impacts of COVID-19 and race, as well as provide recommendations for policymakers to mitigate these negative outcomes in future decisions.

The COVID-19 global pandemic has starkly illuminated the ever-present problems produced by structural racism.

This policy brief was commissioned by the Partnership for Southern Equity and produced through the generous inkind support of our Just Health Circle members, including its authorship by members of the Just Health Circle.

It aims to articulate the relationship between the negative impacts of COVID-19 and race, as well as provide recommendations for policymakers to mitigate these negative outcomes in future decisions.

While these data may be provocative and new to some, we at the Partnership for Southern Equity understand the ways in which systemic racism compounds and accelerates negative outcomes for Black and historically disinvested communities of color. COVID-19 has reminded us that a variety of super-structures can compound the effects of this deadly pandemic, and we at PSE would posit that racism is not a social determinant of health but the social determinant of health for Black and other historically disinvested communities of color.

Even as the most urgent dangers of the pandemic may appear to be subsiding throughout America, communities of color continue to face very real threats. The ongoing detrimental consequences of COVID-19 will impact these communities far beyond this one “pandemic year.”

To effectively turn the tide on the pain inflicted by COVID-19, we must fight against structural racism using an intersectional approach.

By understanding the intersections between health, wealth, and education, we can chart a path towards true victory against COVID-19.

Some of the recommendations you will find in this policy brief include: Increase Apprenticeship Opportunities, Minority Small Business Support, Expand Access to Responsible Credit and Capital, and Advocating for Federal Minimum Wage Increase. These common-sense approaches are anchored in data and research and can set the stage for how policymakers might work collectively to heal communities that have been on the margins for centuries, and whose disparities have been deepened by inequitable policies and responses during this pandemic.

It is my hope that we use this research not only to expand the body of knowledge, but to move towards real policy changes that prioritize the health and well-being of Black and other historically disinvested communities of color – as well as mitigate the deepened divides and new disparities that these communities will continue to grapple with for years to come.

Onward towards equity,

Nathaniel Q. Smith, Jr. Founder and Chief Equity Officer Partnership for Southern Equity

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COVID-19 and Racial Inequities in Georgia Background The COVID-19 pandemic has affected the U.S. more severely than many other nations, probably due to lack of leadership and the divided state of the U.S. government and its citizens. The pandemic has also highlighted the persistent racism in the nation by more severely affecting Black and Hispanic populations and others in low income populations who work in service industries, including health care and other front-line occupations, and who were already at risk due to limited access to multiple societal resources such as education, health care, and justice, which are known and powerful determinants of health.

This document addresses the COVID-19 crisis among racial and ethnic minority populations in Georgia by providing: 1. A description of what is known about COVID-19 in these populations, including underlying social determinants.

2. Recommendations for action that are 2a) specific to the response to COVID-19, and 2b) address the underlying social determinants of health in Black and Hispanic populations in Georgia.

This document could be similarly developed for other states.

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Conditions COVID-19 IN BLACK AND HISPANIC POPULATIONS IN GEORGIA

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Data by race are missing in approximately 25% of records. Statements in this document include available data.

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Rates of COVID-19 cases* are higher in Georgia than in the U.S. for Blacks and even higher for Whites and Hispanics in Georgia than in the U.S. Tables 1-2

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Rates of COVID-19 deaths are higher in Georgia than in the U.S. for Whites, lower for Blacks, and substantially lower for Hispanics. Tables 1-2

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Compared with Whites in Georgia, Blacks have higher rates of cases and deaths, Hispanics have higher rates of cases and lower rates of death. Excesses in Georgia are lower than in the U.S. overall for Blacks, but similar for Hispanics. Tables 1-2

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An analysis of the effects of different characteristics of counties on rates of COVID-19 death in Georgia counties found that 3 county characteristics—% Black, % Poor, and concentration of people population % >65 years of age independently predicted county rates of COVID-19 death. (Gaglioti, 2020) Table 3

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Table 4 adds information about the similar inequitable distribution of vaccines in Georgia.

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Maps of underlying social determinants are found in the Appendix.

*Cases: Cases are people who are tested and found to be COVID-19 positive. They are an unknown undercount of all cases in a population because people with symptoms are more likely to get tested than those who are asymptomatic.

