It is fashionable to say that coronavirus doesn’t discriminate, but this may be misleading. In fact, there is compelling data suggesting that the COVID-19 pandemic is impacting some communities harder than others. In state after state, there is evidence that this pandemic is having a disproportionate effect on people of color, on the economically precarious, and on already stigmatized populations such as the homeless.
These findings may just be the tip of the iceberg. In this episode, U.S. Rep. Joaquin Castro of San Antonio, representing Texas’s 20th congressional district, and Dr. Octavio N. Martinez, Jr., executive director of the Hogg Foundation, join us from their respective worlds of politics and philanthropy to discuss the deep social implications of coronavirus through a health equity lens.
The Disparate Impact of COVID-19
Ike Evans: Just so everyone knows, like pretty much it seems the rest of the world, we’re having this conversation via Zoom, I will do my best to spruce up the audio, but if it’s less than perfect that’s largely the reason. So, my first question is that it’s fashionable to say that the coronavirus doesn’t discriminate. But the pandemic as a social phenomenon certainly seems to be. So even with everything that we’re still learning, what can we say about the disparate impact of COVID-19?
Representative Castro: I would say that it certainly hit some communities harder than other, both in terms of the health impact and in terms of the economic impact.
We’ve seen in city after city, for example, how African Americans have had higher infection rates, often higher death rates. That’s true for Latinos in some cities, it also seems to be impacting the poor much more harshly. And people who work in certain places that are often, I think, forgotten sometimes by our country. The farmworkers in the fields, people working in all these meat-packing plants where there have been explosions of infections. So, it really has exposed a lot of the underlying inequities in American society.
Dr. Martinez: And I can — thank you Representative Castro, I totally agree with everything you just said. And what I would add to that, Ike, from a mental health standpoint there are also other communities and groups of individuals that are being impacted unjustly. In addition to the ones Representative Castro laid out, we also should be thinking about our homeless populations where we already knew and know that the individuals with — dealing with really severe mental illness are overrepresented. That is also true of, unfortunately our jails, prisons, our incarcerated folks. We also already knew, and COVID-19 is exacerbating how they are being affected as well as being treated and having access to the resources that we so woefully need for everyone. But our jails and prisons unfortunately have become, by de facto, the largest psychiatric institution in this country and they’re being affected greatly. As well as our institutionalized folks, those that do need to be taken care of in a state mental health facility for example, how do they respond and how do we ensure in keeping their safety. And once again, if you peel back and take a look at who is overrepresented just in general in these mental health populations dealing with severe mental illness like schizophrenia or bipolar disorder or major depressive disorder, once again it is unfortunately individuals who don’t have access to health insurance, so therefore uninsured or under-insured, as well as individuals who are affected by a whole host of social-determinant factors and that results in, as Representative Castro pointed out, economic but also health and mental health issues all coming to bear on these populations.
Representing All Perspectives
Ike Evans: And so, the accounts and perspectives of those who have the ability to work from home seem to dominate the discussion. So, what can we do to make sure that this crisis is represented, understood, and when it’s over, remembered from all perspectives?
Representative Castro: Well I do think that it’s important in the reporting of this pandemic and its effect on the country, that the voices of people who are still out there working, that don’t have the ability to stay home and stay safe in the same way, that their accounts are recorded both for history and also so that we can learn the lessons from them about what needs to change in terms of policy. You think about the challenges of that, the fact that you don’t have as many reporters going out and doing person on the street interviews for example, because of social distancing. I think it’s been harder in this period to get the perspective of people who are in those meat-packing plants and facing coronavirus infections. As I watch television I see, including myself, interviews with people that are in their homes. But there’s a large segment of the American — of American society that doesn’t have the ability to stay home. Their job requires them to go out and work. I also think that those folks should get hazard pay, for example, from their company or their government. But this period, I hope will be a period that we’re able to look back on as a unique period or at least one of the unique periods in American history in the same way that, as somebody that was born in 1974 I look back on video or photos of the long gas lines of the gas shortage in the early 1970s and look at it as kind of an anachronism. It’s going to be important that as we look back on this period, that all of the perspectives are represented.
