Popular health surveillance in traditional fishing communities and the ecology of knowledges in the fight against COVID-19. / Vigilância popular da saúde nas comunidades pesqueiras tradicionais e ecologia dos saberes no enfrentamento à COVID-19.

Considering the public health emergency of international importance caused by COVID-19, artisanal fishing workers, engaging in a dialogue with Brazilian leaders and scholars, created an Observatory on the impacts of this pandemic on fishing communities in March 2020. The purpose of this article is to analyze the experience of popular surveillance of fishermen and fisherwomen's health through daily reports produced at the Observatory. It is a monitoring process that allowed broadening the recognition of the diversity of vulnerable populations' ways of life that intertwine health, environment and work. The study used a qualitative, horizontal and emancipatory methodology and sought approaches to the practice of the ecology of knowledges, with the following results: shared construction of information and knowledges based on heterogeneous social experiences; practice of collective ombudsman with the appreciation of knowledges built in social struggles); joint assessment of public health inequities, territorial conflicts, and environmental, structural, and institutional racism; guidance of social leaders and fundraising through public notices. Thus, the dynamics and horizontality of learning based on solidarity and social emancipation from inter-knowledge are revealed.

Diante da emergência em saúde pública de importância internacional provocada pela COVID-19, trabalhadores da pesca artesanal, em diálogo com lideranças e acadêmicos brasileiros criaram, em março de 2020, um Observatório sobre os impactos dessa pandemia em comunidades pesqueiras. O objetivo deste artigo é analisar a experiência de vigilância popular da saúde de pescadores e pescadoras através de boletins diários produzidos no Observatório. Trata-se de um processo de monitoramento que possibilitou ampliar o reconhecimento da diversidade de modos de vida das populações vulneráveis que entrelaça saúde, ambiente e trabalho. O estudo utilizou metodologia qualitativa, horizontal e emancipatória e buscou aproximações à prática da ecologia dos saberes, tendo como resultados: construção compartilhada de informações e conhecimentos com base em experiências sociais heterogêneas; prática da ouvidoria coletiva com a valorização de saberes construídos nas lutas sociais; avaliação conjunta de iniquidades em saúde pública, conflitos territoriais e racismo ambiental, estrutural e institucional; orientação das lideranças sociais e captação de recursos através de editais públicos. Revela-se, assim, dinamicidade e horizontalidade de aprendizados com base na solidariedade e emancipação social a partir do interconhecimento.

The Most Vulnerable Hispanic Immigrants in New York City: Structural Racism and Gendered Differences in COVID-19 Deaths.

This paper explores the structural and group-specific factors explaining the excess death rates experienced by the Hispanic population in New York City during the peak years of the coronavirus pandemic. Neighborhood-level analysis of Census data allows an exploration of the relation between Hispanic COVID-19 deaths and spatial concentration, conceived in this study as a proxy for structural racism. This analysis also provides a more detailed exploration of the role of gender in understanding the effects of spatial segregation among different Hispanic subgroups, as gender has emerged as a significant variable in explaining the structural and social effects of COVID-19. Our results show a positive correlation between COVID-19 death rates and the share of Hispanic neighborhood residents. However, for men, this correlation cannot be explained by the characteristics of the neighborhood, as it is for women. In sum, we find: (a) differences in mortality risks between Hispanic men and women; (b) that weathering effects increase mortality risks the longer Hispanic immigrant groups reside in the U.S.; (c) that Hispanic males experience greater contagion and mortality risks associated with the workplace; and (d) we find evidence corroborating the importance of access to health insurance and citizenship status in reducing mortality risks. The findings propose revisiting the Hispanic health paradox with the use of structural racism and gendered frameworks.

COVID-19 Mortality by Race and Ethnicity in US Metropolitan and Nonmetropolitan Areas, March 2020 to February 2022.