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FIGURE 1A

FIGURE 1B

FIGURES 1A AND 1B. CASES PER 100,000 PEOPLE AND DEATHS PER 100,000 PEOPLE BY DEMOGRAPHIC ACROSS GEORGIA

Notes: Georgia has reported demographic data for 80% of cases and 94% of deaths. Figures 1a and 1b only include demographic groups reported by the state. Race categories are mutually exclusive and defined as not Hispanic or Latino.

TABLE 1. RATIOS OF NON-WHITE/WHITE CASES AND DEATHS – GEORGIA AND U.S.

Georgia RACE VS. WHITE

United States

CASES

DEATHS

CASES

DEATHS

BLACK

1.3

1.3

1.8

2.2

HISPANIC

2.0

0.7

1.9

0.7

TABLE 2. RATIO OF CASES OF NON-WHITE RACES TO WHITE, CASES AND DEATHS – GEORGIA COMPARED TO U.S.

Georgia/United States CASES

DEATHS

WHITE

1.8

1.5

BLACK

1.3

0.9

HISPANIC

1.9

0.7

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TABLE 3. UNADJUSTED AND ADJUSTED NEGATIVE BINOMIAL REGRESSION MODELS OF THE ASSOCIATION BETWEEN SOCIODEMOGRAPHIC CHARACTERISTICS, HEALTH CARE ACCESSIBILITY, AND CONFIRMED COVID-19 DEATH RATES IN GEORGIA COUNTIES AS OF DECEMBER 09, 2020

TABLE 4. INEQUITABLE DISTRIBUTIONS OF RACE AND COVID OUTCOMES – GEORGIA, MARCH 2021

% Total Population

% Cases

% Deaths

% Vaccinations

BLACK

31

32

34

19

HISPANIC

10

13

6

2

WHITE

52

47

58

69

Population

KFF “Latest Data on COVID-19 Vaccinations Race/Ethnicity

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Economic Impacts of COVID-19

Economic inclusion of minority populations in economic programs and access is critical for boosting economic competitiveness and racial equity. The public and private sectors share a responsibility to address the lack of financial resources confronting Americans of color.

The Just Health Circle (JHC) of the Partnership for Southern Equity addresses these concerns and lays out four broad suggestions for mitigating the economic impacts of the COVID-19 pandemic on underrepresented communities in the South.

Recommendations 1. INCREASE APPRENTICESHIP OPPORTUNITIES 2. MINORITY SMALL BUSINESS SUPPORT 3. EXPAND ACCESS TO RESPONSIBLE CREDIT AND CAPITAL 4. ADVOCATING FOR FEDERAL MINIMUM WAGE INCREASE

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Increase Apprenticeship Opportunities The labor market for Americans of color has historically been narrower than that of their white counterparts. Black, Latinx, and other Americans of color face countless obstacles to both postsecondary training and entry into the workforce. As a result, wage gaps perpetuate inequities in wealth and the labor market is underutilized as jobs are left unfulfilled.

Middle-skill careers – those that require a high school diploma but not a four-year college degree – account for the largest portion of the labor market in the United States.Yet, these positions, such as health care technicians, computer specialists and electricians, are underemployed. Addressing the middle-skill gap is crucial to promoting financial equity and fighting the racial wage gap.

Promoting apprenticeships is one way to address this disparity as it would situate more Americans of color in the workforce at higher paying jobs. Apprenticeships combine classroom and on-the-job training to situate people in the labor market while simultaneously increasing access to higher education for marginalized groups. Increasing apprenticeship opportunities could increase earnings across underserved communities and reduce labor market segregations by increasing access to middle-skill jobs and training.

Listed below are a few of the pathways that apprenticeship programs can be expanded:

ESTABLISH EMPLOYER CONSORTIA

Creating employer consortia, or groups of employers, offers a cost-effective solution to establishing sustainable apprenticeships. A consortium should provide academic content with current and future employer needs. For employers, participation in a consortium should offer an affordable talent development strategy. Expanding the scale of apprenticeships through consortia can establish high-quality career pathways for people of color but requires large participation from employers.

