[WSMDiscuss] A century of research has demonstrated that poverty and discrimination drive disease. Can COVID push science to finally address the issue?

francine mestrum mestrum at skynet.be
Fri Apr 30 00:35:00 CEST 2021

OK, sorry Brian, in that case the title is a bit misleading ... and 
sure, in one sentence one cannot develop an argument ...


On 30/04/2021 00:16, BrianKMurphy at bell.net wrote:
> I don't think that it is fair game, Francine, to react to the title of 
> an essay without first reading it. This essay makes your point, and in 
> a far more constructive fashion…
> Brian
>> On 29 Apr 2021, at 5:40 pm, francine mestrum via WSM-Discuss 
>> <wsm-discuss at lists.openspaceforum.net 
>> <mailto:wsm-discuss at lists.openspaceforum.net>> wrote:
>> */I do not think any science is needed to solve this problem. Poverty 
>> has to be eradicated and this can be done rapidly by organising a 
>> comprehensive broad system of social protection, with income 
>> security, social security, health care, public services, labour law .../*
>> */Programmes are ready and waiting, the money is available .../*
>> */What are we waiting for?/*
>> */Francine Mestrum
>> /*
>> */
>> /*
>> */
>> /*
>> */A century of research has demonstrated how poverty and 
>> discrimination drive disease. Can COVID push science to finally 
>> address the issue? /*
>> On 29/04/2021 23:27, Brian wrote:
>>> https://www.nature.com/immersive/d41586-021-00943-x/index.html 
>>> <https://www.nature.com/immersive/d41586-021-00943-x/index.html?utm_source=STAT+Newsletters&utm_campaign=e2f044048f-MR_COPY_01&utm_medium=email&utm_term=0_8cab1d7961-e2f044048f-149543349>
>>>>   Inequality’s deadly toll
>>>> */A century of research has demonstrated how poverty and 
>>>> discrimination drive disease. Can COVID push science to finally 
>>>> address the issue? /*
>>>> On a hazy day in November, Hardeep Singh received a text message 
>>>> from the COVID-19 testing system at Foster Farms poultry company 
>>>> saying that his mother had tested positive for the coronavirus.
>>>> He got the alert because his mother, a 63-year-old line worker at 
>>>> one of the company’s meat-packing plants in California’s San 
>>>> Joaquin Valley, doesn’t speak English and doesn’t own a smartphone.
>>>> Singh couldn’t reach her as she continued to handle chicken parts 
>>>> alongside her co-workers. Her supervisors didn’t tell her, either. 
>>>> In fact, they assigned her more shifts for the week.
>>>> Singh broke the news to her that evening, and convinced her not to 
>>>> return to work, where she might spread the infection to others. But 
>>>> he couldn’t reach anyone at the company for another five days, to 
>>>> ask whether she qualified for paid time off while she isolated.
>>>> Singh’s mother ended up being among the more than 400 employees at 
>>>> the plant who were diagnosed with COVID-19 last year, and one of 
>>>> about 90,000 cases linked to food-production facilities and farm 
>>>> work across the United States. Because the sector feeds Americans 
>>>> and powers part of the US economy, agricultural workers such as 
>>>> Singh’s mother have been considered essential workers during the 
>>>> COVID-19 pandemic.
>>>> That important role comes at a cost. One study^1 
>>>> <https://preview-www.nature.com/platform/rh/preview/page/nature/will-covid-force-scientists-to-confront-america-s-epic-inequalit/19046202?view=fragmentPreview#ref-CR1> found 
>>>> that *food and agricultural workers in California had an almost 40% 
>>>> increased risk of dying last year, compared with the state’s 
>>>> general population*. And within that imbalance lies another 
>>>> contrast. *Latinx food and agriculture workers experienced a nearly 
>>>> 60% increase in deaths compared with previous years; *the increase 
>>>> for white workers was just 16%.
>>>> The reasons for such disparities, say public-health researchers, 
>>>> include discrimination, low wages, limited labour protections and 
>>>> inadequate access to health care, affordable housing and education. 
>>>> These are some of the /*‘social determinants of health’,*/ a 
>>>> concept that has been around for at least 150 years, but which has 
>>>> gained recognition during the pandemic.
>>>> The phrase was on the lips of Anthony Fauci, the highest-ranking 
>>>> infectious-disease scientist in the US government, as he explained 
>>>> why Black, Latinx and Indigenous people have been affected by 
>>>> COVID-19 much more than have white people in the United States. The 
>>>> concept has also attracted infusions of grant money from the 
>>>> Centers for Disease Control and Prevention (CDC) and the US 
>>>> National Institutes of Health.
>>>> Yet although scholarship on the social determinants of health has 
>>>> been growing for decades, real moves to fix the underlying problems 
>>>> are complex, politically fraught and, as a consequence, rare.
>>>> The pace of change looks particularly stagnant when compared with 
>>>> advances in infectious-disease biology, in which researchers have 
>>>> isolated pathogens and created life-saving therapies and vaccines 
>>>> to stop them.
>>>> To understand what makes confronting the social determinants of 
>>>> health so hard, I investigated the tumultuous coronavirus response 
>>>> in the San Joaquin Valley, where hundreds of thousands of 
>>>> agriculture workers reside. Most of them were born outside the 
>>>> United States, and many lack legal residency, meaning they have 
>>>> limited access to social services, such as unemployment benefits or 
>>>> health care, despite paying taxes.
