Biden’s COVID-19 Health Equity Task Force

On January 21, 2021, President Biden issued an executive order titled: “Executive Order on Ensuring an Equitable Pandemic Response and Recovery.” The order called for an emphasis on ensuring the people who were disproportionately affected by COVID-19 would receive the help they needed. It also called for the creation of the COVID-19 Health Equity Task Force.

The “Executive Order on Ensuring an Equitable Pandemic Response and Recovery” started with:

“By the authority vested in me as President by the Constitution and the laws of the United States of American, and in order to address the disproportionate and severe impact of coronavirus disease 2019 (COVID-19) on communities of color and other underserved populations, it is hereby ordered as follows:”

Section 1. Purpose

This section starts by pointing out inequities on America’s health care system.

“The COVID-19 pandemic has exposed and exacerbated severe and pervasive health and social inequities in America. For instance, people of color experience systemic structural racism in many facets of society and are more likely to become sick and die from COVID-19. The lack of complete data, disaggregated by race and ethnicity, on COVID-19 infection, hospitalization, and mortality rates, as well as underlying health and social vulnerabilities has further hampered efforts to ensure an equitable pandemic response…”

The Mayo Clinic posted information on August 13, 2020, titled: “Why are people of color more at risk of coronavirus complications?” It was written by William F. Marshall, III M.D. From the information:

Research increasingly shows that racial and ethnic minorities are disproportionately affected by coronavirus disease 2019 (COVID-19) in the United States.

According to recent data from the Centers for Disease Control and Prevention (CDC), non-Hispanic American Indian or Alaska Native people had an age-adjusted COVID-19 hospitalization rate at about 5.3 times that of non-Hispanic white people. COVID-19 hospitalization rates among non-Hispanic Black people and Hispanic or Latino people were both about 4.7 times the rate of non-Hispanic white people.

While there’s no evidence that people of color have genetic or other biological factors that make them more likely to be affected by COVID-19, they are more likely to have underlying health conditions. Having certain conditions, such as type 2 diabetes, increases your risk of severe illness with COVID-19. But experts also know that where people live and work affects their health. Over time, these factors lead to different health risks among racial and ethnic minority groups…

Here are some factors mentioned in the Mayo Clinic information:

Racial and ethnic minority members might be more likely to live in multi-generational homes, crowded conditions and densely populated areas such as New York City. This can make social distancing difficult.

Many people of color have jobs that are considered essential or can’t be done remotely and involve interacting with the public. In the U.S., according to the CDC, nearly 25% of employed Hispanic and Black or African Americans work in the service industry, compared with 16% of non-Hispanic white workers. Black or African Americans also account for 30% of licensed practical and licensed vocational nurses. Many people of color also depend on public transportation to get to work. These factors can result in exposure to the virus.

Members of racial and ethnic minority groups are more likely to encounter barriers to getting care, such as a lack of health insurance or not being paid when missing work to get care. In 2017, according to the CDC only about 6% of non-Hispanic white people were uninsured, while the rate was nearly 18% for Hispanics and 10% for non-Hispanic Black people.

Racism also may play a role in health risks. The stress of dealing with racial discrimination can take a toll on your body, causing early aging. This has been linked to underlying conditions, which can increase the risk of severe illness with COVID-19.

The executive order continues with:

“…Other communities, often obscured in the data, are also disproportionately affected by COVID-19, including sexual and gender minority groups, those living with disabilities, and those living at the margins of our economy. Observed inequities in rural and Tribal communities, territories, and other geographically isolated communities require a place-based approach to data collection and the response. Despite increased State and local efforts to address these inequalities, COVID-19’s disparate impact on communities of color and other underserved populations remains unrelenting…”

Kaiser Family Foundation (KFF) published the results of a poll on March 11, 2021. The poll was titled: “The Impact of the COVID-19 Pandemic on LGBT People”. From the findings:

There has been little data on how the coronavirus pandemic has impacted the lives of lesbian, gay, bisexual and transgender individuals (LGBT) in the U.S. Drawing on previous research indicating that LGBT individuals are at greater risk of both COVID-19 health and economic outcomes, this analysis examines the reported experiences from self-identified LGBT individuals from two months of KFF COVID-19 Vaccine Monitor and finds that LGBT people have experienced the COVID-19 pandemic differently than non-LGBT people, including being harder hit in some areas:

Economic: A larger share of LGBT adults compared to non-LGBT adults report that they or someone in their household has experienced COVID-era job loss (56% v 44%).