STATEWIDE STRATEGIES

To advance apprenticeship programs and workforce development, we recommend that the State of Georgia create a statewide policy to link youth and existing apprenticeships. This will help to greater align Georgia’s education system with the state’s workforce system while also diversifying the labor market. California’s initiative for expanding statewide apprenticeships, The Road to 500,000 Apprentices, offers a good resource for building Georgia’s future.

REFORM THE 1937 NATIONAL APPRENTICESHIP ACT

The 1937 National Apprenticeship Act directs the United States Secretary of Labor to develop national standards for apprenticeship programs in different occupations. The Act also calls on the federal government to link employers with workers. On February 5, 2021 the U.S. House of Representatives passed the first reform of the National Apprenticeship Act in over 80 years. Now awaiting the Senate vote, the bill could greatly increase the number of available apprenticeship slots with its dedication to funding state labor agencies.

If passed, the policy could help enroll underserved populations in the job market.

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Minority Small Business Support Though Black Americans make up over 14% of the national population, only 2.2% of the nearly six million employer businesses are Black owned. Entrepreneurs of color face unique obstacles in comparison to white business owners.

Specifically, minority businesses confront discrimination in acquiring capital and accessing critical support services such as healthcare and paid time off. Minority owned firms are more likely to be have their loan applications rejected, are more likely to pay higher interest rates and tend to receive smaller loans. Making matters worse, existing financial assistance mechanisms do not properly account for the experiences of business owners of color. The following recommendations could help to expand support for marginalized businesses:

Extend the Truth in Lending Act Communities of color are often subjected to predatory and exploitative loans. The Truth in Lending Act (TILA) exists to protect consumers from unjust lending practices. Under TILA, crucial information such as total cost, annual percentage rate, and other specific terms must be explicitly stated in credit card and loan agreements. As of now, TILA does not apply to small business loans. Extending the Truth in Lending Act would promote financial equity in communities of color by protecting small business owners from exploitative loans.

Invest in Black and Latinx Businesses, Suppliers and Donors Strengthen and Expand the Affordable Care Act Small business owners need the assurance of affordable health care in order to stay in operation. Reasonable health insurance supports the prosperity and success of minority business owners by removing an added burden. The Affordable Care Act initially provided minority business owners with greater access to healthcare than ever before. However, recent rollbacks of the law have stunted progress. The reform disproportionately affected people of color and now threaten access to adequate health care for small business owners and their employees. To secure the health and safety of minority small businesses, we suggest the follow changes be made to ACA: • • • •

Guarantee the coverage for people with pre-existing conditions Strengthen the existing system of subsidies to continue making healthcare affordable Continue expanding Medicaid among states, including Georgia Increase investments in Federally Qualified Health Centers since they provide care to entrepreneurs and their families in underserved areas

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Expanding Access to Responsible Credit and Capital Marginalized communities need expanded access to responsible credit and capital.To specify, responsible capital refers to funds that are not attached to exploitative borrowing terms like excessive interest rates. Not only are Black Americans more likely to have their loan applications rejected, they also pay higher interest rates on loans. This makes it more expensive for Black and Latinx Americans to buy a house, secure a car, or further their education. Higher interest rates results in less money available for day-to-day and emergency expenses. The COVID-19 pandemic has exacerbated this shortage of funds amongst marginalized populations.

To promote racial equity moving forward, we recommend financial institutions adapt their system to better address the needs of Black and Latinx households and individuals. Our suggestions include:

Fill Product Gaps Minorities are more likely to make use of alternative financial services (AFS) such as payday lenders and check cashers which address immediate needs but tend to come with higher transaction costs. Moreover, AFS do not help to establish credit. As a result, Black and Latinx communities confront a lack in access to both credit and low interest loans.

Traditional financial institutions can help by offering services that benefit people of lower socioeconomic standing. They may consider offering mechanisms like instant access to check deposit funds, courtesy overdrafts and earlier access to paychecks and wages. These adjustments may not generate as much revenue for institutions but will broaden their market over time while also addressing the needs of more people of color.

Reform Marketing and Communications It is imperative that banks and other financial institutions raise awareness about any existing low-cost banking mechanisms. This can be done by proactively tailoring messages to communities of color, which could include nationwide ad campaigns involving key Black and Latinx influencers and translating materials into other languages.

Invest in Community Development Financial Institutions (CDFI) Community Development Financial Institutions or CDFIs and minority depository institutions (MDIs) serve areas that may typically be overlooked by commercial banks.