Dr. Martinez: You know, that’s so true. It’s going to be a challenge, Ike, because for those that are working from home — and that’s about as I understand from the studies and such, that about one out of three Americans are able to work from home and that’s a real privilege.
The Hogg Foundation staff, myself, we fall in that category. But that means that 70%, as Representative Castro is pointing out, are not and they’re still having to work in such a — we have now a service industry economy and they’re considered to be essential workers. They don’t have a choice but to be out there, and to capture their perspective, their account of what’s happening, their fears, their traumas I think is so important. We can’t leave out, as I mentioned earlier to the question, Ike, is our homeless populations, and those that are institutionalized or incarcerated. But also, I would add, we can’t forget about our retired populations and our elderly and how this is impacting them. And to stay at home, to shelter in place as they’ve told us to for appropriate public health reasons, can lead to an increase of isolation and loneliness. That has a huge impact on our elderly population. But it also has an impact on entire family structures as well, that we need to ensure that we take into consideration as we look toward the future, of how do we stay connected, how do we maintain our humanity in a moment of crisis especially one of this magnitude and that one that will have ongoing sequelae. It’s not just going to end with going over and flattening the curve and coming off the other side. We will be dealing with these issues for years to come. And there will be, unfortunately, crises in the future. I’m with Representative Castro, I hope this gets captured and we learn from it, because if not we will end up, unfortunately, repeating some of our same mistakes. That is one thing that I worry about, I don’t know about you Representative Castro, but something that has been on my mind recently.
Representative Castro: Yeah, no absolutely. I think that it’s ironic because you do have a big percentage of the workforce that’s still out there working. You see sanitation workers, grocery store workers, healthcare workers, and right now a big danger for them is incurring the infection, the coronavirus infection. It’s a physical danger and — but you also have a lot of people who are at home, who are suffering from anxiety, from feelings of isolation, from depression. So, this virus has impacted people, not only those who become infected, but also because of the measures that we’ve had to take, people who have been at home now for several weeks, and what do we learn from that going forward. I think one big lesson that a lot of people will take from this for example, for policy makers, is that the healthcare system that we have now, which is employer-based healthcare, has got to change. Because now that you’ve got 28 or 29 million people out of work in the last month, most of those people who are now out of work no longer have healthcare coverage or maybe trying to roll over to COBRA, which is very expensive. I think that that’s why you see proposals for Medicare for All go up to 69% support or certainly support for universal healthcare coverage. I’m interested, as a policy maker, to see what we take from this and what we start to change.
Dr. Martinez: Boy, that’s so true. It also makes me think of our small business owners and our independent individuals who are out there in the gig economy, and they’re not able to — because of the current infrastructure we’ve developed with employer-based healthcare, to be able to afford the insurance plans that exist out there. The Affordable Care Plan was trying to make some inroads but it still needed some additional ongoing adjustments to our economy. But that’s sort of come to a standstill under this current administration as — but it begs the question, and you’ve brought it and it really makes me think about it, Representative Castro, how do we ensure the health of our citizens, be they employed or they’re the family members, or the unemployed, to be able to continue to be really responsive to our health — but our health is so important for so many different aspects of being a society. You are on a lot of great committees, it makes me think of — if we don’t take care of our health, how can we continue to take care of ourselves from a security standpoint, as just an example.
Representative Castro: No, I absolutely agree.
What Stakeholders are Saying
Ike Evans: Okay, so I was hoping that both of you could maybe share just some of what you’ve been hearing from either constituents or stakeholders that really help to enrich or even complexify our understanding of COVID-19 and the impact that it’s having.
