Reducing inequity, increasing health

When I last wrote, I wrote about wrapping up my first semester of school in seventeen years. Without ever using the words “health equity,” I also touched on that: a state in which “everyone has a fair and just opportunity to be as healthy as possible.”

For my final assignment in one of my courses, I noted, I wrote my assigned letter to the editor on vaccine inequity in my local community. As COVID-19 continues to spread and mutate, vaccine inequity continues to enhance existing health inequities in ways both profound and consequential–most of all, for those already incredibly vulnerable.

The local COVID-19 vaccination gap I described has narrowed slightly since I submitted this assignment in late May. This morning, the gap I addressed in-assignment is now down to around 27 percentage points, which you can see for yourself on the “Vaccines” tab of my city’s COVID-19 dashboard.

Reducing COVID-19 vaccine inequity; increasing health

Over the last several months, the City of Long Beach has made incredible
strides vaccinating its citizens against COVID-19. In a few short months,
fully 50.4% of Long Beach citizens have been vaccinated. Unfortunately,
these vaccinations have not been equitably distributed; those areas with
citizens most desperately in need of vaccinations are the very areas with
the lowest proportion of vaccinated residents. Failure to quickly bridge this
lethal vaccine equity gap could result in ongoing devastation, not only to
residents of these areas but to all those with whom they connect.

Within the United States, COVID-19 infection rates are three times higher
among Black, Latinx, and indigenous individuals. This national inequity is
replicated locally. For example, in Long Beach’s 90813 zip code, which has
both substantial Black, Latinx, and indigenous populations and the city’s
lowest life expectancy, COVID-19 infection rates are nearly the city’s
highest. By tragic contrast, its vaccination rates are the city’s lowest. Today,
only 35.5% of 90813’s residents have been vaccinated. This stands in stark
contrast to the comparatively white, wealthy 90815 zip code, where 67.4%
of residents are vaccinated. This 30-point disparity is about more than
abstract numbers; it is about life and death for those most at risk of
infection.

Sadly, the Long Beach citizens most at risk of infection—those very people
underrepresented in vaccinations to date—are those with the fewest
resources to successfully fend off a COVID-19 infection. For those who
have managed to retain their jobs in the economic devastation wreaked by
COVID-19, their jobs are typically low-wage, low-autonomy ones requiring
face-to-face contact with members of the broader public; for those who
were unable to retain their jobs, enhanced economic precariousness
breeds physical vulnerabilities that also greatly contribute to the severity of
COVID-19 infection. With or without job, these citizens are the ones least
likely to have the resources—such as time, reliable transportation, and
internet access for appointment scheduling—required to obtain vaccination.

Happily, there is much that can be done to begin bridging this gap at little
cost; the costs are certainly much lesser than those correlated with not
acting quickly to bridge them, and thereby continuing to see both infections
and mutations spread! One option is to scale up mobile vaccination clinics;
for people without access to reliable transportation, dramatically increasing
the reach of mobile clinics would reduce the impact of both transportation
and time accessibility issues that greatly contribute to Long Beach vaccine
inequity. Another option includes partnering with sizable local employers—
especially public-facing ones, like grocery stores—to bring vaccinations
directly to where those most vulnerable work; ideally, vaccinations in such
places could also be made available to members of the public. Still another
option involves partnering with local faith organizations to simultaneously
build trust in and make accessible COVID-19 vaccines.

What I’ve written here barely scratches the surface of either the problem or
possible solutions. My hope, though, is not to solve the problem alone, but
to help inspire others to join in solving this eminently solvable problem.
_____

SOURCES

• American Journal of Public Health, November 2020 (https://
ajph.aphapublications.org/doi/10.2105/AJPH.2020.306087)
• Davis, Mike: The Monster Enters: COVID-19, Avian Flu and the
Plagues of Capitalism, 2020
• Los Angeles Times, May 2021 (https://www.latimes.com/science/
newsletter/2021-05-10/vaccine-campaign-canvassing-incentivescoronavirus-
today)
• USC Annenberg Center for Health Journalism, April 2021 (https://
centerforhealthjournalism.org/2021/04/12/covid-19-exposes-longstanding-
health-inequities-california-s-seventh-largest-city)

On COVID-19 & a semester concluded

In the week since finishing my first semester in seventeen years, I’ve wanted to write about the semester. I’ve simultaneously been too bone-weary to muster additional words and unsure what, exactly, I wanted to write about the semester: the period that began my formal journey toward a public health career. I haven’t known what to say, at least not in a handful of words.