Importance: Prior research has established that Hispanic and non-Hispanic Black residents in the US experienced substantially higher COVID-19 mortality rates in 2020 than non-Hispanic White residents owing to structural racism. In 2021, these disparities decreased. Objective: To assess to what extent national decreases in racial and ethnic disparities in COVID-19 mortality between the initial pandemic wave and subsequent Omicron wave reflect reductions in mortality vs other factors, such as the pandemic's changing geography. Design, Setting, and Participants: This cross-sectional study was conducted using data from the US Centers for Disease Control and Prevention for COVID-19 deaths from March 1, 2020, through February 28, 2022, among adults aged 25 years and older residing in the US. Deaths were examined by race and ethnicity across metropolitan and nonmetropolitan areas, and the national decrease in racial and ethnic disparities between initial and Omicron waves was decomposed. Data were analyzed from June 2021 through March 2023. Exposures: Metropolitan vs nonmetropolitan areas and race and ethnicity. Main Outcomes and Measures: Age-standardized death rates. Results: There were death certificates for 977 018 US adults aged 25 years and older (mean [SD] age, 73.6 [14.6] years; 435 943 female [44.6%]; 156 948 Hispanic [16.1%], 140 513 non-Hispanic Black [14.4%], and 629 578 non-Hispanic White [64.4%]) that included a mention of COVID-19. The proportion of COVID-19 deaths among adults residing in nonmetropolitan areas increased from 5944 of 110 526 deaths (5.4%) during the initial wave to a peak of 40 360 of 172 515 deaths (23.4%) during the Delta wave; the proportion was 45 183 of 210 554 deaths (21.5%) during the Omicron wave. The national disparity in age-standardized COVID-19 death rates per 100 000 person-years for non-Hispanic Black compared with non-Hispanic White adults decreased from 339 to 45 deaths from the initial to Omicron wave, or by 293 deaths. After standardizing for age and racial and ethnic differences by metropolitan vs nonmetropolitan residence, increases in death rates among non-Hispanic White adults explained 120 deaths/100 000 person-years of the decrease (40.7%); 58 deaths/100 000 person-years in the decrease (19.6%) were explained by shifts in mortality to nonmetropolitan areas, where a disproportionate share of non-Hispanic White adults reside. The remaining 116 deaths/100 000 person-years in the decrease (39.6%) were explained by decreases in death rates in non-Hispanic Black adults. Conclusions and Relevance: This study found that most of the national decrease in racial and ethnic disparities in COVID-19 mortality between the initial and Omicron waves was explained by increased mortality among non-Hispanic White adults and changes in the geographic spread of the pandemic. These findings suggest that despite media reports of a decline in disparities, there is a continued need to prioritize racial health equity in the pandemic response.

What contributes to COVID-19 online disinformation among Black Canadians: a qualitative study.

BACKGROUND: Black Canadians are disproportionately affected by the COVID-19 pandemic, and the literature suggests that online disinformation and misinformation contribute to higher rates of SARS-CoV-2 infection and vaccine hesitancy in Black communities in Canada. Through stakeholder interviews, we sought to describe the nature of COVID-19 online disinformation among Black Canadians and identify the factors contributing to this phenomenon. METHODS: We conducted purposive sampling followed by snowball sampling and completed in-depth qualitative interviews with Black stakeholders with insights into the nature and impact of COVID-19 online disinformation and misinformation in Black communities. We analyzed data using content analysis, drawing on analytical resources from intersectionality theory. RESULTS: The stakeholders (n = 30, 20 purposively sampled and 10 recruited by way of snowball sampling) reported sharing of COVID-19 online disinformation and misinformation in Black Canadian communities, involving social media interaction among family, friends and community members and information shared by prominent Black figures on social media platforms such as WhatsApp and Facebook. Our data analysis shows that poor communication, cultural and religious factors, distrust of health care systems and distrust of governments contributed to COVID-19 disinformation and misinformation in Black communities. INTERPRETATION: Our findings suggest racism and underlying systemic discrimination against Black Canadians immensely catalyzed the spread of disinformation and misinformation in Black communities across Canada, which exacerbated the health inequities Black people experienced. As such, using collaborative interventions to understand challenges within the community to relay information about COVID-19 and vaccines could address vaccine hesitancy.