Representative Castro: Yeah, I think people were hit with two things at once. I mean they were hit by the fear of becoming infected with a virus that’s been proven deadly, and at the same time a lot of people were suddenly out of work. So, there was both this fear of the infection and an economic fear that I think hit people all at once. And as a congressman in San Antonio, my staff and I saw that very closely because we were getting people calling pretty much in a panic. What I also saw is, besides the healthcare system which is not setup to deal with a situation like this because it is employer-based, other systems were clearly not designed for this volume of a problem. For example, on the economic front, suddenly there were millions of people out of work, in Texas, more than a million people. Those folks were trying to get economic unemployment benefits and people were calling a hundred times, two hundred times, trying to get into the Texas Workforce Commission to get their claim processed with no success. And so, for government it’s been a lesson in how you go back and redesign systems really to account for an unexpected emergency and really to function better. In some places, quite honestly, some of these systems were built not to help people who are in need. In Florida for example, there was a story about critiques of their unemployment system and the fact that they made it hard for people who are unemployed to actually get unemployment benefits because there’s been this notion that people are somehow, through their own laziness, responsible for their unemployment. Well, so what happens all of a sudden when you have millions of people are out of work? What do you do with those folks when it’s clearly not anybody’s fault? And so, it’s been a real lesson here in Texas for us.
Dr. Martinez: And Ike, let me add a different kind of perspective that as you pointed out, stakeholders we’re in touch with and constituents, so being executive director of the Hogg Foundation for Mental Health, stakeholders and constituents I’m involved with are more of — in the world of philanthropy. One of the things that – In addition to what’s happening on the ground, and I think Representative Castro has really captured that, what’s happening to our communities and individuals is what’s also happening though, when you think about organizational structure and leadership. So, there have been ongoing discussions and how do you also, during a crisis, provide support. We mustn’t forget the impact on say, the executive directors and the CEOs of philanthropical organizations and non-profits where all of a sudden, their staff is affected, them themselves or their family is being affected by COVID-19, their constituents, their customers for better lack of a word. And so, what’s happening with this crisis is hitting at every level, and in that sense there’s multiple layers that need to be working in unison together to be able to provide good opportunities as well as resources for all.
It also makes me think of one the areas that we have not invested as well in, in fact in some cases some states have dis-invested, including, in my opinion, the federal government, is our public health infrastructure. That has come to bear and has shown now the gaps and the challenges of how do we address a crisis when our public health infrastructure has really been — has been really minimized over the decades. I want — Representative Castro, there is some great — I’m hoping some good discussions happening as well as ideas and plans and strategies of how, when looking forward what do we need to do to in fact ensure we have a good public health infrastructure. Not only the federal level, but even at the state and county level because that’s multi-level and they all should be working hopefully in unison. But I was wondering what your thoughts were on that.
Representative Castro: Yeah, no that’s right. The first step of that is — of course, I’m chairman of the Congressional Hispanic Caucus, you also have CAPAC, which is the Asian American Pacific Islander Caucus, the Congressional Black Caucus, and then the Native American Caucus, and we’ve joined together because we’re going to work with some researchers on exactly the question of health disparities during this pandemic and what it has exposed or brought to the surface, and then from there a prescription going forward for policy makers on how you start to change those things. In other words what do you do in the area of healthcare, housing, economic development and jobs in the workforce, all of these things for vulnerable populations who have been made more vulnerable during this pandemic. And so, we’ve just gotten that going now and it’s going to be a months-long process, but I do think that for policy makers both at the federal, state, and local levels, that it will bear fruit ,I think, once we can get it done. And certainly, for us in the Congress, we intend to use it as a kind of blueprint on what needs to change.
Dr. Martinez: I think that this is an opportunity for us to come together and to work together, and also reach out to the world of philanthropy. There is many good organizations that could partner with and work with and leverage what you’ve just laid out, like the Well-Being Trust, obviously the Hogg Foundation for Mental Health itself, but it also makes me think of non-profits like Trust for America’s Health. We’re all dedicated to really improving our public health infrastructure as well as our mental health infrastructure for everyone that lives here in the United States.