Wednesday evening, I came across an article that helped me clarify what I want to say, for now. The article movingly wove together themes showing up throughout the semester in both my classes; most noteworthy, however, was how it explicitly joined themes from final assignments in both my Spring 2021 courses. Continue reading “On COVID-19 & a semester concluded”

COVID-19 & the permission to rest

“This is going to sound strange,” my care provider said, “but you have COVID lungs.”

Relieved, I replied, “That doesn’t sound strange at all.”

In late January, my whole family came down with what we thought was a terrible cold. It bowled over three-quarters of the household; me, worst of all. No matter what I did, took, or tried, I couldn’t catch my breath. Continue reading “COVID-19 & the permission to rest”

fueled, well

A few days ago, one of my sons brought up Christmas. Filled with excitement, he imagined aloud what he might get for Christmas.

Far from feeling elated myself, I felt a surge of panic at the mere mention of any day not today. This year, Christmas for me doesn’t mean candy with a side of connection, or peace with a pile of presents nabbed from under a sparkling tree.

It means the promise of even more devastation than has transpired in 2020 so far.

This time of this year, anything bigger than this moment terrifies me.

I asked that Christmas list reflections be kept in Christmas lists,
for which my husband gently chided me: Continue reading “fueled, well”

home

These days, I seldom leave home.

These days, the world as I experienced it pre-COVID now seems absurdly large and over-full:

too much bustle,
too much driving,
too much distraction,
too much to do, all the time.

The last couple of months especially have been, in many ways, just the right level of full: Continue reading “home”

nothing more to do

I asked my husband, Anthony, if our kids could have extra screen time today: “Is 6 p.m. OK? I’d like to write a post.”

“Sure,” Anthony said, before returning to playing his video game.

Having gotten that okay to write a post, I suddenly found that … nothing I wanted to write could possibly fit into so small a time.

I decided not to write. Instead, I made my sons whipped cream; for such a simple treat, they rejoice every single time I make it (?!?!).

But when I was done, I realized I had a veritable ocean of minutes left between then and end of tonight’s-new-screentime-end. So: I decided to read blogs, for the first time in many days.


As luck would have it, the top couple of posts in my feeds described the 22nd of every month as “Pepper Day.” So I decided, knowing these posters but not much about Pepper Day: Why not?

Why not spend a dozen minutes simply stating exactly where I am right now?

Where I am:

The month since my sons began school has been harder than I could possibly explain. I thought last Spring’s willy-nilly, on-the-fly virtual instruction would have prepared me for more structured Fall virtual classes, but, wow, was I wrong.

This became clear when, one day a couple of weeks ago, I found myself struggling to explain to my older son how to answer a math problem. I was so damn tired, I literally couldn’t access the memory to understand–let alone explain–something that has been bone-deep knowledge for me since I was my son’s age.

After a lifetime of telling myself I Can Do Anything, Always, Period,

I went to my car and sobbed for several minutes before, knowing I could not possibly keep going as-was, I wondered what I could change and–still deep into bouts of sobbing–contacted my work team to say I could not sustain working eight hours daily right now … at least not without hurting myself and my family.

Fantastic news: They understood! All pretty much instantly replied that I ought take care of myself, and my family, so that …

I wondered: How did this not occur to me sooner?

How did it not occur to me to tap out?

Why, apart from ever-loud societal expectations (including those non-verbally communicated to me oft by my own intellectually-believed-otherwise mom) that women should work themselves to the bone and then dig even deeper into the bone, had it not occurred to me to just say: “I cannot sustain this in these circumstances”?!

Regardless of what held me back before that tear-filled moment,

I’m glad those sobs brought me clarity:

I cannot sustain this.

So, not yet two weeks into my new-er normal, I am so relieved to have confronted the fact I could not continue as-was.

While I can’t speak for next week, or next month, it seems quite probable, now, that I could continue as-is for some time–

with “as-is” being a combination of time, encouragement, and support,
as well as the bliss of having having made a few moments, every day,
to stare at the ceiling
with nothing more,
then,
to do.

even so, or: “shoes”

This time last year, my husband introduced me to the 2006 music video “Shoes.”

When the video began playing, I couldn’t imagine why Anthony shared it. WTF was it, even?

By the end of the video, though, I was laughing. Hard. I couldn’t remember laughing that hard, or feeling so very-not-serious about anything, for years.

My kids and I ended up watching dozens of videos by the video’s maker, Kelly Liam Kyle Sullivan. Our favorites were “Muffins” and “Kelly’s Hollywood Meeting.”

When my late October birthday came around, my husband bought me two gifts: a Kelly shirt emblazoned with BETCH (Being En Total Control of Herself, natch), and another with the proprietor of Cunningham Muffins at her very wildest, muffin-loving best. Continue reading “even so, or: “shoes””

to reach for the sun

A few weeks ago, my six-year-old and I planted seeds in paper cups.