CDFIs seek to improve the well-being of communities by expanding access to affordable, sustainable financial services. While CDFIs can be profitable, they are not profit maximizing.

They judge their success on the amount of economic opportunity that they bring to a population. When managed properly, CDFIs can responsibly fill lending gaps and provide minorities with necessary initial capital.

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FIGURE 2. INFOGRAPHIC FROM “RACIAL EQUITY IN BANKING STARTS WITH BUSTING THE MYTHS,” BLOG POST, BOSTON CONSULTING GROUP.

Advocate for Federal Minimum Wage Increase Enacting the Raise the Wage Act would gradually increase the U.S federal minimum wage from $7.25.The act proposes an increase to $15 per hour by 2025. This would improve the salaries of millions of people across the country. Nearly 40 percent of Black workers will see an increase in the pay when the minimum wage is increased.

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Impacts of COVID-19 on the Educational System

Disparities in educational achievement between students from racial/ethnic minority families and those from white families, as well as between students from low-income families and those from more affluent families, are well documented. Although reading and math scores generally have improved for all race/ethnic groups since 1992 and for all income levels since 2003, gaps in educational achievement persist. Disparities in student educational achievement have long-term consequences: education has been demonstrated to be one of the most important determinants of health and longevity.

Education is well recognized as a critical determinant of health equity. Education remains a challenging issue during the covid pandemic. The challenge is to continue to provide education at multiple levels while avoiding the spread of COVID-19.

Recommendations 1. PROVIDE UNIVERSAL CENTER-BASED EARLY CHILDHOOD EDUCATION 2. IMPLEMENT HIGH SCHOOL COMPLETION PROGRAMS 3. DEVELOP SCHOOL-BASED HEALTH CENTERS 4. PROVIDE CATCH UP PROGRAMS 5. FILL TECHNOLOGY GAPS

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Provide Universal Center-Based Early Childhood Education Lifelong educational attainment is one of the most important determinants of long-term health. Incomplete or poorquality education can jeopardize a child’s prospects for health and well-being. Risk factors for low educational attainment appear even before children enter the educational system: a mother with less than a high school education; family use of food stamps or receipt of welfare payments; living in a single-parent household; and having parents whose primary language was not English. Black, Hispanic, and Asian children were 2.5, 2.5, and 2.1 times, respectively, as likely as white children to have 1 or more risk factors. A child’s number of risk factors is strongly associated with measures of general knowledge, reading and mathematics abilities, fine motor skills, and social behavior among entering kindergartners.

There is strong evidence that center-based Early Childhood Education (ECE) programs improve educational outcomes.

Program effects on standardized test scores persist following program completion, with declining effect sizes over time. There is evidence that center-based ECE programs improve several long-term social and health outcomes. All program types (state and district programs, Head Start programs, and model programs) are effective.

We recommend that center-based Early Childhood Education be provided for all children in the state and that particular attention be given to assure that low-income and minority children receive high quality center-based Early Childhood Education.

Because poor and minority children are likely to live in poor, often segregated neighborhoods, they are also more likely to attend lower-quality schools, as measured, for example, by average school achievement and school safety. The assurance of high quality post-ECE educational is essential for the persistence of the benefits of ECE.

Hahn RA, Barnett WS, Knopf JA, Truman BI, Johnson RL, Fielding JE, Muntaner C, Jones CP, Fullilove MT, Hunt PC, Community Preventive Services Task Force. Early childhood education to promote health equity: a community guide systematic review. Journal of public health management and practice 2016 Sep;22(5):E1.

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Implement High School Completion Programs On the basis of systematic scientific evidence, PSE recommends High School Completion (HSC) programs for the long-term promotion of the health of minority and low-income communities.

High school completion is an established predictor of long-term health. In 2005, a 25-year-old man in the U.S. with a high school education could expect to live 6.7 years longer than a man who had not completed high school; a woman with a high school education could expect to live 7.0 years longer than a woman who had not.

In the 2009–2010 school year, the proportions of students who completed high school in 4 years varied markedly by race/ethnicity: 83.0% of whites, 66.1% of blacks, and 71.4% of Hispanics. COVID-19 can be expected to exacerbate these differences.