>>>> The valley is one of the richest agricultural regions in the world, 
>>>> and simultaneously has one of the highest poverty rates in the 
>>>> United States. During the pandemic, it has provided a clear example 
>>>> of how inequality renders some groups of people much more 
>>>> vulnerable to disease.
>>>> “We call them essential, but they’re considered expendable,” says 
>>>> Singh, himself a medical student pursuing a dual degree in public 
>>>> health. He asked for his name to be changed because of concerns 
>>>> that speaking out might cost family members their jobs.
>>>> As COVID-19 devastated disenfranchised communities in the San 
>>>> Joaquin Valley (see map), grass-roots organizations joined with 
>>>> local researchers to provide help. They’ve organized testing drives 
>>>> and educated communities about the disease and vaccines. But much 
>>>> of their work falls outside medical care, such as advocating for 
>>>> labour rights and subsidies for housing.
>>>> These types of social and economic intervention are what’s really 
>>>> needed to address health disparities, but many academics and health 
>>>> officials are reluctant to push for such measures publicly, says 
>>>> Mary Bassett, an epidemiologist at Harvard University in Cambridge, 
>>>> Massachusetts, who is a former commissioner of New York City’s 
>>>> Department of Health. That reticence needs to change, she says. “We 
>>>> need to be more outspoken about things that aren’t in our lane.”
>>>> Bassett is one of a growing number of researchers who are getting 
>>>> political, and who hope that COVID-19 will be a catalyst for change 
>>>> in the field. “The pandemic has turned up the dial, and to me it 
>>>> brings out a sense of urgency,” says Arrianna Marie Planey, a 
>>>> medical geographer at the University of North Carolina in Chapel 
>>>> Hill. Not content with simply identifying the social determinants 
>>>> of health, she says public-health researchers should be doing more 
>>>> to address them.
>>>> “I see a study saying COVID is higher in farmworkers, and I’m not 
>>>> interested — I want to know what’s next.”
>>>>     An unhealthy past
>>>> A Prussian doctor, Rudolf Virchow, described the social 
>>>> determinants of health long before the phrase was coined. In the 
>>>> mid-1800s, he began a government-commissioned investigation into 
>>>> outbreaks of typhus in Upper Silesia, a coal-rich region in what is 
>>>> now Poland.
>>>> Virchow documented hunger, illiteracy, poverty and depression among 
>>>> Silesians, and concluded that the root of the problem lay in their 
>>>> exploitation.
>>>> “The plutocracy, which draw very large amounts from the Upper 
>>>> Silesian mines, did not recognize Upper Silesians as human beings, 
>>>> but only as tools,” he wrote in his 1848 report on the typhus 
>>>> epidemic 
>>>> <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1698167>. Virchow’s 
>>>> radical solution was that “the worker must have part in the yield 
>>>> of the whole”.
>>>> The US sociologist W. E. B. Du Bois reached similar conclusions at 
>>>> the turn of the twentieth century, in a body of work that 
>>>> powerfully refuted eugenicist hypotheses suggesting that Black 
>>>> people died earlier in the United States because of their 
>>>> biological make-up and supposed unsanitary behaviours. Du Bois 
>>>> intensively surveyed people across Philadelphia, Pennsylvania, and 
>>>> found that mortality rates were similar across races in city wards 
>>>> that ranked well on metrics for housing, education, occupational 
>>>> status and other variables.
>>>> Higher death rates among Black people were linked to wards that 
>>>> were worse off by these metrics. His conclusion: the conditions of 
>>>> people’s lives mattered, not the colour of their skin.
>>>> Despite a steady drumbeat of studies over the next century calling 
>>>> out the social and economic roots of poor health (see ‘Equity 
>>>> boosts life expectancy’), policies have rarely changed in response, 
>>>> says epidemiologist Michael Marmot, director of the Institute of 
>>>> Health Equity at University College London.
>>>>     Equity boosts life expectancy
>>>> Around the world, life expectancy is generally shorter in countries 
>>>> with a high Gini coefficient, a measure of income inequality. A 
>>>> value of 1 indicates complete inequality, where one person in a 
>>>> population receives all the income and others receive nothing; a 
>>>> value of 0 shows full equality, where everyone in a population has 
>>>> the same income.
>>>> In the United States, higher income correlates strongly with longer 
>>>> life expectancy, even if income percentiles are adjusted to contain 
>>>> the same proportion of Black, Hispanic and Asian adults.
>>>     {see charts at
>>>     https://www.nature.com/immersive/d41586-021-00943-x/index.html
>>>     <https://www.nature.com/immersive/d41586-021-00943-x/index.html?utm_source=STAT+Newsletters&utm_campaign=e2f044048f-MR_COPY_01&utm_medium=email&utm_term=0_8cab1d7961-e2f044048f-149543349> }
>>>>     Sources: Economic Policy Inst./EPI Current Population Survey
>>>>     (left/top); Bureau of Labour Statistics Current Population
>>>>     Survey/Economic Policy Inst.//The Washington Post/ (right/bottom)
>>>> Many of the trends set in place during the 1980s continued, even as 
>>>> ruling political parties changed. US president Bill Clinton’s 
>>>> administration, for example, made welfare harder to receive. And as 
>>>> the gap between the rich and poor grew, so did health disparities.
