Low-Income Communities Are Most at Risk from Coronavirus Outbreak
Human Impact Partners, a nonprofit based in Oakland, California, researches and advocates for policy and systems changes to advance heath equity. Spotlight recently spoke with Lili Farhang, Co-Director of Human Impact Partners, on their work related to economic security, and how it connects to the international outbreak of COVID-19, most commonly known as Coronavirus. The Centers for Disease Control and Prevention (CDC) have advised the American public to limit social interactions, leading schools to close and some employers allowing their full-time employees to work from home. Although the guidelines aim to prevent the public from contracting the illness, some experts believe that these guidelines don’t afford the same opportunities to part-time employees, home health-care nurses, and low-income service employees who are either required to interact with people to complete their job, or who must physically go to work in order to financially support themselves and their families. Concurrently, state and federal laws don’t guarantee employees – either part- or full-time – with paid sick leave, childcare assistance, or adequate medical funding to ensure people are tested and receive the necessary treatment. Farhang discusses these issues as well as policies that might be fast-tracked in order to provide relief for low-income families who will be disproportionately impacted by the outbreak. The conversation has been lightly edited for clarity and length.
Could you tell us about Human Impact Partners and your mission?
Human Impact Partners is a national nonprofit organization that seeks to bring public health evidence and voice – our power – into campaigns and movements for social justice that may not, at first glance, have anything to do with health. Our theory of change is that the root drivers of health outcomes are the social, economic and political conditions that expose people unfairly and disproportionately, particularly based on income and race and other dimensions of identity, to certain harms or certain benefits. HIP uses the available public health evidence and our moral authority as health experts to get decision makers to enact policy change. We focus on making changes in criminal justice, economic security, housing, immigration and other areas that we think significantly contribute to people’s overall health and wellbeing at a population level.
What are some of the ways that the Coronavirus is going to disproportionately impact low-income communities?
The key contextual factors are that we don’t have a vaccine or treatment interventions available. In the absence of such medical interventions that could keep people from getting sick or that treat people when they get sick (i.e., like with the flu), that means that control of COVID-19 is 100% wholly dependent on people’s ability to comply with recommendations to isolate themselves from others. So, if the primary recommendation that public health officials are giving people who are sick, or who may be exposed to others who are sick, is “social distancing” or staying home when you’re sick, people need a set of policies and supports in place to comply with that recommendation.
But people earning lower incomes, who predominately work in the service sector, don’t receive the same kinds of employer and policy supports that folks earning higher incomes have: specifically, paid sick days, the ability to work from home and telecommute, and the ability to have a flexible schedule. Our service sector economy is structured so that in order to get paid, you have to show up at McDonald’s to serve food or you have to show up in someone’s home to provide home care. Or you have to show up to be a baggage handler at an airport. These are occupations with much lower rates of job-protected sick leave, and so it means that those workers have to choose between going to work sick and not complying with social distancing recommendations or losing wages to be able to stay home. This is the primary pathway by which many lower-income people, and lower wage workers in particular, will be affected.
What about medical care and childcare issue? How will people get tested if they don’t have health insurance? And we’re already seeing schools close and some parents don’t have the option of staying home or affording childcare
If you have high deductibles or you don’t have health insurance, as is more common with lower-wage workers, these are impediments to getting tested and treated for COVID-19. Should schools close, unless you live in a community with relatives and supports that you can draw on, low-wage workers will not have the discretionary income to pay others to take care of their children if they have to go to work. As a society, we don’t make widespread childcare subsidies available, we don’t have emergency funds set up to provide for childcare, and we don’t have emergency places for people to take their kids to. Again, these are examples of gaps in our political and social system that really hinder our ability to limit widespread transmission.
Are there other impacts you would note?
We’ve been focusing on how lower-income folks are disproportionately affected, but we should recognize that these impacts are also racialized. People of color are disproportionately in low-wage occupations because of a long history of discrimination and systemic bias that limited who had access to education and wealth-building opportunities. It’s not a coincidence that those low-income workers most vulnerable to COVID-19 are also people of color who are disproportionately represented in service sector occupations.
What are some of the potential policy interventions that could help? It seems unlikely that Congress will instantly pass paid leave legislation, so if I am a city council member or mayor, what are the things that would help?
I agree it would be ideal if Congress could actually pass the Healthy Families Act, which is a paid sick leave law that’s been up there for years and years. But they could establish emergency paid leave funds. They could actually say that we recognize that for people to be able to comply with social distancing in this acute crisis, we need to create an emergency paid leave program so that people could take advantage of it. We could extend our food stamps program. We could increase the childcare subsidy that people get through their federal and state taxes. Perhaps all of these have an income criteria or threshold associated with qualifying for them. But, overall, it does seem that it would be helpful to ensure that part-time workers, self-employed workers, gig workers, workers who don’t have these benefits, would be able to have access to what they need to be able to halt the spread of COVID-19. Some municipalities and states do have paid sick leave laws on the books – California and New York City, for example. These laws could be strengthened and widened. We could suspend the Public Charge rule and the threat of ICE detentions and deportations that may inhibit many undocumented immigrants from seeking care and support.
On the employer side, there are also things state and local governments can do to help small employers, who are also going to be disproportionately impacted. Maybe employers get access to emergency funds as well, or some kind of tax relief if they can show how they supported their workers complying with recommendations? Could state family and medical leave laws, like our paid family leave program in California, be repurposed to cover the costs of social distancing? I don’t know the answers to how you implement these – but I have faith that if there is a will to support people through this acute crisis, then we can figure out how to make it happen.
On the testing question, you could set up free testing clinics but there’s not enough tests right now.
It’s true that there aren’t enough tests right now, but there are examples of policies emerging that will make getting tested more affordable to those who need it. New York state, for example, is saying it will cover the cost of testing and medical care for people with Coronavirus who don’t have coverage. This issue can and should absolutely be addressed since it behooves our health care system – hospitals, insurance companies, providers – to do everything possible to ensure that the system is not overloaded and can focus on critical cases.
And at the human level, if I am a service worker or living paycheck to paycheck, are there things that would help me and my family prepare?
Understanding what your rights are locally and statewide is important. If you’re part of a union, trying to understand what support the union may be able to provide for you. If you’re not connected with a union, there’s the possibility that there are worker centers in municipalities that might be able to help you make sense of what your rights are. This is a moment when grassroots organizing can really shine a light on why we need structural interventions: workers being able to hold their employers accountable for the support they are failing to provide.
During the debate on paid sick leave legislation in California a few years ago, it was the emergence of the H1N1 virus that really allowed us to shine a light on why that law was so necessary. Being able to frame what had traditionally been a labor issue as a health issue really helped push it over the edge. This is one of those moments when people can see how we’re ALL affected when some of us don’t have social and economic protections. It’s a moment that shows how all of our wellbeing is wrapped up in each other’s wellbeing, and that a safety net doesn’t just protect some of us, but all of us.
Lili Farhang is Co-Director of Human Impact Partners