A systematic review found the following types of programs were shown to be effective for all at-risk students, including students who were pregnant, in this approximate order:

VOCATIONAL TRAINING ALTERNATIVE SCHOOLS SKILLS TRAINING, INCLUDING COGNITIVE BEHAVIORAL THERAPY COLLEGE-ORIENTED PROGRAMMING MENTORING AND COUNSELING SUPPLEMENTAL ACADEMIC SERVICES SCHOOL AND CLASS RESTRUCTURING MULTISERVICE PACKAGES ATTENDANCE MONITORING AND CONTINGENCIES COMMUNITY SERVICE CASE MANAGEMENT

Refer to the Economic Impacts of COVID-19 for a details on Apprenticeship Programs.

Details of the review and the programs can be found here: Hahn RA, Knopf JA, Wilson SJ, Truman BI, Milstein B, Johnson RL, Fielding JE, Muntaner CJM, Jones CP, Fullilove MT, Moss RD, Ueffing E, Hunt PC, and the Community Preventive Services Task Force. Programs to increase high school completion: a Community Guide systematic health equity review [PDF - 918 kB]. Am J Prev Med 2015;48(5):599–608.

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Develop School-Based Health Centers School-based health centers would assist in the long-term promotion of the health of children and youth in minority and low-income communities. Inequalities in the U.S. by race, ethnicity, and income in key health outcomes and educational achievement are well documented. Although educational inequalities have declined modestly in recent years, they persist. Health outcomes and educational achievement are related to each other by several causal pathways.

Health problems (e.g., vision and oral health problems, asthma, teen pregnancy, malnutrition, obesity, chronic stress, and inattention and hyperactivity disorders) and risk-taking behavior (e.g., aggression and violence, unsafe sexual activity, unhealthy eating, physical inactivity, and substance use) are associated with low scholastic performance. COVID-19 can be expected to exacerbate these differences.

Conversely, low academic achievement is strongly associated with risk-taking behavior, compromised health status, and reduced longevity. Children from low-income and racial or ethnic minority populations in the U.S. are more likely to develop chronic health problems than are more-affluent and non-Hispanic white children and less likely to have a usual source of medical care. Children and adolescents from low-income and racial and ethnic minority populations in the United States commonly experience worse health, are less likely to have a usual place of health care, and miss more days of school because of illness than do children and adolescents from the less economically and socially disadvantaged populations. They also are more likely to be hungry and have problems with vision, oral health, or hearing. Addressing these obstacles can be critical to their education and long term health.

School-based health centers (SBHCs) provide health services to students preK-12 and may be offered on-site (i.e., school-based centers) or off-site (i.e., school-linked centers).

The systematic review found improvements in both educational and health outcomes for children and youth in schools with SBHC: Improved educational outcomes include school performance, grade promotion, and high school completion. Improved health outcomes include the delivery of vaccinations and other recommended preventive services, asthma morbidity, emergency department and hospital admissions, contraceptive use among females, prenatal care and birth weight, and other health risk behaviors. There was also evidence that the societal benefits of SBHCs are greater than the intervention costs. Further, SBHCs result in net savings to SBHC users and the Medicaid program.

Full details and evidence of this review are available at: Knopf JA, Finnie RK, Peng Y, Hahn RA, Truman BI,Vernon-Smiley M, Johnson VC, Johnson RL, Fielding JE, Muntaner C, Hunt PC. School-based health centers to advance health equity: a community guide systematic review. American journal of preventive medicine. 2016 Jul 1;51(1):114-26

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Provide Catch Up Programs In 2019, national reading ability in 8th grade was 10% lower for Blacks than for Whites, and 7% lower among Hispanics than among whites. Gaps in math and reading achievement expand during the summer months when regular school is not in session. The “faucet theory” hypothesizes that summer loss is caused by the relative scarcity of academic resources for low-income students during summer when resources available during the school year are “turned off.”

Higher-income students often have access to enrichment activities. “Summer loss” effects accumulate over a lifetime of schooling and are a source of the persistent achievement gap between students of lower and higher socioeconomic status (SES). Summer out-of-school-time programs may be particularly effective in countering summer loss. COVID-19 can be expected to exacerbate these differences. Out-of-School-Time Academic Programs for the COVID-related learning loss for children and youth in minority and low-income communities could help to fill the achievement gap.