>>>> By 2014, t*he wealthiest 1% of men in the United States were living 
>>>> 15 years longer, on average, than the poorest 1% of men*^3 
>>>> <https://www.nature.com/immersive/d41586-021-00943-x/index.html#nature-ref-3>. 
>>>> Those inequalities are poised to grow, predicts a report in /The 
>>>> Lancet/ in February^4 
>>>> <https://www.nature.com/immersive/d41586-021-00943-x/index.html#nature-ref-4>. 
>>>> The report notes that former US president Donald Trump legislated a 
>>>> trillion-dollar tax cut for corporations and high-income 
>>>> individuals, while weakening labour protections, health-care 
>>>> coverage and environmental regulations.
>>>> Bassett, an author on the /Lancet /report, says, “We had every 
>>>> reason to prepare ourselves for a bad epidemic when COVID reached 
>>>> us because this country is full of holes.” She lists several: it 
>>>> lacks universal health coverage and mandatory paid sick leave; it 
>>>> has a minimum wage that is below a living wage; and it relies on an 
>>>> immigrant workforce, many of whom lack legal status.
>>>>     Ground truth
>>>> In the bone-dry grape fields of the San Joaquin Valley, farmworkers 
>>>> clip and bag bunches of grapes at a furious speed — they’re paid by 
>>>> the package. A farmworker whose eyes peek out above a dirt-caked 
>>>> bandana doesn’t stop moving as I ask, through a translator, whether 
>>>> she would get tested for the coronavirus if the owner of the farm 
>>>> provided tests.
>>>> No, she whispers, because if it were positive, she couldn’t afford 
>>>> to miss work. Another farmworker, a broad-shouldered man with 
>>>> calloused hands, echoes the sentiment. “Farmworkers don’t stop for 
>>>> a pandemic,” he says. “We keep working.” Both requested anonymity 
>>>> because they are undocumented immigrants from Mexico.
>>>> I drive past tidy rows of nectarine, pomegranate and almond trees, 
>>>> on the way to a melon-packing plant in the city of Mendota, where 
>>>> hundreds of farmworkers queue in their cars alongside a road. 
>>>> They’re waiting for boxes filled with vegetables and starches.
>>>> Food drives such as this occur regularly in California, to assist 
>>>> the estimated 800,000 farmworkers in the state who live far below 
>>>> the poverty line. On this sweltering afternoon, free COVID-19 tests 
>>>> are available in the car park across from the food distribution 
>>>> site. But that area remains vacant.
>>>> About a dozen farmworkers waiting for food echo what those in the 
>>>> grape fields had told me: /a positive test threatens their survival./
>>>> In a beaten-up minivan, a woman with blonde hair grips her steering 
>>>> wheel and confesses, “I’m very frustrated.” She had COVID-19 a few 
>>>> months earlier, but returned to pick lettuces as soon as she felt 
>>>> well enough to stand. Her “bones hurt”, she says, but she hid the 
>>>> pain from her supervisor out of fear that she might be fired. 
>>>> “Essential workers are forgotten,” she says, before inching 
>>>> forwards in line.
>>>> Similar fears and frustrations had flooded the Facebook inbox of 
>>>> Tania Pacheco-Werner, a medical sociologist and co-director of the 
>>>> Central Valley Health Policy Institute at California State 
>>>> University in Fresno. Many farmworkers know of Pacheco because she 
>>>> immigrated to the valley from Mexico City as a child with her 
>>>> parents, who worked in the fields.
>>>> Pacheco observed the contrast between what public-health officials 
>>>> were recommending, and what agriculture workers can realistically 
>>>> do. For example, the CDC said people should physically distance, 
>>>> but that is often impossible in food-processing plants or in the 
>>>> cars that people share to get to work.
>>>> Such realities meant that deaths mounted for Black and Hispanic 
>>>> people in the United States, who are more likely than white people 
>>>> to hold low-paying jobs that cannot be performed at home.
>>>> With people she knew in dire straits, Pacheco wasn’t content to 
>>>> study COVID-19 disparities. She got in touch with grass-roots 
>>>> organizations in Fresno — the most populous city in the valley — 
>>>> and learnt that they had similar concerns.
>>>> By May, around a dozen groups, such as the *African American 
>>>> Coalition*, the *Immigrant Refugee Coalition* and the *Jakara 
>>>> Movement *(representing immigrants from Punjab state in India), 
>>>> were lobbying Fresno’s leaders for interventions tailored to the 
>>>> needs of their communities. They warned that the coronavirus 
>>>> response would fail without their help, because disenfranchised 
>>>> groups trusted them — not the government.
>>>> This was particularly true among undocumented immigrants, who had 
>>>> faced increasing discrimination since the election of Trump in 
>>>> 2016. Trump repeatedly denigrated Mexicans as criminals, and passed 
>>>> policies to increase deportations.
>>>> Farmworkers told me they watched videos of raids by US immigration 
>>>> and customs officers in fear. It made them as wary of public-health 
>>>> officers as they were of the police. “When you realize how screwed 
>>>> people get here,” Pacheco says, “mistrust begins to make sense.”
>>>> For the first few months, Pacheco and her colleagues say that the 
>>>> Fresno county government, led by a predominantly white board of 
>>>> supervisors, ignored their requests to enforce safer conditions on 
>>>> farms, food-packing plants and warehouses, or to provide paid sick 
>>>> leave and other financial assistance for essential workers.