Representative Castro: Yeah, and it’s been very stark. I gotten many calls and people reaching out about even basic things like not being able to get tested, not being able to get a mask when they needed one. So, from fairly complex things to very simple things, our system in different ways broke down. It just wasn’t prepared for this. And we need to really understand exactly what happened and, as much as possible, extract the politics from that to understand what happened so that we don’t experience these same shortcomings again.
Dr. Martinez: I totally agree, it makes me also think of one the populations we haven’t mentioned really are individuals that are immigrants or undocumented that are here in the United States. It happened during Hurricane Harvey, and it’s happening now with COVID-19, many of these folks are part of the economic infrastructure and they’re, in many cases, considered essential employees but they don’t have any of the benefits or the resources to ensure their health. That puts them at risk, but also puts others at risk. And I think we need to really have a comprehensive humanistic approach to understanding the impact of the flow of economies between countries and the impact within the infrastructure, and not really just allow it to continue as it has been because unfortunately, it has just not — status quo currently is just not working for anyone.
Representative Castro: Yeah, no we’ve never been completely honest in our country about the fact that there are four or five or more major American industries that would not exist the way they do, would not have been successful the way they are but for immigrant labor, and some of that undocumented immigrant labor. And so far, I think one of the greatest injustices of what the Congress has done is that many of those immigrants have been completely left out of some of the healthcare relief and all of the economic relief in the legislation that’s been passed. So, for example, immigrants will often use instead of a social security number, they’ll used what’s called an individual tax identification number, ITIN number. So, anybody using that ITIN number, anybody using that number was denied any kind of financial assistance. So, no $1200 payment for them, no $500 for their dependents.
But it gets worse than that because they were also denied, even if they were married to an American citizen and have American citizen children, they were completely denied any benefits.
In other words, the whole family, the spouse who’s an American citizen, the kids who are American citizens, the whole family got x-ed out of any kind of financial assistance in the legislation that Congress has passed so far. That’s an injustice that needs to be corrected by Congress as soon as possible.
Ike Evans: Okay, so that’s a, I think a perfect jumping off point for my next question. And you touched on some of this, but what promising ideas or initiatives do you see emerging from either the world of politics or philanthropy, that might begin to address some of the issues that both of you have raised?
Representative Castro: Well, what I have seen is new legislative ideas for addressing some of our public policy failings. Again, I think moving us away from an employer-based model of healthcare delivery, that’s going to be an important one. Also, I think we’re moving closer to the idea that healthcare is a human right, that housing is a human right, that education opportunities are fundamental to everybody in the country. Those have been very promising. For example, in education, the Congress committed more money to close the digital divide between wealthy and poor school districts, or sometimes urban and rural school districts. So that’s going to be I think, a lasting positive from — silver lining from what has happened. I also think that it’s created new people and institutions that have stepped up to help in different ways. I’ll give you an example of that, we’ve spoken during the podcast — Dr. Martinez has about the homeless and last year my brother Julian who was HUD secretary under President Obama, was in Las Vegas and he walked under these bridges that looked more like caves actually, but they’re tunnels and you have an entire homeless population in Las Vegas that’s living in these tunnels amidst one of the wealthiest areas in the world, the Las Vegas strip, with all these hotels worth hundreds of millions of dollars. What we’ve seen is that as these hotels have been empty in different cities, some cities have now started to use those hotels as places where homeless are able to stay and others have been able to stay. That is a marked changed in how we use our resources, I understand that this is a very different period because right now hotel rooms are empty and so forth, but it’s using assets that traditionally have not been allowed to that group of people, using them in this time to be helpful. Hopefully we’ll start to rethink more things like that.