Mental Health: Three-fourths of LGBT people (74%) say worry and stress from the pandemic has had a negative impact on their mental health, compared to 49% of those who are not LGBT, and are more likely to say that negative impact has been major (49% v 23%).

Views: One-third (34%) of LGBT adults say the news has generally underestimated the seriousness of the pandemic (compared to 23% of non-LGBT adults). Three-fourths of LGBT adults (74%) are either “very worried” or “somewhat worried” that they or someone in their family will get sick from the coronavirus, similar to responses from non-LGBT adults (67%). A large share of LGBT adults report being willing to take CDC recommended steps to avoid acquisition/transmission of the virus.

…Limited early data available on how LGBT people have experienced the COVID-19 pandemic in the United States (U.S.) has suggested that this group may be disproportionately impacted. The reasons are far-reaching and may include: LGBT individuals being at a greater risk of worse COVID-19 outcomes due to higher rates of comorbidities; working in highly affected industries such as health care and restaurants/food services; living on average on lower incomes than non-LGBT people; experiencing stigma and discrimination related to sexual orientation/gender identity, including in accessing health care and, for transgender individuals, being less likely to have health coverage…

Johns Hopkins University posted a report on April 23, 2020, titled: “COVID-19 poses unique challenges for people with disabilities”. From the report:

…For people with disabilities, all the general challenges that come with the pandemic certainly apply, but there are additional barriers. The first is communication – getting information can be more difficult for people with vision, hearing, and even cognitive disabilities, as popular news sources may not be accessible, especially when information is changing quickly… Keeping all of us informed is key to the COVID-19 public health response, but information is not accessible to the disability community…

…The second barrier involves adopting recommended public health strategies, such as social distancing and washing hands. For example, frequent hand-washing is not always feasible for people with certain types of physical disabilities… …public health policies often do not consider people with disabilities, leaving a gap in guidance. Those who have personal aides and caregivers also need to be considered, as they cannot participate in social distancing in the same way that others are…

…The third, equitable access to health care, is a long-standing barrier worsened by COVID-19. This ranges from getting a coronavirus test to being seen in an emergency room. For instance, drive-up testing may be impossible if you rely on state mobility services. There are also existing barriers in health care settings that are exacerbated as the industry aims to meet the surge of COVID-19 cases. For example, the use of personal protective equipment, including masks, can make communication more difficult for patients with hearing loss…

…There’s fear that medical resource allocation, including ventilators, may be discriminatory against patients with disabilities, and complaints have been filed in multiple states about these rationing policies…

The Centers for Disease Control and Prevention (CDC) posted information on August 19, 2020, titled: “CDC data show disproportionate COVID-19 impact in American Indian/Alaska Native populations”. From the information:

The Centers for Disease Control and Prevention (CDC) released a new study that specifically examines how COVID-19 is affecting American Indians and Alaska Natives (AI/AN) – one of the racial and ethnic minority groups at highest risk of the disease. CDC found that in 23 selected states, the cumulative incidence of laboratory-confirmed COVID-19 cases among AI/AN was 3.5 that of non-Hispanic whites.

These data also showed that AI/AN who tested positive for SARS-CoV-2 tended to be younger than white non-Hispanic individuals with COVID-19 infection. Compared to whites, a higher percentage of cases among AI/AN individuals were in people under 18 years of age (12.9 percent AI/AN; 4.3 percent white), and a smaller percentage of cases were among AI/AN 65 years or older (12.6 percent AI/AN; 28.6 percent white). Limited data were available to quantify the disparity in COVID-19 incidence, COVID-19 disease severity, and outcomes among AI/AN persons compared with those among other racial/ethnic groups, reinforcing the need to prioritize improved data collection as a key strategy to understand and improve health outcomes.