>>>> The board also resisted some public-health measures aimed at 
>>>> reducing the spread of the virus. In May, for example, it revised 
>>>> the wording on masking guidance from the Fresno county health 
>>>> department and publicly undermined the messaging.
>>>> In a statement released just after the original guidance, a Fresno 
>>>> county spokesperson wrote, “The updated Health Officer Order is a 
>>>> recommendation, NOT a mandate.”
>>>>         After the pandemic began, Fresno residents pleaded with
>>>>         county leadership to provide protection and financial
>>>>         support. These two comments were shared by a Fresno-based
>>>>         advocacy organization, the Leadership Counsel for Justice
>>>>         and Accountability.
>>>>         I ask that you have the compassion to ensure families can
>>>>         stay in their homes during this pandemic. We do not need
>>>>         more people in Fresno County without housing… I lead the
>>>>         food distribution and we have doubled the number of
>>>>         families we serve and desperately need PPE. We have reached
>>>>         out to various agencies and have been turned down. I really
>>>>         need help to keep families in our county fed, we need to
>>>>         work together as a team during times like these.
>>>>         Isabel Solorio, Lanare resident
>>>>         Our youngest son lost his job due to COVID-19, and now our
>>>>         whole family is paying two rents. We are struggling to
>>>>         ensure our son completes the school year and our bills get
>>>>         paid on time. We please ask that the county consider
>>>>         families like ours, hardworking families, who are not
>>>>         asking for a handout, we are asking for help to get by
>>>>         during this pandemic.
>>>>         Lucia Salmeron Marroquin, Fresno resident
>>>> Meanwhile, Fresno’s public-health department found itself serving 
>>>> as a mediator between community organizations and agriculture 
>>>> companies. The tension between the two groups comes through in 
>>>> e-mails obtained through a national COVID-19 documentation project 
>>>> <https://documentingcovid19.io/> run by Columbia University in New 
>>>> York City.
>>>> In a message from July, for example, Tom Fuller at the health 
>>>> department wrote to his colleagues about his conversations with 
>>>> farm and food-plant owners: “I have detected an undercurrent of 
>>>> suspicion and perhaps resistance towards some of the groups that 
>>>> have identified themselves as wanting to be part of the County 
>>>> response to the pandemic.”
>>>> Fresno’s health department had little ability to fight the board’s 
>>>> decisions, because its jurisdiction is limited to a handful of 
>>>> measures, such as immunizations and disease surveillance. Plus, 
>>>> says Miguel Arias, a member of Fresno’s city council, the board 
>>>> dictates the health department’s leadership and budget.
>>>> “The department of health is as strong as the board of supervisors 
>>>> allows it to be,” Arias explains. Similar power dynamics played out 
>>>> across the United States, and were exacerbated by protests against 
>>>> coronavirus measures. At least 181 public-health officials 
>>>> resigned, retired or were fired last year, and many of them had 
>>>> faced harassment from the public for doing their jobs, according to 
>>>> an investigation 
>>>> <https://apnews.com/hub/underfunded-and-under-threat> by Kaiser 
>>>> Health News and the Associated Press.
>>>> Arias, too, was threatened. He and other city-council members 
>>>> pushed the board to expand testing on farms, and couple it with 
>>>> paid sick leave. But his confrontational approach got him into trouble.
>>>> “One of the supervisors said to me, ‘Stay in your lane — we aren’t 
>>>> going to disrupt the agriculture industry at the peak of harvest’,” 
>>>> he recalls. On another occasion, men associated with the Proud 
>>>> Boys, a violent, far-right organization, showed up at Arias’s home 
>>>> to confront him 
>>>> <https://twitter.com/ABC7Veronica/status/1260430304315146251>.
>>>> Buddy Mendes, the chair of the board of supervisors last year, 
>>>> refutes claims that they didn’t push for testing on farms because 
>>>> it would be bad for business. Rather, he says, the board had 
>>>> concerns about the type of rapid diagnostic tests being proposed. 
>>>> And he says the board wasn’t ignoring community groups. “It took 
>>>> until August to get the scope of works prepared, and contracts in 
>>>> place.”
>>>> Indeed, the community organizations found their footing in August, 
>>>> just as the outbreak in the San Joaquin Valley exploded. California 
>>>> governor Gavin Newsom approved US$52 million to fund the 
>>>> coronavirus response in the region, and specified that it should 
>>>> target the disproportionate number of Hispanic people who were 
>>>> testing positive for the coronavirus — they accounted for nearly 
>>>> 60% of cases.
>>>> It was during this surge that the board gave $8.5 million to the 
>>>> community organizations, after they partnered with doctors and 
>>>> researchers from the Fresno campus of the University of California, 
>>>> San Francisco (UCSF), to form the *Fresno COVID-19 Equity Project*. 
>>>> A few weeks later, the team converted an austere church belonging 
>>>> to the Fresno Interdominational Refugee Ministries into a 
>>>> coronavirus testing site.
>>>>     Community action
>>>> Two hands grasp a heart on a billboard outside the church for 
>>>> refugees, beside a Bible quotation from Leviticus: “You shall love 
>>>> the foreigner as yourself.” People drive slowly past it all 
>>>> afternoon as they head to a car park and wait for a test from a 
>>>> health worker who will slide a swab far into their nostril.