The following subject areas should be focused on in these programs:

Reading Programs are recommended for academically at-risk students in grades K-3.

Math Programs are recommended for academically at-risk students, with potentially larger effects among older students (grade levels 7-12).

General Academic Programs that focus on more than one subject are recommended for academically at-risk students of all grade levels.

Programs with Minimal Academic Content are recommended provide time for homework, i.e., supervised work time do not have insufficient evidence to determine their effectiveness.

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Fill Technology Gaps COVID-19 emphasized the digital divide within the United States. As the country responded to the pandemic and moved to virtual settings, those without stable internet and adequate technological skills struggled to adapt. As a result, disparities between the haves and the have-nots widened.This gap in technological access is also shown in metro areas versus rural areas.

TO COMBAT THIS, WE SUGGEST THE FOLLOWING:

STUDENTS OF COLOR DO NOT HAVE EQUAL

Ensure Minority Schools Have Tech Resources Assure that low-income and minority school youth and children have needed digital technology learning equipment and digital connectivity.

ACCESS TO TECHNOLOGY

Parental Academic Tutorial Supports Virtual/public broadcast learning circles (engagement, outreach).

Parental Technology Usage Hubs Parental learning devices supports (PTO-21 parental coaching policy by parent-teacher planning days).

TECHNOLOGY GAPS ALSO EXIST BETWEEN METRO AND NON-METRO STUDENTS

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Health and Race The COVID-19 pandemic has affected the U.S. more severely than many other nations, probably due to lack of leadership and the divided state of the U.S. government and its citizens. In addition, federal and state public health infrastructure has been inadequately funded in recent decades. The pandemic has also highlighted the persistent structural racism in the nation by more severely affecting Black and Hispanic populations and others in low-income populations who work in service industries including health care and other front-line occupations and who were already at risk due to poor access to multiple societal resources such as education, health care, justice, which are known powerful determinants of health.

As a result of past mistreatment of the Black community by the US health system, (e.g., the Tuskegee Experiment, and broader discrimination in health care) there is general distrust of public health programs among minority populations. Although the intention to seek vaccination is increasing, there is distrust of the COVID-19 vaccination program on the part of Blacks and Hispanics and frontline workers, many of who are members of minority populations (CDC. gov). However, access to testing, vaccines, and health care for Black, Hispanic, and low-income populations in Georgia and the U.S. remain the dominant problems.

Recommendations 1. REBUILD PUBLIC HEALTH INFRASTRUCTURE 2. EXPAND HEALTH CARE ACCESS 3. EXPAND TESTING AVAILABILITY 4. EXPAND VACCINATIONS AVAILABILITY 5. IMPLEMENT VACCINE MEDIA CAMPAIGNS

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Rebuild Public Health Infrastructure The proportion of the federal budget allocated to public health has declined substantially in last 50 years, and per capita funding for public health matters varies substantially among states—with Georgia among the lower levels of state funding.

National estimates of recent public health expenditures exceed true expenditures by large amounts. In addition, federal funding for emergency preparedness has declined steadily since 2000. Substantial underfunding, among other causes, has limited the ability of local, state, and federal public health responses to COVID-19. Underfunded public health activities include epidemiological surveillance, immunization services, disease prevention programs, and the operation of public health laboratories.

Restoration of funding for these activities is essential for improved capacity to respond to public health crises such as the COVID-19 pandemic.

Himmelstein DU, Woolhandler S. Public health’s falling share of US health spending. American journal of public health. 2016 Jan;106(1):56-7.

Leider JP, Resnick B, Bishai D, Scutchfield FD. How much do we spend? Creating historical estimates of public health expenditures in the United States at the federal, state, and local levels. Annual review of public health. 2018 Apr 1;39:471-87.

Leider JP, Resnick B, McCullough JM, Alfonso YN, Bishai D. Inaccuracy of official estimates of public health spending in the United States, 2000–2018. American journal of public health. 2020 Jul;110(S2):S194-6.

Maani N, Galea S. COVID-19 and underinvestment in the public health infrastructure of the United States. The Milbank Quarterly.