Racial and ethnic disparities in excess mortality among U.S. veterans during the COVID-19 pandemic.

OBJECTIVE: The COVID-19 pandemic disproportionately affected racial and ethnic minorities among the general population in the United States; however, little is known regarding its impact on U.S. military Veterans. In this study, our objectives were to identify the extent to which Veterans experienced increased all-cause mortality during the COVID-19 pandemic, stratified by race and ethnicity. DATA SOURCES: Administrative data from the Veterans Health Administration's Corporate Data Warehouse. STUDY DESIGN: We use pre-pandemic data to estimate mortality risk models using five-fold cross-validation and quasi-Poisson regression. Models were stratified by a combined race-ethnicity variable and included controls for major comorbidities, demographic characteristics, and county fixed effects. DATA COLLECTION: We queried data for all Veterans residing in the 50 states plus Washington D.C. during 2016-2020. Veterans were excluded from analyses if they were missing county of residence or race-ethnicity data. Data were then aggregated to the county-year level and stratified by race-ethnicity. PRINCIPAL FINDINGS: Overall, Veterans' mortality rates were 16% above normal during March-December 2020 which equates to 42,348 excess deaths. However, there was substantial variation by racial and ethnic group. Non-Hispanic White Veterans experienced the smallest relative increase in mortality (17%, 95% CI 11%-24%), while Native American Veterans had the highest increase (40%, 95% CI 17%-73%). Black Veterans (32%, 95% CI 27%-39%) and Hispanic Veterans (26%, 95% CI 17%-36%) had somewhat lower excess mortality, although these changes were significantly higher compared to White Veterans. Disparities were smaller than in the general population. CONCLUSIONS: Minoritized Veterans experienced higher rates excess of mortality during the COVID-19 pandemic compared to White Veterans, though with smaller differences than the general population. This is likely due in part to the long-standing history of structural racism in the United States that has negatively affected the health of minoritized communities via several pathways including health care access, economic, and occupational inequities.

How Trust in Cancer Information Has Changed in the Era of COVID-19: Patterns by Race and Ethnicity.

COVID-19 emerged during an era of heightened attention to systemic racism and the spread of misinformation. This context may have impacted public trust in health information about chronic diseases like cancer. Here, we examine data from the 2018 and 2020 Health Information National Trends Survey (N = 7,369) to describe how trust in cancer information from government health agencies, doctors, family and friends, charitable organizations, and religious organizations changed after COVID-19 became a pandemic, and whether that change varied by race/ethnicity. Statistical methods included chi-square tests and multiple logistic regression modeling. Overall, the proportion of respondents who reported a high degree of trust in cancer information from doctors increased (73.65% vs. 77.34%, p = .04). Trends for trust in information from government health agencies and family and friends varied significantly by race/ethnicity, with substantial declines observed among non-Hispanic Blacks (NHB) only. The odds of reporting a high degree of trust in cancer information from government health agencies and friends and family decreased by 53% (OR = 0.47, 95% CI = 0.24-0.93) and 73% (OR = 0.27, 95% CI = 0.09-0.82), respectively, among NHB, but were stable for other groups. Future studies should monitor whether recent declines in trust among NHB persist and unfavorably impact participation in preventive care.

The impact of systemic racism on health outcomes among Black women: Recommendations for change.

ABSTRACT: Black women suffer disproportionately from healthcare inequities in comparison to their White counterparts. Using the Public Health Critical Race framework, this article explores the lasting effects of systemic racism on the health outcomes of Black women across the lifespan. A case study and specific strategies are presented to examine how clinicians, educators, and policymakers can work with Black women to mitigate and eliminate health inequities.

Empirical evidence on structural racism as a driver of racial inequities in COVID-19 mortality.