>>>> Kenny Banh, an emergency-medicine physician at UCSF Fresno, paces 
>>>> excitedly around the transformed church in medical scrubs, 
>>>> reinvigorated by a chance to help people who are healthy enough to 
>>>> walk.
>>>> He explains that people of colour with COVID-19 were often the 
>>>> “sickest of the sickest” patients that he treated at the university 
>>>> hospital. A key problem contributing to higher death rates in this 
>>>> group is that they delay seeking help because they don’t have 
>>>> health insurance, can’t afford medical bills or fear doctors in the 
>>>> United States, he says.
>>>> “A lot of them don’t trust the medical community, and I don’t blame 
>>>> them in some respects because historically they haven’t been 
>>>> treated well.”
>>>> On the lawn outside the church, leaders of the Fresno COVID-19 
>>>> Equity Project were training a legion of people with a knack for 
>>>> grasping the latest coronavirus news and relaying it to their 
>>>> neighbours.
>>>> The project hired and trained 110 of these community health 
>>>> workers, who together speak 16 different languages. That investment 
>>>> of time and money meant turning down researchers who had asked to 
>>>> join the project to study inequities, says Pacheco. She and her 
>>>> colleagues thought that community workers would have a higher 
>>>> pay-off in the near term, even if it cost them publications and 
>>>> grants down the road. What’s more, Banh adds, communities in the 
>>>> valley had grown exhausted with scientists surveying them year 
>>>> after year.
>>>> “By asking people questions, you give them a false belief that 
>>>> you’re going to deliver some sort of help,” he says; when change 
>>>> never arrives, people grow disillusioned.
>>>> Still, a century of neglect isn’t easily undone. Sparse 
>>>> neighbourhoods along the rural roads of the San Joaquin Valley can 
>>>> be traced back to temporary housing tracts built for migrant 
>>>> workers in the 1930s.
>>>> Today, some of these towns don’t have safe drinking water or a 
>>>> single clinic. And the city of Fresno itself is sharply divided. 
>>>> Predominantly Black, Latinx and Asian neighbourhoods are in the 
>>>> south of the city. These sections were shaded red on maps from the 
>>>> 1930s <http://salt.umd.edu/T-RACES/mosaic.html>, indicating areas 
>>>> with large, non-white populations where banks were discouraged from 
>>>> issuing home loans.
>>>> This practice, known as redlining, pushed down property values in 
>>>> the areas, and helped to reinforce racial segregation and 
>>>> inequality. Although lawmakers attempted to mitigate the 
>>>> discriminatory practice in the 1960s, parts of south Fresno still 
>>>> have limited access to parks, Internet services, healthy food and 
>>>> other benefits.
>>>> According to the Central Valley Health Policy Institute, a child 
>>>> born in a wealthy neighbourhood in northern Fresno is expected to 
>>>> live past the age of 80 — more than 10 years longer than a child 
>>>> born in parts of south Fresno, and 20 years longer than a child in 
>>>> rural neighbourhoods in the San Joaquin Valley, where average life 
>>>> expectancy is similar to that for many low-income countries.
>>>> Southwest Fresno is where Guadalupe Lopez lives with her husband 
>>>> and three children in a rented mobile home without drinkable tap 
>>>> water. By the time she connected with a community group serving 
>>>> Indigenous people from Mexico — /Centro Binacional para el 
>>>> Desarrollo Indígena Oaxaqueño/ — she was facing eviction and eating 
>>>> barely a tortilla a day.
>>>> “It’s a nightmare,” she told me as we sat beside a bed and 
>>>> child-sized desk in her tidy living room. Just after garlic-picking 
>>>> season in late July, her 34-year-old husband developed a severe 
>>>> case of COVID-19. He gasped for air, but refused to go to a 
>>>> hospital because he was terrified by the possibility of being 
>>>> permanently separated from his family.
>>>> How would Lopez — who asked for her name to be changed because 
>>>> she’s an undocumented immigrant — care for their children without him?
>>>> But her husband agreed to see a doctor referred to him by a friend. 
>>>> The doctor sold Lopez injections of unapproved drugs that he said 
>>>> would help with COVID-19. She says the bill came to $1,500 — all of 
>>>> the family’s savings.
>>>> In the ensuing weeks, her husband’s health deteriorated, and Lopez 
>>>> tested positive for the coronavirus, too. Neither of them could 
>>>> work in the fields, and their cupboard ran empty. She cries as she 
>>>> describes how her children became so thin that she could see the 
>>>> outlines of their ribs.
>>>> Lopez’s family was not eligible for federal funds to cover 
>>>> unemployment, and the state’s funds for sick leave had run dry. The 
>>>> /Centro Binacional/ granted her money to cover rent. In October, 
>>>> Lopez’s husband returned to the fields, even though he still has 
>>>> bouts of intense fatigue.
>>>> Lopez’s eyes fill up again as she explains what it feels like to be 
>>>> an essential worker in a country that seems to want her dead. “When 
>>>> I go to the store covered in dust from working in the field, white 
>>>> people will look at me in disdain, even when I’m wearing a mask and 
>>>> they aren’t,” she says. “I feel awful because they look at us as 
>>>> less than human.”
>>>> Community health workers share similar stories of desperation. 
