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New leaders are the suburbs’ best shot at health equity


Inauguration Day, Jan. 20, will bring much-needed change in our country. President-elect Joe Biden has made controlling the coronavirus pandemic a priority, and for the first time, the incoming administration will have a presidential adviser who will focus solely on health equity and pandemic-related racial health disparities.

Dr. Marcella Nunez-Smith, a Yale physician and researcher, will lead a new White House task force that will focus on equitable access to testing, treatments and vaccines, particularly in communities hardest hit by Covid-19.

This national strategy promises to give the appropriate attention to the longstanding issue of health inequity that existed long before the pandemic began. An effective approach will need to be adjusted based on place, because where you live plays a role in your health. More than half of Americans live in suburbs, and health equity will look different here. Even with the political influence that suburban voters had in recent elections, there has been little attention paid to understanding the significant role that suburban spaces have on the health of their residents.

On Long Island and across the country, Black and Latino residents have disproportionately been infected by and died from the coronavirus. The reasons for their increased risk include working in “essential” in-person jobs, taking public transportation, living in more crowded housing, and lacking access to quality health care and respectful treatment. Though the task force’s immediate focus will be targeting medical resources and vaccines to vulnerable communities, members will also tackle the underlying social and economic inequalities that put them at risk in the first place.

Nunez-Smith said that “what’s needed to ensure equity in the recovery is not limited to health and health care. We have to have conversations about housing stability and food security and educational equity, and pathways to economic opportunities and promise.”

This comprehensive health equity approach needs to be understood in suburban regions like Long Island. Though we saw an outpouring of response to food insecurity in our communities as hundreds of distribution sites were set up, many of our fellow suburbanites used these services for the first time.

The need for healthy and affordable food will persist when the pandemic has passed. Housing stability in the suburbs requires shifting from traditional single-family homes to multifamily housing and overcoming community resistance to supportive housing. Zoning changes will be required. At the same time, educational equity on Long Island is a fundamental suburban challenge as residential segregation and local control has restricted the quality of schools.

Even something as basic as having local data publicly available to quantify health disparities so actions can be targeted is often missing in the suburbs. Nowhere on Nassau County’s daily “Covid-19 by the Numbers” tracker, for example, is there a count of coronavirus cases, hospitalizations or deaths segmented by race and ethnicity. We cannot address what we do not see.

Creating health equity in the suburbs will require a shift in how we approach what it means to be healthy. We cannot use the same approach and expect different results. The pandemic may have provided the push we need. Consider that the approved Covid-19 vaccines are based on a new approach to protecting against infectious diseases. Instead of putting an inactive germ in our bodies to trigger an immune response, mRNA vaccines teach our cells how to make a protein that produces antibodies to protect us from infection. This approach has been around for decades, but it took a crisis to push it into reality.

The incoming Biden administration’s stated commitment to combating health care injustice during and after the pandemic is an opportunity for the suburbs to shift our approach to finally attain health equity.

Dr. Martine Hackett is an associate professor in the Master of Public Health and Community Health Programs at Hofstra University.