Objective: This study contributes to the literature by empirically testing the extent to which place-based structural racism is a driver of state-level racial inequalities in COVID-19 mortality using theoretically-informed, innovative approaches. Methods: CDC data are used to measure cumulative COVID-19 death rates between January 2020 and August 2022. The outcome measure is a state-level Black-White (B/W) ratio of age-adjusted death rates. We use state-level 2019 administrative data on previously validated indicators of structural racism spanning educational, economic, political, criminal-legal and housing to identify a novel, multi-sectoral latent measure of structural racism (CFI = 0.982, TLI = 0.968, and RMSEA = 0.044). We map B/W inequalities in COVID-19 mortality as well as the latent measure of structural racism in order to understand their geographic distribution across U.S. states. Finally, we use regression analyses to estimate the extent to which structural racism contributes to Black-White inequalities in COVID-19 mortality, net of potential confounders. Results: Results reveal substantial state-level variation in the B/W ratio of COVID-19 death rates and structural racism. Notably, regression estimates indicate that the relationship between the structural racism and B/W inequality in COVID-19 mortality is positive and statistically significant (p < 0.001), both in the bivariate model (adjusted R2 = 0.37) and net of the covariates (adjusted R2 = 0.54). For example, whereas states with a structural racism value 2 standard deviation below the mean have a B/W ratio of approximately 1.12, states with a structural racism value 2 standard deviation above the mean have a ratio of just above 2.0. Discussion: Findings suggest that efficacious health equity solutions will require bold policies that dismantle structural racism across numerous societal domains.

No Equity without Data Equity: Data Reporting Gaps for Native Hawaiians and Pacific Islanders as Structural Racism.

Data on the health and social determinants for Native Hawaiians and Pacific Islanders (NHPIs) in the United States are hidden, because data are often not collected or are reported in aggregate with other racial/ethnic groups despite decades of calls to disaggregate NHPI data. As a form of structural racism, data omissions contribute to systemic problems such as inability to advocate, lack of resources, and limitations on political power. The authors conducted a data audit to determine how US federal agencies are collecting and reporting disaggregated NHPI data. Using the COVID-19 pandemic as a case study, they reviewed how states are reporting NHPI cases and deaths. They then used California's neighborhood equity metric-the California Healthy Places Index (HPI)-to calculate the extent of NHPI underrepresentation in communities targeted for COVID-19 resources in that state. Their analysis shows that while collection and reporting of NHPI data nationally has improved, federal data gaps remain. States are vastly underreporting: more than half of states are not reporting NHPI COVID-19 case and death data. The HPI, used to inform political decisions about allocation of resources to combat COVID-19 in at-risk neighborhoods, underrepresents NHPIs. The authors make recommendations for improving NHPI data equity to achieve health equity and social justice.

A policy pathway: Nursing's role in advancing diversity and health equity.

PURPOSE: The aim of this manuscript is to embolden nurses to engage in policy that promotes diversity, equity, inclusion, and belonging to advance health equity. BACKGROUND: It uses the Future of Nursing Report 2020-2030 to acknowledge the impact of structural racism and the need for a more equitable, just, and fair society. DISCUSSION: It also recognizes that nurses must harness their power and political will, to change and strengthen policies, so all nurses can practice to the full extent of their education and license. CONCLUSION: A case study of the response to COVID-19 in one underserved community is included to illustrate policy in action.

Teaching Health Equity in the Time of COVID-19: a Virtual Look Through the Lens of Structural Racism.

INTRODUCTION: In the context of marked health disparities affecting historically marginalized communities, medical schools have an obligation to rapidly scale up COVID-19 education through the lens of structural racism. AIM: To develop and implement a virtual curriculum on structural racism in a required COVID-19 course for medical students using "just-in-time" training. SETTING: Academic medical institution during the height of COVID-19 in the spring of 2020. PARTICIPANTS: Three hundred ninety-three 3rd and 4th-year medical students prior to re-entry into clinical care. PROGRAM DESCRIPTION: Three educational sessions focused on (1) racial health disparities, (2) othering and pandemics, and (3) frameworks to address health inequity. The virtual teaching methods included narrated recorded presentations, reflections, and student-facilitated small group dialogue. PROGRAM EVALUATION: In matched pre- and post-surveys, participants reported significant changes in their confidence in achieving the learning objectives and high satisfaction with small group peer facilitation. DISCUSSION: The use of "just-in-time" training exploring the intersection between COVID-19 and structural racism facilitated the delivery of time-relevant and immediately clinically applicable content as students were preparing to re-enter a transformed clinical space. Similar approaches can be employed to adapt to changing healthcare landscapes as academic medical centers strive to build more equitable health systems.