>>>> Although their intended role was to educate communities about the 
>>>> coronavirus and assist in contact tracing, they find themselves on 
>>>> phone calls at all hours, scrambling to find funds for parents who 
>>>> cannot feed their children or keep the lights on.
>>>> “I see so much sadness when I talk with people,” says Leticia Peréz 
>>>> de Trujillo, a community health worker with Cultiva La Salud, a 
>>>> Fresno-based health-equity advocacy organization involved in the 
>>>> COVID-19 Equity Project. Still, with guidance from this and other 
>>>> groups, around 1,000 people received grants that staved off hunger 
>>>> and homelessness — and the outreach probably prevented more than a 
>>>> few infections.
>>>> Part of the county’s infusion of coronavirus funds had been set 
>>>> aside for paid sick leave, and that assurance seemed to drive a 
>>>> rise in testing. In December, people were lining up for tests at 
>>>> the converted church before daylight, prompting the team to 
>>>> relocate to a larger spot. But the situation remained far from 
>>>> resolved.
>>>> As the coronavirus surged across the country over the holiday 
>>>> season, the San Joaquin Valley emerged as a hotspot. “This is 
>>>> driven by infections among our essential workers,” Arias tells me 
>>>> on a phone call in late December. Nearly 500 people had died of 
>>>> COVID-19 in the valley in that month alone.
>>>> “We’ve got huge outbreaks at meat-packing plants and at an Amazon 
>>>> distribution centre,” he says. “There’s no capacity in hospitals, 
>>>> and we’re bringing in freezer trailers meant for produce to store 
>>>> bodies, because we’ve run out of space in the morgue.”
>>>>     COVID’s unequal toll
>>>> Black and Latinx people and Indigenous Americans are roughly three 
>>>> times as likely to be hospitalized and twice as likely to die from 
>>>> COVID-19 as are white, non-Hispanic people in the United States.
>>>> The pandemic has the potential to widen economic inequality. 
>>>> Low-wage workers experienced some of the heaviest job losses in 
>>>> 2020, whereas higher-wage workers gained nearly one million jobs.
>>>>     Political limits
>>>> By the end of last year, initiatives such as the COVID-19 Equity 
>>>> Project in Fresno had cropped up across the United States. These 
>>>> programmes are now spearheading equitable vaccine distribution. But 
>>>> the projects are funded by short-term infusions of money. When that 
>>>> dries up, much of the work towards eliminating health disparities 
>>>> will fall back on the health system, says Banh.
>>>> But unlike grass-roots groups, officials in the US public-health 
>>>> system — comprising the CDC and health departments across the 
>>>> country — tend to avoid politically sensitive topics, such as 
>>>> calling for higher wages and immigration reform.
>>>> Government researchers have identified the social determinants of 
>>>> health during the pandemic, but they’re typically treated as 
>>>> immutable factors. For example, an October 2020 investigation^5 
>>>> <https://www.nature.com/immersive/d41586-021-00943-x/index.html#nature-ref-5> in 
>>>> the CDC’s journal, /Morbidity and Mortality Weekly Report/, finds 
>>>> that Black and Hispanic people are disproportionately dying of 
>>>> COVID-19, possibly because of underlying diseases, dense 
>>>> households, in-person work, poor access to health care and 
>>>> discrimination (see also ‘COVID’s unequal toll’).
>>>> But instead of suggesting affordable housing, universal health care 
>>>> and labour protections, the report recommended masks, hand washing 
>>>> and social distancing.
>>>> Another CDC study^6 
>>>> <https://www.nature.com/immersive/d41586-021-00943-x/index.html#nature-ref-6> posted 
>>>> online on 12 April finds that COVID-19 hospitalizations were 
>>>> highest for Hispanic or Latinx people in the United States, 
>>>> compared with other racial or ethnic groups. The authors attribute 
>>>> the disparity to the social determinants of health, and recommend 
>>>> that health departments distribute vaccines accordingly. But they 
>>>> don’t suggest ways to correct the underlying problems.
>>>> Ronald Labonté, a public-health researcher at the University of 
>>>> Ottawa in Canada, isn’t surprised to see government scientists 
>>>> dodging political flashpoints, because there can be severe 
>>>> consequences for speaking out — some have received death threats, 
>>>> for instance. Similarly, he says, public-health researchers often 
>>>> link poverty and marginalization to disease, but don’t challenge 
>>>> the status quo by digging deeper into why people are poor or 
>>>> marginalized in the first place.
>>>> “What drives it is essentially oppression, exploitation and the 
>>>> pursuit of power and profit,” he says. “But I don’t think you’re 
>>>> gonna have too many public-health departments come out and say that.”
>>>> This doesn’t mean that people in the public-health system don’t 
>>>> want to address systemic injustice. One obstacle is that health 
>>>> departments have limited control. For example, Fuller at Fresno’s 
>>>> health department says he can advise companies on best COVID-19 
>>>> practices, but the department can’t enforce rules. “The safety and 
>>>> health of employees is not under our jurisdiction.”
>>>> Indeed, that duty typically falls to the Occupational Safety and 
>>>> Health Administration (OSHA), the US regulatory agency with the 
>>>> power to inspect workplaces to ensure that conditions are safe.