Dr. Martinez: I think that’s a great point that Representative Castro has made, Ike. In that — let me add on to that in the sense that there have been some challenges we’ve had for example, in really rolling out telemedicine, telepsychiatry, telepharmacy, really that whole use of broadband and the infrastructure that’s needed to be able to provide care outside of the four walls of the clinic. We can actually do it now in folks’ homes through these new platforms. We’ve had challenges that we’ve basically self-created, that haven’t allowed us to really expand that. And during this crisis, a lot of those challenges, those rules and regs that were not allowing us to fully implement have been laid aside to deal with the crisis. My hope is that we’ve learned from that, that we actually can do this and that once the crisis is over, however that is defined in the near future, that we don’t roll back and go to our pre-COVID-19 infrastructure that was not allowing us to move things forward. And as Representative Castro has pointed out, really being creative in identifying the resources we all really do have and how can we maximize their use for everyone and for specific groups and populations that are dealing with the issues of say, homelessness, or maybe they’re unemployed, or they’re dealing with mental health or chronic illness. The other thing that I’ve seen that is coming to bear is the importance of acquiring data and metrics to be able to truly inform us on how we are doing and what we need to do.
It’s already been brought up, the disparities that we’re seeing that have popped up in Chicago, New York, Houston, Miami in reference to what’s happening to our African American population, what’s happening to our Hispanic and Latinos, Native American population, how COVID-19 is affecting from a morbidity and a mortality standpoint.
And yet, we don’t have good process and ability to gather that data across the board. So there is much we hopefully are learning from this experience of how to do that and why it is so important to gather that data, why it’s important to know your race and ethnicity, why it’s important to know what language you speak or what language you prefer, why it’s important to know do you have access to insurance or why you don’t. And the list can go on and on. And because — getting to what Representative Castro said and I totally agree — hopefully this brings us all to really be thinking about that health — and there is no health without mental health, in fact is a right and should be a right, and hopefully we can actually move that agenda forward, and in my opinion, add it to the Constitution because health is such an important critical component of our humanity to be able to do anything and everything as individuals and as communities and as families.
Ike Evans: Okay, is there anything else that either of you would like to bring up while we have you here?
Representative Castro: I hope that the Congress — we’re still in the middle of this pandemic and there’s going to have to be more relief packages. I hope that that will include more funding for mental health and for physical health, but also more economic relief, and that the lessons that we’re learning now will not be lost on us and that they will continue for many years to come, and that future generations will learn from what we’ve experienced. Like I said, I hope that people will be able to look back on this the way that I look back on the gas shortage, long lines and the gas shortages of the early 1970s, as a kind of period piece. Even if that’s the case, the lessons that we’ve learned and the policy changes that we make because of this, I think, have the opportunity to be significant and profound for this country.
Dr. Martinez: I think that’s spot on, Representative Castro. And Ike, I’ll end with this, COVID-19 is an unmasker and a revealer of our challenges and our gaps, but it’s also testing our resilience. What I’m hopeful is that we are coming together to be more resilient as a society and really as a world because this a worldwide event. It isn’t just any one country that is now being impacted by COVID-19. We need to think about how do we stay resilient because there are going to be ongoing issues related to COVID-19 we have to deal with in the near future, but even going out a couple of years. We still don’t have a vaccine; we’re still working on evidence-based treatments to have into place. But even once we have those on board, we’re going to have to then be able to roll those out and be able to adjust and adapt as a society, to be able to have a functioning society and one where all of us can still feel we’re a member of it and we’re not going to be othering or blaming or pointing a finger at anyone else because we’re all in this together.
Ike Evans: Okay, Representative Castro give our regards to your brother, we really appreciate you taking the time out of your very busy schedule to talk to us. And Dr. Martinez, as always, we are grateful anytime you are able to come on to the podcast and share your insights, so thank you to you both.
Representative Castro: No, thank y’all. Take care.
Dr. Martinez: Thank you Representative Castro, thank you Ike, you were great.