Recent CDC studies have shown that AI/AN are among the racial and ethnic minority groups at higher risk for severe COVID-19 outcomes. Persisting racial inequity and historical trauma have contributed to disparities in health and socioeconomic factors between AI/AN and white populations that have adversely affected tribal communities. The elevated incidence within this population might also reflect differences in reliance on shared transportation, limited access to running water, household size, and other factors that might facilitate community transmission…

The last part of the Purpose section says:

“Addressing this devastating toll is both a moral imperative and pragmatic policy. It is impossible to change the course of the pandemic without tackling it in the hardest-hit communities. In order to identify and eliminate health and social inequalities resulting in disproportionately higher rates of exposure, illness, and death, I am directing a Government-wide effort to address health equity. The Federal Government must take swift action to prevent and remedy differences in COVID-19 care and outcomes within communities of color and other underserved populations.”

Section 2. COVID-19 Health Equity Task Force

The second part of the executive order is about setting up a COVID-19 Health Equity Task Force.

“There is established within the Department of Health and Human Services (HHS) a COVID-19 Health Equity Task Force (Task Force).”

On January 30, 2020, CBS News posted an article titled: “Trump creates task force to lead U.S. coronavirus response”. From the article:

President Trump has created a new task force to lead the government’s response to the fast-spreading coronavirus, the White House announced Wednesday.

Led by Health and Human Services Secretary Alex Azar and coordinated through the National Security Council, the task force is made up of subject matter experts from across the federal government and has been meeting daily since Monday. Members of the 12-member group include National Security Adviser Robert O’Brian, Centers for Disease Control and Prevention Director Dr. Robert Redfield, and the National Institutes of Health’s Dr. Anthony Fauci.

“The task force will lead the administration’s efforts to monitor, contain and mitigate the spread of the virus, while ensuring that the American people have the most accurate and up-to-date health and travel information,” the White House said…

President Biden’s executive order describes who will be on his COVID-19 Health Equity Task Force, what the group will do, and other information.

“The task force shall consist of the Secretary of HHS; an individual designated by the Secretary of HHS to Chair the Task Force (COVID-19 Health Equity Task Force Chair); the heads of such other executive departments, agencies, or offices (agencies) as the Chair may invite; and up to 20 members from sectors outside the Federal Government appointed by the President.”

Xavier Becerra is the Secretary of Health and Human Services (HHS). According to The New York Times, he is the first Latino to serve as health secretary. On March 18, 2021, the Senate confirmed him with a vote of 50-49. Senator Susan Collins of Maine was the only Republican to support his confirmation. Previously, he was California’s Attorney General. The Secretary of Health and Human Services will select someone to be the COVID-19 Health Equity Task Force Chair.

Federal members may designate, to perform the Task Force functions of the member, a senior-level official who is a part of the member’s agency and a full-time officer or employee of the Federal Government.

Nonfederal members shall include individuals with expertise and lived experience relevant to groups suffering disproportionate rates of illness and death in the United States; individuals with expertise and lived experience relevant to equity in public health, health care, education, housing, and community-based services; and any other individuals with expertise the President deems relevant. Appointments shall be made without regard to political affiliation and shall reflect a diverse set of perspectives.

Members of the Task Force shall serve without compensation for their work on the Task Force, but members shall be allowed travel expenses, including per diem in lieu of subsistence, as authorized by law for persons serving intermittently in Government service (5. U.S.C. 5701-5757).

At the direction of the Chair, the Task Force may establish subgroups consisting exclusively of Task Force members or their designees under this section, as appropriate.

Mission and Work of the COVID-19 Health Equity Task Force:

“Consistent with applicable law and as soon as practicable, the Task Force shall provide specific recommendations to the President, through the Coordinator of the COVID-19 Response and Counselor to the President (COVID-19 Response Coordinator), for mitigating the health inequities caused or exacerbated by the COVID-19 pandemic and for preventing such inequities in the future. The recommendations shall include:”

Recommendations for how agencies and State, local, Tribal, and territorial officials can best allocate COVID-19 infection, hospitalization, and mortality in certain communities and disparities in COVID-19 outcomes by race, ethnicity, and other factors, to the extent permitted by law;

Recommendations for agencies with responsibility for disbursing COVID-19 relief funding regarding how to disburse funds in a manner that advances equity;

Recommendations for agencies regarding effective, culturally aligned communication, messaging, and outreach to communities of color and other underserved populations.