>>>> But if public health has been underfunded, OSHA’s resources are 
>>>> even more scant, and its powers are consistently undermined by 
>>>> business interests, says epidemiologist David Michaels at the 
>>>> George Washington University School of Public Health in Washington 
>>>> DC, who directed OSHA under former president Barack Obama. Last 
>>>> year, the number of OSHA workplace safety inspectors was lower than 
>>>> at any time in the past 45 years, according to the National 
>>>> Employment Law Project.
>>>> Perhaps this is why so few of more than 13,000 complaints to OSHA 
>>>> about coronavirus-related hazards were followed up with inspections 
>>>> and fines. “We have structured our economy so that many workers 
>>>> have few rights, and are underpaid, and face hazards that would be 
>>>> unacceptable to the corporate leaders who profit from their work,” 
>>>> Michaels says.
>>>> Singh’s mother lives that reality. Two weeks before she tested 
>>>> positive for the coronavirus at the Foster Farms meat-packing 
>>>> plant, she told her son that 140 people at work might have 
>>>> COVID-19. The factory floor looked emptier, she told him, and a 
>>>> flyer in English on the notice board included the number 140.
>>>> Singh didn’t know what to make of his mother’s fears. “I feel like 
>>>> everyone I know at Foster Farms speaks Spanish, Hmong and Punjabi, 
>>>> and like very few speak English,” he explains. He told his mother 
>>>> to ask a co-worker with a smartphone to photograph the sign, and 
>>>> send it to him to read. But her colleague refused because she 
>>>> didn’t want to get into trouble.
>>>> A couple of days later, she said the sign had disappeared — but the 
>>>> outbreak was silently growing larger. In December, the United Farm 
>>>> Workers of America union sued Foster Farms on behalf of several 
>>>> employees from a plant in Livingston, alleging that “Foster Farms 
>>>> has failed to take the necessary safety precautions to prevent the 
>>>> spread of COVID-19”.
>>>> In fact, Foster Farms’ Livingston plant is exceptional because it 
>>>> is one of very few agricultural businesses shut down by 
>>>> health-department officials for a COVID-19 outbreak.
>>>> Salvador Sandoval, an officer at the Merced health department — 
>>>> where Livingston is located — became upset when he found out that 
>>>> two employees had died at the plant in July. That prompted the 
>>>> department to request a list of all worker infections. “Buried in 
>>>> it were more people who were deceased,” Sandoval says.
>>>> He and the department’s epidemiologist were alarmed. They wanted to 
>>>> shut the Livingston plant until everyone could be tested. So they 
>>>> reached out to California’s health department and the state’s OSHA 
>>>> office for help as Merced’s leaders pushed back against the closure.
>>>> The health department even got a call from a federal official in 
>>>> mid-August, saying that the plant must remain open because of 
>>>> Trump’s executive order to keep meat-processing plants operational.
>>>> But Merced’s tiny department persisted. At the end of August, after 
>>>> eight workers had died, the Livingston plant partially closed for 
>>>> six days so that it could be cleaned, and workers tested. “It 
>>>> wasn’t easy,” Sandoval says. “This was blood, sweat and tears.”
>>>> In a statement to /Nature/, Foster Farms writes that the company is 
>>>> committed to the health and welfare of its employees, and that it 
>>>> has implemented COVID-19 protective measures throughout the 
>>>> pandemic, including an extensive testing system.
>>>> In February, the company began vaccinating California employees. 
>>>> And as for specific complaints from workers, the company writes, 
>>>> “Since March 2020, all company employees have been encouraged to 
>>>> share any concerns about their health and safety regarding COVID-19 
>>>> with their supervisors.”
>>>>     Protecting public health
>>>> Evidence on the toll of outbreaks at meat-packing plants has been 
>>>> undeniable. In a paper in /Proceedings of the National Academy of 
>>>> Sciences/^7 
>>>> <https://www.nature.com/immersive/d41586-021-00943-x/index.html#nature-ref-7>, 
>>>> researchers estimated that, in just the first half of 2020, up to 
>>>> 310,000 cases and as many as 5,200 deaths in the United States were 
>>>> due to outbreaks at livestock plants that spread through 
>>>> surrounding communities.
>>>> And those figures point to a larger problem. Public-health 
>>>> specialists are correct in saying that they don’t have control of 
>>>> workplaces, but when they can’t successfully push back against 
>>>> policies that favour corporate interests, historians say the field 
>>>> can’t accomplish one of its core functions — protecting the most 
>>>> vulnerable from disease.
>>>> “We know what the impact is of a lack of employment, a lack of fair 
>>>> wages, a lack of transport, of poor education and racism,” says 
>>>> Graham Mooney, a public-health historian at Johns Hopkins 
>>>> University in Baltimore, Maryland. “So, if public health has no 
>>>> power to influence these issues, then public health becomes nothing.”
>>>> Georges Benjamin, executive director of the American Public Health 
>>>> Association, agrees. He adds that the time to push for social and 
>>>> economic changes is now, when the tragedies of the pandemic have 
>>>> laid bare an urgent need for reform. He recalls how the devastation 
>>>> of the Great Depression in the 1930s led to the ‘New Deal’, a 
>>>> series of programmes that included unemployment insurance, housing 
>>>> reform and welfare benefits under former president Franklin D. 
>>>> Roosevelt.
>>>> “Once again, we need to come up with a new social compact for 
>>>> America,” says Benjamin. “One that says that everyone should have 
>>>> access to a living wage, to affordable housing, to affordable 
>>>> health care, that our environment should be safe.”
