Texas shield logo

Navigating the COVID-19 Waters: Systemic inequities come to the surface amid a public health crisis

By Jessica Sinn

image of dr. Mullen
Dr. Jewel Mullen, associate dean for health equity and associate professor in the Dell Medical School’s Department of Population Health

Turn on the TV or radio, and you’re likely to hear celebrities and newscasters repeating the phrase “We are all in this together.” Some may even say COVID-19 is the great equalizer. But the experiences of different communities during the current pandemic reveal a different picture.

As we learn more about the novel coronavirus—and its disproportionately fatal effects on Black and Brown communities—the grim realities of our societal injustices have surfaced in the nation’s consciousness.

Multiple factors determine transmission risk and, therefore, which communities have a greater infection rate, says Dr. Jewel Mullen, associate dean of health equity at Dell Medical School.

According to Austin data released in August, Hispanics accounted for 52% of the Austin-Travis County residents who tested positive for the coronavirus, although they make up just 33% of the population.

COVID-19, Mullen notes, is known to target the lungs, heart and other organs that are weakened by chronic conditions such as asthma, diabetes and high blood pressure, which are more common in some minority groups.

“In many parts of the country, among Hispanic or Latino groups, deaths from COVID-19 far exceed the percentage of Latinos in the population, and in some places the same holds true for African Americans,” she says.

This finding isn’t surprising for Virginia Cumberbatch, former director of equity and community advocacy. She devoted much of her work at the DDCE’s Center for Community Engagement to studying and addressing social inequities here in Austin.

“There is a perception that Austin is a very liberal and progressive city, but the truth is that Austin has always had significant inequities determined by race and spatial and economic segregation,” Cumberbatch says.

Prior to leaving the university in July 2020, Cumberbatch led a number of community advocacy projects, including the monthly Front Porch Gatherings held at various Austin locations that address persistent societal inequities like food deserts, substandard education and inaccessible health care. These are just a few of the systemic inequities, she notes, that play a big role in putting certain demographics of people at high risk for contracting the deadly virus.


VULNERABLE WORKING CLASS

image of Hogg Foundation director
Dr. Octavio Martinez is the executive director of the Hogg Foundation for Mental Health

The waters are especially turbulent for many low- income essential workers interacting with potential virus carriers regularly at checkout counters, warehouses, restaurants and other public spaces. In fact, the Institute for Urban Policy Research & Analysis (IUPRA) published a research brief in May that confirmed that many of the more than 2 million frontline positions in Texas, particularly the lower-wage ones such as home health aides, go to Blacks and Hispanics.

According to the study, conducted by IUPRA Research Associate Ricardo Lowe Jr., 36% of Black female workers and 29% of Hispanic female workers statewide are deemed essential. Asian women and Asian men also frequently serve on the frontline as nurses, physicians and surgeons.

“Fewer than one out of five Black or Latino workers in this country can actually stay home and do that social distancing that’s a part of staying safe,” says Mullen.

Mullen cautions against judging a person’s health risk by their skin color or biology, especially when factors that stymie health care access can ultimately matter more when it comes to someone’s individual risk.

Indeed, essential workers keeping society afloat throughout this global health crisis are often putting their lives at risk without their own health care safety net. Data from the U.S. Census Bureau indicate that a total of 27.5 million Americans, many of whom were either unemployed or working in low-paying essential worker positions, had no health insurance during 2018. The Kaiser Family Foundation found that 13% of essential workers nationwide lack any health insurance and about one in three is in a household earning at or below $40,000 a year.

Should anything positive come out of this pandemic, Dr. Octavio Martinez Jr. hopes it is increased attention to America’s flawed health care system. He notes that mental health care is as critical as physical health care in these times of fear and uncertainty.

As executive director of the Hogg Foundation for Mental Health, Martinez is leading a number of initiatives that provide access to mental health through multimillion-dollar grantmaking, public policy, education and outreach efforts. In 2018, the foundation shifted its focus to transforming mental health at the community level with the goal of achieving health equity for all Texans.

Given the 2018 U.S. Census statistics, these efforts are needed in the state of Texas, where more than 5 million residents are without health insurance— up from 4.8 million in 2017. Texas also shares the unfortunate distinction of being one of 14 states that have not expanded Medicaid, a key provision of the Affordable Care Act that provides health care to low-income individuals.

“The State of Texas chose not to expand Medicaid,” Martinez says. “This leaves a lot of families in a very difficult situation because they’re not able to afford insurance on the marketplace or they’re underinsured. And then to have a major health pandemic exacerbate the resource issues—that brings added fears, anxieties and concerns.”


OVERBURDENED STUDENTS

image of ShaNya James
Sha ‘Nya James, College of Natural Sciences junior

Sha’Nya James is one of many college students who found herself in need of basic resources after the campus shut down in the spring. The final straw came in mid-April, when her father lost his 13-year job as a security guard at a Dallas hospital due to pandemic-related layoffs. Soon after, he caught the coronavirus himself.

“It made me a little sad and a little stressed, trying to make sure that he was OK and scared that he might die at any moment from the virus, while still trying to maintain my grades,” says James, who—despite it all— successfully completed her 13-hour semester in May.

Between worrying about her father’s health and her own viral exposure during weekend shifts at Walmart, James decided to put her job and her University Leadership Network (ULN) internship with the DDCE’s communications office on hold as she finished out the semester. The struggle to complete her coursework while working 30-plus hours each week was too much, especially when some instructors began adding regular quizzes to check on students’ remote schooling progress. It didn’t help that those assignments had to be done on James’ old Windows 7 computer, adding to her many layers of stress.