“The Task Force shall submit a final report to the COVID-19 Response Coordinator addressing any ongoing health inequalities faced by COVID-19 survivors that may merit a public health response, describing the factors that contributed to disparities in COVID-19 outcomes, and recommending actions to combat such disparities in future pandemic responses.”

What the COVID-19 Health Equity Task Force will do regarding data collection:

“…To address the data shortfalls identified in section 1 of this order, and consistent with applicable law, the Task Force shall:”

Collaborate with the heads of relevant agencies, consistent with the Executive Order entitled “Ensuring a Data-Driven Response to COVID-19 and Future High-Consequence Public Health Threats,” to develop recommendations for expediting data collection for communities of color and other underserved populations and identifying data sources, proxies, or indices that would enable development of short-term targets for pandemic-related actions for such communities and populations;

Develop, in collaboration with the heads of relevant agencies a set of longer-term recommendations to address these data shortfalls and other foundational data challenges, including those relating to data intersectionality, that must be tackled in order to better prepare and respond to future pandemics; and

Submit the recommendations described in this subsection to the President through the COVID-19 Response Coordinator.

The next few paragraphs set up more about what the Task Force can do. They may seek the views of health professionals; policy experts; State, local, Tribal and territorial health officials; faith-based leaders; businesses; health providers; community organizations; those with lived experience with homelessness, incarceration, discrimination, and other relevant issues; and other stakeholders.

The Federal Advisory Committee Act may apply to the Task Force, and any functions of the President under the Act, (except section 6) shall be performed by the Secretary of Health and Human Services. HHS will provide funding and administrative support for the Task Force (as permitted by law and within existing appropriations).

The Chair shall convene regular meetings of the Task Force, determine its agenda, and direct its work. The Chair shall designate an Executive Director of the Task Force, who shall coordinate the work of the Task Force and head any staff assigned to the Task Force.

The COVID-19 Health Equity Task Force will terminate within 30 days of accomplishing the objectives set forth in this order, including the delivery of the report and recommendations specified in this section, or 2 years from the date of this order, whichever comes first.

Section 3. Ensuring an Equitable Pandemic Response.

“…The Secretary of Agriculture, the Secretary of Labor, the Secretary of HHS, the Secretary of Housing and Urban Development, the Secretary of Education, the Administrator of the Environmental Protection Agency, and the heads of all other agencies with authorities or responsibilities relating to the pandemic response and recovery shall, as appropriate and consistent with applicable law:”

Consult with the Task Force to strengthen equity data collection, reporting, and use related to COVID-19;

Assess pandemic response plans and policies to determine whether personal protective equipment, tests, vaccines, therapeutics, and other resources have been or will be allocated equitably, inducing by considering:

The disproportionately high rates of COVID-19 infection, hospitalization, and mortality in certain communities; and

Any barriers that have restricted access to preventative measures, treatment, and other health services for high-risk population;

Any barriers that have restricted access to preventive measures, treatment, and other health services for high-risk populations;

The effect of proposed policy changes on agencies’ abilities to collect, analyze, and report data necessary to monitor and evaluate the impact of pandemic response plans and policies on communities of color and other underserved populations

Policy priorities expressed by communities that have suffered disproportionate rates of illness and death as a result of the pandemic;

Strengthen enforcement of anti-discrimination requirements pertaining to availability of, and access to, COVID-19 care and treatment; and

Partner with States, localities, Tribes, and territories to explore mechanisms to provide greater assistance to individuals and families experiencing disproportionate economic or health effects from COVID-19, such as by expanding access to food, housing, child care, or income support.

The next part instructs the Secretary of HHS to provide recommendations to State, local, Tribal, and territorial leaders on how to facilitate the placement of contact tracers and other workers in communities that have been hardest hit by the pandemic, recruit such workers from those communities, and connect such workers to existing health workforce training programs and other career advancement programs.

The Secretary of HHS must also conduct an outreach campaign to promote vaccine trust and uptake among communities of color and other underserved populations with higher levels of vaccine mistrust due to discriminatory medical treatment and research and engage with leaders within those communities.

Members of the Biden-Harris Administration COVID-19 Health Equity Task Force

On February 10, 2021, President Biden announced who would be on the COVID-19 Health Equity Task Force.