>>>> A month after I talked to Benjamin, US President Joe Biden proposed 
>>>> a $2-trillion economic plan that includes features reminiscent of 
>>>> the New Deal. It even echoes Virchow’s report on curbing typhus in 
>>>> Upper Silesia in the 1850s, with calls for higher wages, improved 
>>>> working conditions, public schools and affordable housing — paid 
>>>> for, in part, through tax increases on corporations. If enacted, 
>>>> proponents say, the plan could reverse 40 years of rising 
>>>> inequality in the United States.
>>>> On 31 March, the American Public Health Association released a 
>>>> statement in favour of Biden’s proposal, calling it essential to 
>>>> addressing disparities in health.
>>>> Other scientists are getting political, too. When I asked Fauci to 
>>>> elaborate on statements he’s made about the social determinants of 
>>>> health, he said that disparities are rooted in systemic racism and 
>>>> economic inequality, and that it’s time to discuss them.
>>>> “As scientists,” he says, “we have a societal responsibility to 
>>>> talk about this — we’re the ones in the trenches taking care of 
>>>> people, and analysing the data on disparities first-hand.”
>>>> The authors of the /Lancet/ report on US health problems were more 
>>>> prescriptive^4 
>>>> <https://www.nature.com/immersive/d41586-021-00943-x/index.html#nature-ref-4>. 
>>>> They listed solutions, such as higher wages and immigration reform. 
>>>> They also elaborated on how researchers might push for these 
>>>> policies by framing arguments to attract broad support, using 
>>>> hashtags on social media and forming unusual coalitions, such as 
>>>> with activist groups.
>>>> Planey, the medical geographer, says that academics could learn how 
>>>> to write memos that politicians can understand in three minutes. To 
>>>> get more traction, they should consider the costs of the solutions 
>>>> they propose, as well as the benefits. “People think, ‘If I produce 
>>>> good evidence, people will listen,’ but that isn’t how it works,” 
>>>> she says.
>>>> Whether the public-health field can become more radical and 
>>>> outspoken in demanding policy changes remains to be seen. Several 
>>>> early-career researchers told me they’ve been advised not to speak 
>>>> publicly on charged political topics until they have tenured positions.
>>>> But the status quo won’t help Singh and his family. Their financial 
>>>> stress worsened after his mother left her job in March. “Ever since 
>>>> she had COVID, she’s felt fatigued and not able to stand for the 
>>>> long hours required,” Singh explains. She also has chronic neck and 
>>>> back pain after years of factory labour. The family has received 
>>>> temporary assistance: food stamps to subsidize the cost of 
>>>> groceries, and a month’s rent was covered by the Jakara Movement, a 
>>>> group in Fresno’s COVID Equity Project.
>>>> In his graduate programme at one of the leading public-health 
>>>> schools in the country, Singh’s lectures cover the links between 
>>>> poverty and other socio-economic factors and disease. He’s begun to 
>>>> find it frustrating. “There’s a lot of research about health 
>>>> disparities and inequities,” he says. “But what are we doing to 
>>>> eradicate or even reduce them?”
>>>> He suggests that researchers partner with community organizations 
>>>> that have been advocating for marginalized people. “Publishing 
>>>> another paper saying workers are at higher risk of COVID isn’t 
>>>> solving the problem,” he says. “Don’t you want to prevent that from 
>>>> happening?”
>>>> /This piece was supported by grants from the Pulitzer Center and 
>>>> the MIT Knight Science Journalism fellowship./
>>>> ------------------------------------------------------------------------
>>>>     References
>>>>  1. Chen, Y-.H. /et al/. Preprint at medRxiv
>>>>     <https://doi.org/10.1101/2021.01.21.21250266> (2021).
>>>>  2. Gray, A. M. /Int. J. Health Serv/. *12*, 349–380 (1982).
>>>>     Article <https://doi.org/10.2190%2FXXMM-JMQU-2A7Y-HX1E>
>>>>  3. Chetty, R. /et al. J. Am. Med. Assoc/. *315*, 1750–1766 (2016).
>>>>     Article <https://doi.org/10.1001%2Fjama.2016.4226>
>>>>  4. Woolhandler, S. /et al. Lancet/ *397*, 705–753 (2021). Article
>>>>     <https://doi.org/10.1016%2FS0140-6736%2820%2932545-9>
>>>>  5. Gold, J. A. W. /et al. Morb. Mortal. Wkly Rep/. *69*, 1517–1521
>>>>     (2020). Article <https://doi.org/10.15585%2Fmmwr.mm6942e1>
>>>>  6. Romano, S. D. /et al. Morb. Mortal. Wkly Rep/. *70*, 560–565
>>>>     (2021). Article <https://doi.org/10.15585%2Fmmwr.mm7015e2>
>>>>  7. Taylor, C. A., Boulos, C. & Almond, D. /Proc. Natl Acad. Sci.
>>>>     USA/ *117*, 31706–31715 (2020). Article
>>>>     <https://doi.org/10.1073%2Fpnas.2010115117>
>>>> ------------------------------------------------------------------------
>>>> © 2021 Springer Nature Limited. All rights reserved.
>>> Visit: https://murphyslog.ca <https://murphyslog.ca/>
>>> Twitter:  @BrianKMurphy2
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