“It would freeze a lot, and my keyboard started lagging, so every time I had a quiz or exam, I would just ask my roommate if I could borrow
her computer for a moment,” say James, a soft-spoken junior who’s planning to become a math professor and in- spire others to pursue STEM fields.

Despite the odds, James finished strong before head- ing home to Dallas to work at Walmart and take summer classes. A 2018 survey by Georgetown Uni- versity’s Center on Education and the Workforce suggests James fared better than many working students when her GPA slipped from a 3.4 to a 3.2.

Although about two-thirds of higher education students work these days, the national survey found that those who work less than 15 hours a week (who tend to be from wealthier families) had a greater likelihood of holding a 3.0 or above. The average dropped to a C or below for students who work more than 15 hours a week.

The survey also showed that more affluent students are 8% likelier to have jobs or internships in a lucrative career-related field rather than pay-the-bills jobs. For James, pandemic-related buying splurges meant being asked to work more hours at Walmart. Her stress level still was an 8 out of 10 after putting her jobs on hold, she says, as carving out time to meet new coursework demands meant losing money for necessities.

James does have a Pell Grant, student loans, and a scholarship and emotional support through ULN, which she has been a part of since her freshman year. CARES Act funds helped cover two months’ rent, and her father helped with bills, despite her protests given his job loss and her three brothers at home. She prefers to make it on her own and hopes to buy her own laptop one day after failing to get one through UT’s overwhelmed Student Emergency Fund.

“We go to school, we work, we try to do everything for ourselves because we don’t want to put pressure on our parents to help out when we know they don’t really have the money,” James says.

Jennifer Roman image
Jennifer Roman, Human Dimensions of Organizations junior

Jennifer Roman, a junior majoring in the Human Dimensions of Organizations program, can relate to these struggles. She finished her classes on an outdated laptop while remotely taking care of family issues back home. Attempts at securing emergency funding were thwarted due to her parents’ undocumented status.

Prior to the campus closure, Roman had limited employment options without a car, so she took on part-time work at the University Co-op located within walking distance of her expensive four- bedroom apartment. After being laid off this spring, her work prospects are still up in the air.

“I didn’t make a ton of money, but it was still something I relied on to go buy groceries every week and to be able to pitch in for rent without my parents having to help as much,” she says, noting that her father’s home remodeling work has disappeared and her mother must now oversee the education of her four siblings in Del Valle.

Concerned that she might put her mother, who has had bronchitis and other lung issues, at risk of infection, Roman has lived in her apartment since the pandemic began. She also wanted to give her siblings space but quickly discovered that they needed assistance with understanding their assignment instructions and schoolwork. She helped them over the phone while taking 12 credit hours in the spring.

“When they were at school, they could ask the teachers,” she says of her four siblings. “My mom hadn’t had a lot of schooling back in Mexico, so there’s a lot of things she doesn’t know. And she doesn’t read or speak English, so it’s been really difficult.”


SUPPORTING STUDENT POTENTIAL

image of Tiffany
Tiffany Tillis Lewis, assistant vice president of the Longhorn Center for Academic Equity

The DDCE’s Longhorn Center for Academic Equity (LCAE) team has been working hard to help the university’s growing number of low-income students. On March 18, the day after classes went virtual, team members began surveying students about pandemic-related needs. The biggest concern was health care access, which affected nearly one-quarter (132) of the predominantly low-income, first-generation respondents.

Transportation proved to be the second-biggest concern for the 544 students even though the survey only asked about emergency transportation access. Fourteen students in the LCAE’s Gateway Scholars and Longhorn Link programs had no access to transportation, while 25 others had the technology to access rideshare options but no funds to pay for them.

Meanwhile, about one in 10 respondents struggled with computer or internet access, and two had become homeless when the campus shut down. Although many students found support through available resources, lack of funding means some students are falling through the cracks, says Tiffany Tillis Lewis, assistant vice president of the LCAE, which offers diverse programs that prepare students for career success and world travel.

“I believe the university has done a great job responding to the immediate needs of most students, but we have to do a better job of making sure all students impacted by COVID-19—particularly undocumented students—have equal access to resources,” Tillis Lewis says.

As a first-generation college graduate, Tillis Lewis understands her students’ financial and emotional hardships. During her time at the LCAE, she has seen many students go on to work in industries that need diversity and innovation the most, including health care, public policy and law.

“It’s important to expose students to career opportunities that they might not know much about or know how to prepare for, not only for their sakes, but to meet national goals of economic prosperity and diversity,” she says.

At the Dell Medical School, Mullen sees great potential in her aspiring healthcare professionals— especially among underrepresented Black and Brown students—and encourages them to keep up the momentum to succeed.

“Students are in a perfect place as young, active, thinking, vocal adults with all kinds of communication mechanisms at their fingertips to advocate for policies for people to be well, to advocate for good housing policies, to go out and register people to vote, to make sure people have participated in the census so there’s the best representation for them, and to advocate for better access to health care for everyone,” Mullen says.

While the pandemic is bringing to light social inequities in health care, education, employment and many other areas, Tillis Lewis notes that it is also offering opportunities for communities to band together in support of their most vulnerable members.

“COVID isn’t the great equalizer,” Tillis Lewis says. “Not everybody started off at the same point. This pandemic will widen the equity gap that already exists for some. But we can stay hopeful and take whatever steps possible to pull each other up, which benefits everyone in the end.”

Story by Barbra Rodriguez
Photography by Bret Brookshire
Photograph of Tiffany Tillis Lewis by Shelton Lewis
Photograph of Jennifer Roman provided by Jennifer Roman