Rose EnglertToday’s guest post — part of our continuing series on equity and COVID-19 — is authored by Rose Englert; Ben King, PhD, MPH; and John Gilvar, on behalf of the APHA Caucus on Homelessness.

Mortality data associated with COVID-19 shines an uncomfortably bright light on inequitable outcomes stemming from institutional racism in America. A significant body of evidence has long proven that communities of color face inequities leading to worse health outcomes and higher rates of homelessness than their white counterparts. The current pandemic has amplified the devastating effects of these disparities. 

Since the Centers for Disease Control and Prevention released preliminary COVID-NET data on hospitalizations by race, dozens of reports suggest that being black is a risk factor for progression of severe illness related to the novel coronavirus. As of mid-April, available state-level data showed that black Americans account for 33% of reported COVID-19 hospitalizations, yet constitute only 13% of the overall U.S. population. Ben King

Further, black populations are dramatically overrepresented among people experiencing homelessness, and those who lack housing are at greater risk of contracting infectious diseases, including the novel coronavirus. 

In a crisis, communities tend to open mass shelter space to serve people who are homeless. Local systems are struggling to find enough safe, humane spaces to isolate people who test positive or show symptoms of COVID-19. But scores of asymptomatic people can spread the virus in congregate settings. What is the solution to social distancing when tests are scarce and congregate shelters pose a clear danger?  

Now consider the devastating intersection of race and housing status for black Americans experiencing homelessness. Not only are risk factors compounded, but also members of the black community often face higher barriers than white people when seeking housing. Multiple independent researchers have found that a critical tool embedded in many communities’ housing access systems actually reinforces or exacerbates the inequity created by persistent and institutionalized drivers of racism. This is why leaders and response planners must apply an equity lens when addressing the current emergency.

John GilvarThe Coronavirus Aid, Relief and Economic Security Act, a more than $2 trillion economic relief package, was passed by Congress and signed into law on March 27. CARES Act funding is giving communities a singular opportunity to address the disproportionate impact of homelessness on people of color as billions of dollars are distributed to prop up housing safety nets. 

The CARES Act includes over $6 billion for the U.S. Department of Housing and Urban Development to increase communities’ capacity to prevent the spread of coronavirus among three groups disproportionately comprising minorities: people who are homeless, at-risk of homelessness and with HIV.

This funding represents a necessary but insufficient response given that we know existing systems produce inequitable outcomes. Will we once again look at these populations and say the problems are too hard or too expensive to fix, or will we address systemic drivers and undertake real change?

While moving quickly, communities can undertake immediate steps to ensure that spending priorities and strategic responses to the pandemic do not end up worsening the effects we observe in our current housing system outcomes:

  • Collect demographic data and develop measures to evaluate how crisis interventions are specifically impacting minority groups compared to whites. 
  • Choose a simple prioritization method for allocating resources to populations with the most relevant risk factors, e.g., age, race and number and severity of chronic or comorbid conditions.
  • Prioritize outreach efforts that seek out homeless communities of color.
  • Set aside sufficient levels of funds from CARES, HUD, the Federal Emergency Management Agency and others to enable people experiencing homelessness to isolate in non-congregate settings where they can access critical medical, behavioral health and other supportive services.
  • Include homeless service providers and people of color at emergency management and other civic planning tables that are developing on-the-fly strategies to minimize COVID-19 infection and progression rates. 

In the long term, communities need access to simple housing prioritization tools that can ensure more equitable systems to index health risk factors and eradicate racial disparities. We must consider whether the strategy of congregate sheltering needs to simply be replaced by one with individual units, such as the hotel rooms that some communities are currently providing to infected and high-risk people. And we must capture and monitor data to ensure fair resource allocation by race, ethnicity, gender and age. 

Together, we can overcome the inertia of “too hard” and justly serve the most disenfranchised in our communities.

Photos: Rose Englert, independent health and social services consultant; Ben King, PhD, MPH, clinical assistant professor of public health at the University of Texas at Austin; and John Gilvar, principal at Gilvar Consulting.