We can’t ignore the lessons of the COVID-19 crisis: our healthcare and public health system were not ready for the pandemic, and we have to be honest about how we got here. In his first days in office, President Biden acted swiftly and decisively to improve health equity in the U.S. by signing at least nine executive orders addressing systemic issues that adversely affect racial and ethnic minority communities.
As Daniel E. Dawes, a leader in the health equity movement, told me—COVID-19 has proven to be “the great revealer” of disparities in our healthcare system. The disease is not the cause, rather, a symptom of inequities stemming from more than 150 years of the political determinants of health, which actually cause the social determinants of health. In addition to healthcare provider disparities, we’re suffering from a previous dearth of investment in public health infrastructure and supply chains, a lack of coordinated federal response to COVID-19, and previous data siloes (or gaps) that make coordination of pandemic response nearly impossible.
Some of the specific orders from President Biden that could impact health equity include1:
EO 13985: Advancing Racial Equity and Support for Underserved Communities through the Federal Government establishes a “whole of government” approach to create opportunities for communities that have been historically underserved, marginalized, and adversely affected by persistent poverty and inequality. It cites an analysis that this approach “benefits everyone” where closing racial gaps in wages, housing credit, lending, and access to higher education could amount to an additional $5 trillion in GDP over the next five years.
EO 13994: Ensuring a Data-Driven Response to COVID-19 and Future High-Consequence Public Health Threats creates a framework for better data collection while preserving personal privacy through an improved public health infrastructure that will collect, provision, and analyze data, including key equity indicators, regarding the COVID-19 response.
EO 13995: Ensuring an Equitable Pandemic Response and Recovery establishes the COVID-19 Health Equity Task Force to mitigate health inequities caused or exacerbated by COVID-19 and to prevent such inequities in the future.
EO 14009: Strengthening Medicaid and the Affordable Care Act (ACA) seeks to establish a Special Open Enrollment period to address the 30 million Americans who remain uninsured, many of whom are Black, Latino, and Native American. It also imposes a review of all existing agency actions to ensure they advance ACA and Medicaid to make high-quality healthcare accessible and affordable for every American.
Another result of these orders is a new distribution of COVID-19 vaccine to communities disproportionately affected by COVID-19. Because distribution was previously a function of states, the federal government is now prioritizing sending vaccines directly to pharmacies and community health centers that are not subject to layers of bureaucracy that typically result in inequitable distribution.
While we have a long way to go as a country, addressing healthcare disparities, investing in public health, and coordinating federal response will reduce inequities while concurrently preparing us for future disasters and their disproportionate effects on LGBTQ+ and communities of color.