We stuck the paper cups outside and committed to watering them. Daily, ish.

With such a vague “commitment,” we watered them every few days. In the intense heat of August in SoCal, the seeds failed not only to thrive, but to show even the merest hints of growth.

Last weekend, my six-year-old and I planted new seeds in paper cups.

We planted green bean, watermelon, and tomato seeds. We committed to watering these each and every evening. Continue reading “to reach for the sun”

to be: healed

In late April, I read about an ER doctor in Manhattan who had committed suicide. Her father said, “She tried to do her job, and it killed her.”

I tweeted a link to the New York Times article with the below text:

The MD BIL who persuaded me to pursue #publichealth instead of social work told me #moralinjury could kill me:
being deprived, systemically, of the ability to do the right thing.

This doctor was—IS—a hero.
Had we better systems,
she could have remained a *living* hero.

I followed up that

The one person still in my life since I was born is a nurse. She told me she’s trying to survive these days without serious trauma.

I told her it sounded like she was describing trying to survive moral injury. She said that was exactly it.

Today, I saw on Twitter that the doctor about whom I read in April had been profiled in the New York Times. I read the article with aching heart, after which I tweeted a link with the words:

“Still, when the casualties of the coronavirus are tallied, Dr. Breen’s family believes she should be counted among them.” After reading this, I agree. Completely.

I followed up that

Recently texted dear family friends, married nurses, on being reminded “once again, how much care and fortitude are involved in nursing. I am so grateful for you & so absolutely livid that you are, it feels, being punished for your caring. You deserve better.” Dr. Breen did, too.

What’s funny about my April post is that I called Dr. Breen “a hero.”

I don’t believe in heroes. As I wrote three years ago, I believe in hero-ing. That’s to say, I believe in “hero” as a verb, not a noun. I wrote about this last month:

“hero” not as a binary trait attainable by a few
but a verb achievable
every day, by
everyone
still
living.

When I wrote these words in June, I wasn’t thinking about the dangers to so-called “heroes” of using “hero” as a noun. I just loathed how hero-as-noun deprived most of humanity, unjustly and potentially catastrophically, the opportunity to hero out of the blue today or tomorrow, should such opportunity arise.

(Does humanity benefit more from heroes, or from everyone understanding they may be called upon, and may choose to, hero today, no matter what they did every other day before today?)

Today, I began to see the personal dangers of doctor-hero-as-noun thanks to one in a thread of tweets inspired by the NYT’s piece on Dr. Breen. Wrote Dr. Esther Choo:

I think the “hero” rhetoric, as well intentioned as it was (seriously, we appreciated the compliment) also makes it harder to admit feelings of despair, defeat, and fatigue.

I still haven’t quite worked out my definition of what it means to hero. I think it comes down to being willing to improve someone’s life at potential expense of one’s own, but that’s a very, very tentative working definition.

I don’t believe in heroes. I do, however, believe that some people might be particularly inclined to hero. I think it’s okay to acknowledge that, while not denying anyone else the joy and privilege of heroing.

And so, when I think of Dr. Breen today, I think, “Man, did she know how to hero!”

I just wish … we had systems that had enabled her to hero on her own behalf.

If we did, she might be alive to hero again today, and tomorrow.

If we want to enable more heroing, we need better systems:

systems that enable people to acknowledge, without punishment, when they are hurting,

to hero twenty times one day and then barely be able to crawl out of bed the next fifty,

to love and appreciate people whether or not they ever,

one single time,

are able

to hero.

When we acknowledge that everyone, everywhere is capable of hero-ing,
we take a load off those we currently expect to be “heroes”—
by evidencing understanding that being human is messy,
and hard, and hurt-filled, and confusing
(on the best of days),
and giving everyone a chance to not only hurt
but to be the inspiration
for hurts, at long last,
finally, given a chance
to be:
healed.

how we (get to) remember

Twitter has often been an unhealthy place for me.

That’s changed recently, and it’s changed because:
I now mostly check list filled with doctors and public health experts
who sometimes despair at the odds they’re up against,
but keep fighting, with data and love, anyway.

Now, when I check Twitter, I tend to stick to these lists,
which means I leave not with a depleted heart,
but a fuller one:

These people LIVE IN MY WORLD!

They inspire me, and I am
so glad to know (about) them.

If you’ve read more than two posts here, you know that Nassim Nicholas Taleb is my favorite author. His early words about the threat of COVID shifted me from thinking, “What’s the big deal?” to, “Oh, boy, we’ve just entered Extremistan, haven’t we?” Continue reading “how we (get to) remember”