An Inequity Ignored is an Inequity Enabled

The numbers, from the start of the pandemic through 2/10/21. Source: VT Department of Health.

The subject of today’s sermon is racial inequity in health care, and more specifically, racial inequity in access to Covid-19 vaccines. We have two readings. First, a legislative hearing about racial inequity in health care. Second, a racial equity activist’s efforts, apparently ignored, to get answers about Vermont’s vaccination policy.

As you can see above, Black and Hispanic Vermonters are far more likely to contract Covid than their white counterparts. And yet, the state isn’t doing much (if anything) to address the disparity in its vaccine policy.

More on that in a moment, but let’s turn to the hearing. The House Health Care Committee is considering H.210, a bill addressing racial disparities in health care. Wednesday morning, the panel heard from a nationally known expert in the field: Dr. Maria Mercedes Avila, a UVM prof and member of the Governor’s Task Force on Racial Equity.

Dr. Avila spent the better part of two hours unspooling a wide-ranging overview of those disparities. Their roots in history, their scope and persistence, their effects, and what can be done to address and eliminate them. It was a sobering presentation.

Well, it was for most of the committee.

On the other hand, there was freshman Rep. Art Peterson of Clarendon, assigned to the Health Care Committee in what must have been a cosmic joke by Speaker Jill Krowinski. He was last seen exposing his ignorance in a previous hearing on H.210, when he asserted that there is no such thing as systemic racism, and that targets of racism should just suck it up and get on with their lives.

So of course Peterson wasn’t going to sit still for Dr. Avila. After all, she pushes all his buttons — as a researcher on racial bias, as a woman, as an Hispanic American and an immigrant, and as an academic presenting, y’know, actual evidence and stuff. Folks like Peterson prefer to keep their minds closed to anything outside their own experience and perception.

As he did in that previous hearing, he brushed aside Dr. Avila’s presentation and asked for a specific, real-life example of bias in health care. After all, he said, “the doctors I’ve talked to say they treat a patient, they don’t look at skin color.”

Yeah, Art. I’m sure the doctors practicing in and around Clarendon see patients of color all the time. What you don’t want to understand is that there’s a big bad world outside your blinkered existence, and Dr. Avila just presented mountains of evidence that this is a real problem with real consequences.

Avila was ready with a real-life example anyway,. Her mother, she said, is 77 years old and doesn’t speak English. And in spite of federal law requiring providers to offer interpretive service to non-English speakers, she said “there have been at least 47 instances where we had to advocate for interpretive service.”

Near the end of the hearing, Peterson went Full Peterson. “I’m a personal responsibility guy,” he said. “My grandparents came to this country. They couldn’t speak English, and they made it through hard work. I get frustrated with giving things to people instead of making them work for it.”

My God, a full Hallelujah Chorus of dog whistles.

Avila was far more patient than I would have been. She gently explained that people of color experience extra burdens that his white grandparents didn’t, and provided a few examples, such as Black drivers being pulled over by the cops far more often than white motorists and being accused of shoplifting for no good reason.

Well, Art’s gonna Art. Committee chair Bill Lippert expressed a determination to pass H.210 in the near future. And with a solid Dem/Prog majority, he will almost certainly be able to do that.

I’ve gotten off track here. Let’s get back to Covid-19. The pandemic, she said, “has resurfaced many of the health disparities that have existed for a long time.” She noted that Black Vermonters account for 14% of all Covid cases but are only 1.4% of the population, and that people of color accounted for a whopping 56% of all cases among people aged 0-19.

It’s those kinds of numbers that caused Mark Hughes of the Vermont Racial Justice Alliance to write a letter to Gov. Phil Scott and Health Commissioner Dr. Mark Levine, asking if they would take any steps in state vaccination policy to counter those awful statistics.

Hughes sent the letter on February 8. He received no response. He sent a follow-up on February 18. As far as I know, he hasn’t gotten an answer yet.

Scott and Levine have defended their vaccination policy, which puts the oldest Vermonters at the front of the line with no exceptions. They have resisted pressure to prioritize school personnel, those in essential public-facing jobs, or younger people with pre-existing conditions that put them at higher risk.

The administration has stuck to its guns, arguing that its plan targets those at highest risk of serious illness or even death. However, nationally, Covid death rates are far higher among people of color than among white people. One might infer that Vermont’s people of color are more vulnerable, and ought to be prioritized in vaccinations.

Even more pertinent, vaccination rates among people of color (again, nationally) are lagging far behind rates for white people. There are socioeconomic reasons for this, but it mainly reflects the racial bias in the larger health care system. All of this is well-established in the literature, but Scott and Levine are choosing not to adjust vaccination policy to counteract the bias.

The problem is, if there’s an established bias in the system and you’re doing nothing to address it, then you are perpetuating the bias. This isn’t something you can be neutral about. Hughes has asked some pertinent questions, and he deserves answers.

In closing, I’ll post this illustration from Dr. Avila’s presentation. It applies to Art Peterson, it applies to Dr. Levine and the governor, it applies to you, me, and the sycamore tree. Please ponder.


5 thoughts on “An Inequity Ignored is an Inequity Enabled

  1. Matt

    Are you or Dr. Avila asserting that the disparity in covid cases among black and hispanic Vermonters is the result of racism in the state’s healthcare system?

    Nationally, both demographics disproportionally possess attributes that pose a higher risk of contracting covid, including concentration in urban areas, use of public transit, and multi-generational households. Underlying health issues prevalent among these groups, such as diabetes and obesity, pose greater risk of hospitalization or death from covid.

    Nevertheless, both populations contain many healthy, non-geriatric individuals for whom covid poses no risk. Children, especially, are particularly resistant to the virus. That “a whopping 56% of all cases among people aged 0-19” are minorities, does not therefore merit a drastic reallocation of limited resources away from the elderly.

    Prioritizing the vaccination of at-risk individuals — the elderly and health-compromised — regardless of race/ethnicity, is in fact the most effective way to help at-risk blacks and hispanics deal with covid. Blanket distribution based on race, with the pointless vaccination of many young and healthy individuals, would not benefit minorities. Worse, it would lead directly to the needless deaths of many non-minority seniors by depriving them of the vaccines they desperately need.

    Killing off people solely because of the color of their skin — in your proposal, white — may be what you call “equity”, but its real name is ‘genocide’.

    1. John S. Walters Post author

      Hahahahaha, oh you’re serious. Who in Hell said anything about putting people of color in front of all white people, or “killing off people solely because of the color of their skin”? Not I.

      1. Matt

        Did I somehow miss your meaning when you wrote, “one might infer that Vermont’s people of color … ought to be prioritized in vaccinations”?

      2. John S. Walters Post author

        Oh, c’mon now. I didn’t mean putting every single person of color at the front of the line. I meant taking reasonable steps to counteract systemic bias.

      3. Matt

        You’ve yet to establish that the disparity in infection rates is attributable to systemic bias. As I pointed out, several confounding demographic factors indicate for higher risk of infection.

        Whether your “reasonable steps” include prioritizing one racial group over another, or prioritizing individuals within segments (e.g., age) based on race, what you propose is racist.

        The solution to racism can never be more racism in the opposite direction ‘to even things up.’

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