2020 May 14;98(2).

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Expand Health Care Access Georgia is one of only 12 states that have not yet expanded Medicaid coverage. The benefits of expanding Medicaid coverage are numerous and could serve to insure more than 50% of currently uninsured non-White adults in Georgia.

Medicaid expansions in other states have been shown to decrease various forms of mortality, including maternal and infant mortality, and to reduce delated medical care and illness as well. Medicaid expansion also improves economic welfare as well as reducing uncompensated hospital care which may be associated with the closing of hospitals in rural Georgia. Expanding Medicaid in Georgia would promote racial equity in the health system. Georgians for a Healthy Future propose multiple recommendations in response to the COVID-19 pandemic, with a focus on low-income, minority, and rural populations. Expanding Medicaid in Georgia is a central recommendation of this paper.

https://www.cbpp.org/research/health/chart-book-the-far-reaching-benefits-of-the-affordable-care-acts-medicaid-expansion

Expand Covid Testing Availability In collaboration with Federal agencies, Georgia should actively design, promote and implement COVID-19 screening and surveillance monitoring programs in minority high risk communities/neighborhoods. Racial and ethnic minority populations in the U.S. suffer an excess burden of COVID-19 because of the multiple forms and manifestations of racism.

State public health agencies should implement county-level community-based panels consisting of appointed community leaders, to serve as advisory members of local boards of health. Accurate and timely surveillance data should be shared with affected community and neighborhood leadership (via inclusive leadership models), and as an adjunct quarterly reporting requirement of district office county health board meetings (i.e., standing agenda item).

Expand Vaccination Availability While suspicion of government programs is reasonable given past and ongoing racial discrimination in the health system, the Partnership for Southern Equity believes that the nation’s current COVID-19 vaccination campaign is legitimate and necessary. We believe the vaccination campaign can help mitigate the harms of the pandemic across Black, Hispanic and other marginalized groups. It is likely that the major impediments to vaccination among minority and low-income populations is not vaccine resistance by lack of access. We recommend that those eligible for vaccination, including racial and ethnic minority populations and especially those in high-risk categories – frontline workers, nursing home residents, the elderly, and those living with other health conditions – get vaccinated to protect themselves, their families and their communities.

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Implement Vaccine Media Campaigns Developing media campaigns to counteract vaccine hesitancy can help to assure communities of color that the vaccine is safe. Some suggestions for the campaigns include: • •

Feature and emphasize respected voices from Black and Latinx communities.

Highlight the no-cost aspect of the vaccine. Many people still don’t know that the vaccine does not require insurance.

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American Rescue Plan: A Step in the Right Direction The newly enacted American Rescue Plan Act of 2021 (ARPA) will provide a wide range of benefits to states, and demonstrates a strong focus on low-income populations. (Center on Budget and Policy Priorities) Examples of ARP provisions are:

•

Funding for COVID-19 testing, contact tracing, and mitigation activities

•

Emergency development grants for rural healthcare

•

Allows employers to provide FFCRA leave and obtain tax credits to offset certain costs associated

•

Funding for rental and utility assistance to people who are in danger of being evicted

•

Funding to help the homeless, including the conversion of properties like motels into shelters

•

Funding to food assistance programs to mitigate the nation’s high levels of hunger

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Temporary tax relief for student loan forgiveness

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Reforming the Narrative While numerous actionable recommendations can be made to promote equity among Americans of color, deeper issues are embedded in society’s common narratives and work to perpetuate racial inequities. For real systemic change, we must confront these ideas and advocate for reform.While the resistance demonstrations of the summer of 2020 and the manifest inequitable consequences of COVID-19 in U.S. society have enlivened recognition of the deep racist roots of inequity in the U.S., a basic understanding of structural racism, and its history and ongoing presence, is still not widespread in the U.S. and is fiercely resisted by large segments of the nation.

Progress in the promotion of racial equity in the U.S. is likely to require major policy changes, such as have been initiated in the American Recovery Plan, as well as extensive educational programs and campaigns to bring awareness to more of the population of the presence, persistence, deep roots of inequity and pathways to reform.

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APPENDIX A MAPS OF SOCIO-DEMOGRAPHIC CHARACTERISTICS IN GEORGIA COUNTIES

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APPENDIX B CASES AND DEATHS OF COVID-19 IN GEORGIA AS OF NOVEMBER 7, 2020

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