Few events better illustrate the chasm that exists between the wealthiest and most vulnerable Americans than the coronavirus pandemic that struck the United States in early 2020.
So said a panel of experts at St. John’s University’s 12th Biennial Poverty Conference. The October 29 symposium, “Pandemic and Poverty,” considered ways in which underserved populations experienced additional crisis points in the early stages of the pandemic.
The experts agreed that economic and social disparities laid bare inequities in the health-care system that stressed marginalized communities to a near breaking point. While COVID-19 has moderated, the social circumstances it magnified linger.
“It revealed what we already knew, that inequities exist in our society,” said Dave A. Chokshi, M.D., the former Commissioner of the New York City Department of Health and the symposium’s keynote speaker. “These are avoidable and unfair. These are choices that we make as a society and they resulted in the outcomes we saw: People who were of low incomes bore the brunt of the COVID pandemic.”
The three-hour symposium, held in the D’Angelo Center Ballroom, brought together Dr. Chokshi, who headed up New York City’s medical response to COVID-19, and six members of St. John’s faculty whose sectors were impacted by the pandemic.
The panel featured Jennifer S. Bhuiyan, Pharm.D., College of Pharmacy and Health Sciences; Fred P. Cocozzelli, Ph.D., Associate Professor, Government and Politics, St. John’s College of Liberal Arts and Sciences; Cdr. (ret.) Harlem Gunness, Ph.D., M.P.H., Associate Professor, College of Pharmacy and Health Sciences; Aliya E. Holmes, Ph.D., Associate Professor, Curriculum and Instruction, The School of Education; Rafael Art. Javier, Ph.D., ABPP, Professor, Psychology, St. John’s College of Liberal Arts and Sciences; and Ansel Schiavone, Ph.D., Assistant Professor, Economics and Finance, The Peter J. Tobin College of Business.
A collaboration between the Vincentian Center for Church and Society and the Faculty Research Consortium of the Vincentian Institute for Social Action, the conference was attended by members of the St. John’s community and the public at large. Still others watched via livestream.
Dr. Chokshi’s hour-long speech touched on the need to learn lessons from the coronavirus response, anticipating that another future pandemic is almost certain. Asking hard questions about health-care access, he said, is the best way to protect the most vulnerable.
“Why in the wealthiest nation in the history of nations do we have so many New Yorkers who struggle to make ends meet?” Dr. Chokshi asked. “I see this in my clinical practice—people who have to live paycheck to paycheck just to cover their insulin costs.”
“The fundamental question we have to wrestle with starts with putting health-care equity at the center of the conversation,” he continued. “When we talk about equity, it’s often a sideshow and not the main event.”
That was particularly evident in the earliest days of the pandemic, Dr. Chokshi said, when the virus tore through the city’s less affluent neighborhoods. Unable to retreat to less populated environments, the city’s poor were easy targets for the virus. Once infected, prior medical conditions, often untreated, left them more likely to experience serious illness.
Even as vaccinations became available in early 2021, the poor often lacked the ability to travel to a vaccination center.
“There is a reason people from certain groups were more likely to be infected by the virus,” Dr. Chokshi said. “Our task is to ask why. And why were some people more prone to serious illness? Some groups are more likely to suffer from obesity, heart disease, and diabetes, but the conversation can’t end there.”
“We need to have the courage to keep unpacking layers and asking why upon successive why,” Dr. Chokshi added.
The answer to those questions, he said, will come from an honest assessment of systemic inequities in health-care delivery that include racism.
“Why, for example, are some groups more likely to have diabetes? The answer is not primarily in biology,” Dr. Chokshi said. “It’s in structural factors. It’s in the way certain people have access to food, or to physical activity in a neighborhood where they can exercise in safety, or from stress in the way racism gets under the skin and makes people more prone to certain medical conditions.”
As officials ask why, Dr. Chokshi said, they also must ask the Vincentian question, “What must be done?” How can systemic inequities in health-care delivery be overcome?
A start, he said, was his department’s October 2021 declaration of racism as a public health crisis. That was followed a month later by the establishment of the city’s first-of-its-kind Coalition to Confront Racism in Medical Algorithms. The city even offered financial incentives to those willing to be vaccinated and restricted indoor dining to vaccinated guests.
“Far too often, the conversation about equity remains just that—a conversation,” Dr. Chokshi said. “But it has to be about moving to action. I derive inspiration from the Vincentian philosophy.”
Fittingly, he was joined by members of St. John’s faculty who added their own observations. Dr. Bhuiyan, who heads up a mobile health-care delivery service, noted how the poor often lack the means to buy COVID-19 deterrents such as hand sanitizer or masks.
Dr. Holmes, a curriculum specialist, noted how a quick pivot to online learning unsettled many families who were unable to afford technological necessities. “Some homes didn’t have internet access, and some families only had one device and had to share it among all the children,” she said.
And as the pandemic lingered, Dr. Javier said psychologists noted an increase in alcohol and substance abuse, domestic violence, and child abuse. “We lost the sense of safety and security that guided us before,” he said.