The Task Force is chaired by Dr. Marcella Nunez-Smith. She is an associate professor of internal medicine, public health, and management at Yale, and is one of the nation’s foremost experts on disparities in healthcare access. According to information posted by Yale, Dr. Marcella Nunez-Smith had called attention to the unequal burden borne by communities of color.

She is also associate dean for health equity research, director for the Center for Community Engagement and Health Equity, and the founding director of the Equity Research and Innovation Center (ERIC) at Yale School of Medicine. Dr. Marcella Nunez-Smith grew up in the U.S. Virgin Islands.

In the press briefing about the Task Force, it states: “As Chair, Dr. Nunez-Smith will also ask six additional Federal agencies to be represented on the COVID-19 Health Equity Task Force as federal members. This includes the United States Department of Agriculture, Department of Education, Department of Health and Human Services, Department of Housing and Urban Development, Department of Justice and Department of Labor.

The twelve Task Force members represent a diversity of backgrounds and expertise, a range of racial and ethnic groups, and a number of important populations, including: children and youth, educators and students; health care providers, immigrants; individuals; public health experts; rural communities; state, local, territorial, and Tribal governments, and unions.

Mayra E. Alvarez, MPH is President of the Children’s Partnership, a California advocacy organization working to advance child health equity.

Previously, she served in the U.S. Department of Health and Human Services during the Obama-Biden administration, including at the Centers for Medicare and Medicaid Service, the Office of Minority Health, and the Office of Health Reform. She also served as a Legislative Assistant in the US Senate and House of Representatives. She grew up in California, and graduated from the School of Public Health at University of North Carolina at Chapel Hill and the University of California at Berkeley.

James Hildreth, PhD, MD is president and chief executive officer of Meharry Medical College, the nation’s largest private, independent historically black academic health sciences center.

Dr.Hildreth served previously as the dean of the College of Biological Sciences at University of California, Davis and as a professor and associate dean at Johns Hopkins University School of Medicine. Dr. Hildreth is a member of the National Academy of Medicine an an internationally acclaimed immunologist whose work has focused on several human viruses including HIV.

He currently serves on the advisory council for the NIH director and as a member of the FDA Vaccines and Related Biological Products Advisory Committee. Dr. Hildreth has led Meharry’s efforts to ensure that disadvantaged communities have access to COVID-19 testing and vaccines. He graduated from Harvard University as a Rhodes Scholar, from Oxford University with a PhD in immunology and obtained an MD from Johns Hopkins School of Medicine.

Andrew Imparato, JD Andy Imparato is a disability rights lawyer and Executive Director of Disability Rights California, where he has spearheaded advocacy on crisis standards of care and vaccine prioritization in the last year.

Imparato joined DRC after a 26-year career in Washington DC, where he served as the chief executive of the Association of University Centers on Disabilities and the American Association of People with Disabilities. From 2010-2013, Imparato served as Chairman Tom Harkin’s Disability Policy Director on the U.S. Senate Committee on Health, Education, Labor and Pensions. Imparato’s perspective is informed by his lived experience with bipolar disorder.

Victor Joseph was elected by the 42 member tribes to the position of Tanana Chiefs Conference (TCC) Chief/Chairman in March of 2014 and served through October of 2020. As the Chief Chairman he was the principle executive officer for the corporation and presided over all corporate meetings of the member tribes.

Prior to being elected TCC’s Chief Chairman Victor was employed as TCC’s Health Director from 2007 to 2014. He worked for TCC a total of 28 years in a variety of leadership positions. He has also served as Alaska Representative on the U.S. Department of Health and Human Services Secretary’s Tribal Advisory Committee and on the Indian Health Services Budget Formulation Committee. Joseph is a tribal member of the Native Village of Tanana. He has extensive experience building strong working relationships with tribal leaders, colleagues, staff, and funding agencies and corporate beneficiaries.

Joneigh Khaldun, MD, MPH is the Chief Medical Executive for the State of Michigan and the Chief Deputy Director for Health in the Michigan Department of Health and Human Services (MDHHS). She is the lead strategist for Michigan’s COVID-19 response.

