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We Protect Health By Prioritizing Equity

Columns appearing on the service and this webpage represent the views of the authors, not of The University of Texas at Austin.

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10% and 11% of Texans polled believed health care was the most important problem facing the country and Texas, respectively.

While it may be the case that coronavirus doesn’t discriminate, people and health systems still do.

The lack of public data available about the racial and ethnic dimensions of the coronavirus pandemic means we cannot know the true impact this disease is having on our communities. This gap in our understanding blunts the effectiveness of our mitigation efforts and undermines our resilience in the face of this crisis over the long run. The collection and reporting of this data should be a top priority at all levels of government, including the state of Texas.

Even without complete demographic data, early reports highlight historic disparities. Data released by the Centers for Disease Control and Prevention list the race and ethnicity of 65 percent of all coronavirus cases as unspecified. While Texas has a much smaller gap of 18 percent missing data, complete demographic data about this crisis is crucial for allocating resources and prioritizing equity in their allocation.

For example, current Texas data shows COVID-19 prevalence among African Americans at more than one-third higher than their share of the Texas population (17.2 percent versus 12.3 percent), but accurate data might reveal a true proportion ranging from equal to nearly three times worse. Absent comprehensive data, health professionals are unable to understand the pandemic to its full extent.

Lawmakers and leading boards of medicine, including the American Medical Association, the American Academy of Pediatrics, and the American Psychiatric Association, have released letters to the U.S. Department of Health and Human Services (HHS) urgently calling on the government to collect, standardize, and make publicly available race and ethnicity data regarding testing, hospitalization, and mortality associated with COVID-19.

Tragically, the limited demographic data that is available reveals a common trend: coronavirus is infecting and killing black Americans at a disproportionately high rate. While the President acknowledged this disparity, commenting that the impact of coronavirus on the African American community is “terrible” and “a tremendous challenge,” his administration, alongside a bipartisan array of state governments across the nation, has so far failed to deliver more comprehensive data on the race and ethnicity of COVID-19 patients.

This public health crisis is underscoring the well-documented health disparities that African Americans already face, including higher risk for experiencing obesity, high blood pressure and diabetes compared with white Americans. On average, black Americans are less likely than other groups to have health insurance and are more likely to live in densely packed areas and in multigenerational housing. When taken together, these reasons are part of why U.S. Surgeon General Dr. Jerome Adams has said that people of color are “socially predisposed” to coronavirus exposure.

Texas can set a better example.

The state has been tracking demographics on people who test positive for COVID-19, but the race and ethnicity data on people who have died is far less complete. Only 32 states are reporting COVID-19 mortality data by race/ethnicity. Texas has released the data that it does have, but it is woefully incomplete, with race and ethnicity only known for just under a third of confirmed fatality cases.

To be sure, some people prefer not to report their race or ethnicity on medical forms. There is no mandate in place requiring patients to fill in those fields or public health systems to track down that information.

Despite the evidence showing the importance of having complete and accurate data on race and ethnicity for improving the quality, usefulness, and representativeness of public health surveillance and monitoring systems, the notion of increased surveillance or mandated data collection about vulnerable communities is, understandably, not always an easy sell for patients.

Still, it is crucial that we summon the will to act now to assemble the complete racial and ethnic data necessary to address disparities in health equity, both now and into the future. Lives stand in the balance, and without a complete picture of how this public health crisis is disproportionately affecting our communities, we do not stand a chance against the spread of this disease. Government leaders must prioritize robust and complete demographic data collection about this crisis, and Texas can lead the way.

Octavio N. Martinez, Jr. is the executive director of the Hogg Foundation for Mental Health and senior associate vice president for diversity and community engagement at The University of Texas at Austin. He is also a clinical professor at the UT School of Social Work and professor of psychiatry at Dell Medical School.

Andy Keller is president and CEO of the Meadows Mental Health Policy Institute. He is a psychologist with more than 20 years of experience in behavioral health policy.

A version of this op-ed appeared in the San Antonio Express News and the Austin American Statesman.

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Texas Perspectives is a wire-style service produced by The University of Texas at Austin that is intended to provide media outlets with meaningful and thoughtful opinion columns (op-eds) on a variety of topics and current events. Authors are faculty members and staffers at UT Austin who work with University Communications to craft columns that adhere to journalistic best practices and Associated Press style guidelines. The University of Texas at Austin offers these opinion articles for publication at no charge. Columns appearing on the service and this webpage represent the views of the authors, not of The University of Texas at Austin.

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