Florida health equity experts reflect on progress, setbacks two years into COVID

When she began her career as a primary care doctor more than two decades ago, Kelli Tice could point to a slew of troubling statistics about health disparities among minority and underserved communities compared to the rest of the population.

She knew that Black people have a lower life expectancy, and disproportionately high rates of asthma, diabetes and heart disease; that Black people die of most cancers at rates higher than people in other racial groups; that deaths among pregnant Black people in the United States are comparable to those in developing nations; and that Black babies die at a higher rate than white babies.

“I spent most of my career doing that sort of work,” said Tice, who now serves as chief health equity officer for GuideWell, a health-care nonprofit that oversees Florida Blue. “I felt like we were sounding the alarm.”

Even so, Tice said the harrowing statistics remained. So when the COVID-19 pandemic began nearly two years ago, Tice knew the effect on minority communities would be devastating, and disproportionately felt.

But as the pandemic raged on and stories about health disparities began to sweep headlines, Tice saw an opportunity to bring widespread attention to the inequities she and others had been working to address for so long.

She asked herself, could this be what leads to lasting change?

Disparities in limelight

Experts like Tice have been working to close the gaps between the health care haves and have-nots for years. But gaining the traction necessary to result in a substantial change in health outcomes has been difficult, Tice said.

What’s different about the pandemic, she said, is that it exposed and exploited disparities in health, health care access and resources on a global scale. People were forced to start paying attention.

“It became an emergency, an illustration of how we’ve neglected Black and brown communities,” Tice said.

Now, with many public officials and private citizens eager to move past the still-active pandemic, experts say it’s vitally important to keep attention on the massive resources still needed to eliminate health disparities.

CDC data shows that Black people have accounted for at least 92,000 COVID-19 deaths since the pandemic began. Researchers say that’s likely an underestimate, because 15 percent of the deaths reported did not include information on race. They say Black people are about 1.7 times more likely to die of the virus than are white people, when age adjustments are made.

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Because minority and underserved communities already have a higher prevalence of preventable chronic diseases such as diabetes and heart disease, the risk of becoming seriously or fatally ill from the coronavirus increased, said Sabrina Dickey, a Florida State University scientist and nurse educator who focuses on health disparities within the Black population.

On top of the greater risk of illness, other factors resulted in a higher risk of exposure. People in lower-paying jobs had to continue working indoors at places with lots of foot traffic, such as grocery stores. When vaccines became available, some weren’t able or willing to get them, because they lacked transportation or access to accurate information.

Furthermore, the stressors and the financial hardships disproportionately felt by people of color during the pandemic have had serious consequences for both mental and physical health, Dickey said.

“It was a crisis on top of a crisis,” Dickey said.

Frustration and affirmation

If any good comes out of this moment of collective grief and widespread loss, it is that “a black light” has been shone on the effect of biases in health care delivery, said LaDonna Butler.

Butler is the founder of The Well for Life, a mental health and community center in St. Petersburg’s historically Black 22nd Street S district, known as the Deuces.

“It’s affirming to know that the general population can now see things that people of color have been saying forever,” Butler said. “But it’s also alarming and frustrating that this is what it took to get people to care.”

It’s encouraging that investors now seem more interested in putting money and time into lifting up Black and brown communities, Butler said. Now the question becomes whether or not the investment lasts or if the support fades away as disparities move out of the headlines and are no longer thought of as a “hot issue.”

“There’s a sense of urgency about lifting these priorities up now, but historically we have a short-term memory,” Butler said. “What will the long-term commitment be? There’s concern that once this moment passes things will go back to the way they have always been, and that would be more harmful, because that is saying, ‘We recognize the need, we just don’t care enough to address it.’”

Jing Wang, the dean of the College of Nursing at Florida State University, said it will be important for universities to invest in opportunities to bring people from diverse backgrounds into the medical profession.

Kevin Sneed, dean of the USF Health Taneja College of Pharmacy, added that it’s equally crucial for medical professionals and researchers to get out into the community and learn the needs of their patients — and to avoid relying solely on old models of engagement.

“Not all African Americans go to church, so singularly using the churches isn’t good enough,” Sneed said. “If we really want to affect people, we have got to find a way to build further trust, and communicate with the community.”

A moment or a movement?

Although the pandemic has propelled health care inequities into focus, experts say there are already some signs that momentum is flagging.

While there was early emphasis on displaying data on COVID outcomes by race, for example, several states have stopped publishing that data, which is an important part of identifying needs. Early disparities in vaccine distribution were corrected with mobile clinics and targeted outreach, but those efforts have also slowed. In a letter to Gov. Ron DeSantis last month, a group of Florida pastors said they felt their communities had been left behind.

Legislative pushback to addressing systemic racism has come in a number of bills during Florida’s legislative session, including the governor’s “anti-WOKE” bill, which would let parents sue schools based on discomfort, targeting the teachings of critical race theory.

The medical community has long looked to the public and philanthropic sectors to lead the way on initiatives meant to tackle health inequities, Tice said. While good work comes out of public health departments — where she spent the majority of her career — she said funding can be a barrier to radical change.

“A lot of work that needs to be done requires upfront resources that your public sector isn’t really going to have access to,” Tice said.

Alison Yager, executive director of the Florida Health Justice Project, said that although philanthropic donations have streamed toward health-equity issues, the pandemic has underscored how underprepared the state is to deal with these problems.

“We know that Florida has systematically disinvested in our public health infrastructure year over year for the past decade,” she said. “It’s in a moment like this where those decisions have really come home to roost. We’ve seen how our systems have really lost (their) muscle.”

Still, Tice said, she was encouraged by health officials’ ability to mobilize for community needs in the pandemic. Before 2020, people working to address health equity were spending time and resources on telling the story of disparities, to try and get people to acknowledge the disparities and invest.

“Rather than trying to convince you that this is an actual thing, we can work together to solve it,” Tice said. “Because the pandemic was an emergency. We didn’t have time to do convincing. We had to just build the thing that works.”

Former Times staff writer Margo Snipe contributed to this report.

The Foundation for a Healthy St. Petersburg provides partial funding for Tampa Bay Times stories on equity. It does not select story topics and is not involved in the reporting or editing.

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How to get tested

Tampa Bay: The Times can help you find the free, public COVID-19 testing sites in Citrus, Hernando, Hillsborough, Manatee, Pasco, Pinellas, Polk and Sarasota counties.

Florida: The Department of Health has a website that lists testing sites in the state. Some information may be out of date.

The U.S.: The Department of Health and Human Services has a website that can help you find a testing site.

• • •

How to get vaccinated

The COVID-19 vaccine for ages 5 and up and booster shots for eligible recipients are being administered at doctors’ offices, clinics, pharmacies, grocery stores and public vaccination sites. Many allow appointments to be booked online. Here’s how to find a site near you:

Find a site: Visit vaccines.gov to find vaccination sites in your ZIP code.

More help: Call the National COVID-19 Vaccination Assistance Hotline.

Phone: 800-232-0233. Help is available in English, Spanish and other languages.

TTY: 888-720-7489

Disability Information and Access Line: Call 888-677-1199 or email DIAL@n4a.org.

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