Featuring Dr. Tony Iton, Senior Vice President for Healthy Communities at The California Endowment: Learn which of us are most vulnerable during this pandemic, and why. In this third of a podcast series with host Brenda Gazzar, Dr. Tony Iton describes the intersection of policy, income inequality, race and social vulnerability. Which policy solutions weaken our nation in the face of health crises like the coronavirus and which will increase our resilience? After all, the next pandemic may be just around the corner.
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CORONAVIRUS: AMERICA’S SELF-CREATED VULNERABILITY
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(Opening MUSIC – “Talk Back” 10 seconds, fade down)
Welcome to Code WACK!, your podcast on America’s broken healthcare system and how Medicare for All could help. I’m your host Brenda Gazzar. Today we’ll hear from a public health expert about the coronavirus crisis and which communities are the most vulnerable.
We have Dr. Tony Iton here with us. He’s the senior vice president for Healthy Communities at The California Endowment, a statewide health foundation. He previously served for 7 years as director of Alameda County’s Public Health Department. This is the third episode in a series with Dr. Iton about the deadly coronavirus.
Welcome back to Code WACK!, Dr. Iton.
Iton: Thank you.
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What communities are most vulnerable in this crisis and why?
Iton: Well, the folks that are most vulnerable in the COVID crisis are folks that are either they have to work, so you see security guards, cleaners, people in food service, grocery store clerks, the folks that have to be out there so they’re actually at risk just from interacting with other folks. Clearly health care — both the frontline nurses and doctors — but also the folks working in clerical, the folks working in janitorial, the folks that are working in the kitchens, they’re all at greater risk because they’re considered essential employees and a lot of essential employees are actually low-paid employees in this country so they are at great risk.
And then you see folks of color, African Americans, Latinos, Native Americans, folks that are forced to take those kinds of risks to make ends meet in their lives. They’re working those kinds of jobs that don’t have health insurance, don’t have paid leave and are on the front lines of either customer service or interacting with the public. Police officers, firefighters, other first responders are also at great risk.
And all of these folks have to be protected in this response but I’m particularly concerned about low-income, people of color, people who don’t speak English as a first language. You’ve got folks like day laborers, obviously homeless populations that can’t even seek shelter to shelter in place — who have to come to congregate places just to find food — so they’re just at much higher risk than your sort of average American who can work from home on a computer.
And would you say these are the people who are generally at risk in public health crises?
Iton: Yes, much of my work is around mapping life expectancy by neighborhood and these maps predict the severity of disease across a wide range of diseases and social crises so the maps predict foreclosures in a foreclosure crisis, they predict HIV/AIDS, they predict opiate overdoses, they predict epidemic outcomes because these maps are basically maps of social vulnerability and that social vulnerability is a product of policy… the lack of universal healthcare, the lack of paid sick leave, the lack of appropriate wage policy — all of these things that contribute to income inequality and profound social vulnerability amongst different populations that lack political power.
Got it. What impact will the novel coronavirus have on the uninsured and underinsured?
Iton: That’s the big worry for all of us that are involved in public health is that folks are going to hesitate to go to the doctor, particularly as we’ve seen in some cases bills as high as $35,000 for being evaluated for coronavirus. And that’s something that will throw most people into bankruptcy. There has been an effort federally driven by the Democrats to try to ensure that people can get access to testing and care for free or can get access to Medicaid within their state programs, but still, you’ve got all kinds of issues and disincentives that have been structured by the federal government for actually seeking care.
If you’re an immigrant, even a legal immigrant, you’re concerned about the public charge issues — that this can be held against you when you’re seeking like your green card. If you’re low income, you’re worried about essentially being taken to court for these ridiculously high medical bills and losing your house or your credit rating being destroyed. And if you’re uninsured, you’re worried about not being able to pay at all. You may be already carrying medical bills and so this could add on to your debt burden.
So in no other developed country in the world is this a problem. This only in the United States and it hasn’t been getting better. The Affordable Care Act did help somewhat but since the passage of the Affordable Care Act, there has actually been push back in many states to try to push people off the rolls, particularly off Medicaid. So this is a very uniquely American problem. We created it for ourselves. Now we’re tripping all over it in the face of a pandemic. This is just purely self-injurious behavior.
And can that be solved by Medicare for All?
Iton: It can be solved by a single-payer program like Medicare for All that’s well-designed and well-articulated with public health.
Thank you so much, Dr. Iton! Find more Code WACK! episodes on ProgressiveVoices.com and on the PV app. You can also listen at HEAL dash C-A dot org. This project is powered by HEAL California, which uplifts the voices of those fighting for healthcare reform around the country. I’m Brenda Gazzar.
Thank you so much, Dr. Iton! Find more Code WACK! episodes on ProgressiveVoices.com and on the PV app. You can also listen to our episodes at HEAL dash C-A dot org. This podcast is powered by HEAL California, which uplifts the voices of those fighting for healthcare reform around the country. I’m Brenda Gazzar.
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