Educators Countering the Impact of Structural Racism on Health Equity.

Health equity endorses that all persons are respected equally, and society must exert intentional efforts to eradicate inequities. Race, frequently taught as an impartial risk factor for disease, is a facilitator of structural inequities stemming from racist policies. Nursing educators must help students understand the impact of structural racism on patient populations, communities, and society at large. This article illustrates the face of structural racism, highlights how structural racism impacts health care outcomes, and provides meaningful ways for educators to unmute racism and facilitate race-related discourse in the classroom to counter the impact of structural racism on health equity.

Structural Racism and Cancer: Calls to Action for Cancer Researchers to Address Racial/Ethnic Cancer Inequity in the United States.

As leaders with the American Society of Preventive Oncology (ASPO) Cancer Health Disparities Special Interest Group, we describe the role of structural racism in perpetuating cancer health inequity historically, and potential implications of COVID-19 in exacerbating the effects of structural racism on patients with cancer seeking screening, diagnostic care, treatment, and survivorship support. As a strategy to reduce cancer inequities in the United States, we provide the following calls to action for cancer researchers to help alleviate the burden of structural racism: (i) identify and name structural racism while describing its operation within all aspects of scientific research; (ii) comprehensively integrate discussions on structural racism into teaching, mentoring, and service activities; and (iii) understand and support community actions to address structural racism.

Efforts to advance NIH-funded behavioral and social sciences research on structural racism and health.

This commentary provides background and context for the increasing attention to research designed to better understand and address the impact of structural racism on health, with particular attention to the role of the behavioral and social sciences. The manuscript describes the impetus provided to this work by recent public health crises of COVID-19 and the racial justice movement that emerged following the murder of George Floyd in the summer of 2020. A range of initiatives from the National Institutes of Health (NIH) focused on structural racism and health equity are discussed in this context and opportunities and gaps for future research are identified.

Assessing the Influence of Food Insecurity and Retail Environments as a Proxy for Structural Racism on the COVID-19 Pandemic in an Urban Setting.

A collaborative partnership launched the Great Grocer Project (GGP) in March 2021 in Detroit, Michigan where health inequities, including deaths due to COVID-19, have historically been politically determined and informed by socially entrenched norms. Institutional and structural racism has contributed to a lack of diversity in store ownership among Detroit grocers and limited access to high-quality, affordable healthy foods as well as disparate food insecurity among Detroit residents. The GGP seeks to promote Detroit's healthy grocers to improve community health and economic vitality through research, programs, and policies that have the potential to advance health equity. A cross-sectional design was used to explore relationships between scores from the Nutrition Environment Measures Surveys-Stores (NEMS-S) in 62 stores and city-level data of COVID-19 cases and deaths as well as calls to 211 for food assistance. Regression and predictive analyses were conducted at the ZIP code level throughout the city to determine a relationship between the community food environment and food insecurity on COVID-19 cases and deaths. COVID-19 cases and deaths contributed to greater food insecurity. The use of ZIP code data and the small sample size were limitations within this study. Causation could not be determined in this study; therefore, further analyses should explore the potential effects of individual grocery stores on COVID-related outcomes since a cluster of high-scoring NEMS-S stores and calls to 211 for food security resources inferred a potential protective factor. Poor nutrition has been shown to be associated with increased hospitalizations and deaths due to COVID-19. It is important to understand if a limited food environment can also have a negative effect on COVID-19 rates and deaths. Lessons learned from Detroit could have implications for other communities in using food environment improvements to prevent an uptick in food insecurity and deaths due to COVID-19 and other coronaviruses.