Prior to her role in Michigan she was the Director of the Detroit Health Department, where she established a comprehensive reproductive health network and led Detroit’s response to the Hepatitis A outbreak. Dr. Khaldun has held former roles as the Baltimore City Health Department’s Chief Medical Officer and Fellow in the Obama-Biden Administration’s Office of Health Reform in the US Department of Health and Human Services. She obtained her BS from the University of Michigan, MD from the Perelman School of Medicine at the University of Pennsylvania, and MPH in health policy from George Washington University. She practices emergency medicine part-time at Henry Ford Hospital in Detroit.

Octavio N. Martinez, Jr. MD, MBA, MPH is the Executive Director for the Hogg Foundation for Mental Health at The University of Texas at Austin. Additionally, Martinez is a Senior Associate Vice President within the university’s Division of Diversity and Community Engagement; clinical professor in the university’s School of Social Work; and professor at Dell Medical School’s Department of Psychiatry.

He grew up in Texas, and has a MPH from Harvard University’s School of Public Health, an MD from Baylor College of Medicine, and an MBA and BBA in Finance from The University of Texas at Austin.

Tim Putnam, DHA, EMS is President and CEO of Margaret Mary Health, a community hospital in Batesville, Indiana and has over 30 years of healthcare experience. He received his Doctorate in Health Administration from the Medical University of South Carolina where his dissertation was focused on acute stroke care in rural hospitals.

He is a past president of the Indiana Rural Health Association and the National Rural Health Association. In 2015 he was appointed by the Governor to the newly created Indiana Board of Graduate Medical Education and has chaired the Board since its inception. Dr. Putnam is also a certified Emergency Medical Technician.

Vincent C. Toranzo is an active student from Broward County, Florida. Mr. Toranzo has experience with the inner workings of municipality functions. He serves as the State Secretary of the Florida Association of Student Councils advocating for the inclusion of student voices in their community, such as assistance to foster children and the assurance of students’ safety amidst the COVID-19 pandemic.

Mr. Toranzo was awarded the U.S. President’s Award for Educational Excellence and a Citizenship Award for School and Public Services from his local U.S. congresswoman.

Mary Turner, RN is an ICU nurse at North Memorial Medical Center in Robbinsdale and in her sixth year as President of the Minnesota Nurses Association (MNA) union – the Minnesota affiliate of National Nurses United.

She previously worked at Abbott Northwestern Hospital in Minneapolis for 10 years. Turner has been on the National Nurses United’s Joint Nursing Commission since 2011. She serves as the Chair of the Board for Isuroon, which provides empowerment, culturally sensitive health education, and advocacy for Somali women.

Homer Venters, MD is a physician and epidemiologist working at the intersection of incarceration, health, and human rights. Dr. Venters is currently focused on addressing COVID-19 responses in jails, prisons, and immigration detention facilities.

Dr. Venters is the former Chief Medical Officer of the NYC Correctional Health Services and author of Life and Death in Rikers Island. Dr. Venters has also worked in the nonprofit sector as the Director of Programs for Physicians for Human Rights and President of Community Oriented Correctional Health Service. Dr. Venters is a Clinical Associate Professor of the New York University College of Global Public Health.

G. Robert (“Bobby”) Watts, MPH, MS is the CEO of the National Health Care for the Homeless Council, which supports 300 Health Care for the Homeless FQHC’s and 100 Medical Respite programs with training, research, and advocacy to end homelessness. Watts has 25 years’ experience in administration, direct service, and implementation of homeless health and shelter services.

Watts served as Executive Director of Care for the Homeless in New York City for twelve years. He is a graduate of Cornell University and Columbia University’s Mailman School of Public Health from which he holds an MPH in health administration and an MS in epidemiology.

Haeyoung Yoon, JD is Senior Policy Director at the National is Senior Policy at the National Domestic Workers Alliance. Over the course of her career, Yoon has worked on low-wage and immigrant workers rights issues.

Prior to National Domestic Workers Alliance, Yoon was a Distinguished Taconic Fellow at Community Change. Yoon also has extensive litigation experience and taught at the New York University School of Law and Brooklyn Law School. She recently testified before the House Judiciary Committee’s Subcommittee on Immigration and Citizenship regarding Immigrants as Essential Workers during COVID-19. Yoon received her JD from CUNY School of Law, her MA from Harvard University, and her BA from Barnard College.

Biden’s COVID-19 Health Equity Task Force is a post written by Jen Thorpe on Book of Jen. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!