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(clockwise from upper right) Dr. Zeenia Junkeer, Dr. Aileen Alfonso Duldulao, and Multnomah County Public Health Director Rachael Banks held a remote video conference last week to discuss the pandemic's disparate impact on communities of color.
Saundra Sorenson
Published: 14 May 2020

 At least 40% of COVID-19 cases in Multnomah County were experienced by Black, Indigenous, and other people of color, according to data released by Multnomah County’s public health division. These populations make up only a third of Multnomah County residents, highlighting disparities in how communities of color experience the pandemic.

Multnomah County has become one of the few to include race and ethnicity and housing status demographic information in its COVID-19 data, available and updated on the regional COVID-19 data dashboard. Last week, county health authorities and advocates gathered by video conference call to emphasize the importance of disaggregated data collection, and to inform the public of available resources.

“It’s important to understand the history that precedes this data, a history that makes some people more vulnerable not because of choices they’ve made, not because of their age, but simply because they were born Black or Brown in a society that’s treated them and their ancestors unfairly,” Multnomah County Public Health Director Rachael Banks said in opening the April 29 webinar.

zeenia junkeer introDr. Zeenia Junkeer, executive director of the Oregon Health Equity Alliance, says that detailed patient data is key to getting more resources to vulnerable communities hit hardest by the pandemic. Banks was joined by Dr. Zeenia Junkeer, executive director of the Oregon Health Equity Alliance and Dr. Aileen Alfonso Duldulao, a senior epidemiologist in the Multnomah County Health Department. Junkeer and Duldulao are members of a data review committee that includes culturally specific leaders from the county, as well as OHEA, the Coalition of Communities of Color, and the Native Wellness Institute.

The panel emphasized that more thorough data collection that accurately reports patients’ race and ethnic backgrounds was essential, and that key to this is using Race, Ethnicity, Language, and Disability or REALD implementation, which the Department of Human Services and the Oregon Health Authority are now required to do under state law. REALD surveys including more than 30 subcategories of racial or ethnic identity.

“We recognize that culturally responsive and specific strategies are going to be less effective if we don’t know how folks identify, and we recognize that umbrella categories may not allow us to see the nuances of who’s most impacted, and then subsequently, be able to allocate resources or strategies for those communities,” Junkeer told The Skanner.

Detailing Cases

Duldulao emphasized that these categories are used “as a proxy for experiencing racism, and how racism shapes people’s experiencing of the COVID-19 pandemic.”

“Black, Indigenous, and people of color are more likely to be exposed to coronavirus because they’re more likely to engage in public-facing essential work⁠—working in grocery stores, in janitorial services, working as nurses,” Duldulao said during her presentation. “They’re less likely to have the privilege of teleworking, and also we see a lot of communities who are very tight-knit and have close social networks, and we also know that proximity to people is one way that COVID-19 is spread. We see more severity among Black, Indigenous, and people of color because they are more likely to experience severe symptoms and hospitalization because of racial disparities in chronic disease, and access to healthcare and opportunities to health. We also see disparities in mortality or death: Black, Indigenous, and people of color are more likely to die because of higher rates of chronic disease in both young and old. So these underlying conditions that we often hear about that exacerbate what people experience with COVID-19.”

Duldulao confirmed that local numbers reflect what has happened nationally, but cautioned that this data only reflects people who have had access to testing for the disease.

“We also look at housing status, which is also displayed, and we include this information on our dashboard to help our community understand that COVID-19 might impact groups differently because of inequitable testing, inequitable risk of exposure, inequitable access to medical care and testing,” Duldulao said.

“And so essentially people in our communities have differential access based on their experiences with discrimination and racism, colonization and historical trauma.”

One category of data the county has chosen to omit from its dashboard is the zip code of residents who have tested positive for COVID-19.

“Zip code is where somebody lives, and it doesn’t tell you where the exposure is,” Banks said. “So we talk about this false sense of security about knowing where the infection is.

"We’re more concerned with where people are being exposed than with where they live.

"It’s also wanting to be thoughtful about what the potential unintended impacts of that are. We have seniors and folks that need meals delivered, we have folks that are at home that need services in their

communities. And the thought that perhaps a zip code that doesn’t even talk about where the exposure happened could stop somebody from getting the resources that they need, is something that really weighs very heavily.”

Identifying Need

More detailed data sets allow for more culturally specific health care services, but also enable counties and other jurisdictions to better understand how to reach impacted populations, Junkeer said.

“The OHEA really strongly advocates for community-led and driven solutions around health care, but also education and other systems,” Junkeer told The Skanner. “I would imagine a best practice would be for county and state health departments to reach out to those communities, offer them resources, and ask them what the best ways to reach out to the community’s members are. Are folks on social media? Do flyers work well? Or culturally specific radio ads? Do communities need insurance assisters? Without that information, what we’re saying is we will take what we’ve created in English for dominant populations, or use those same processes and shift them a little bit. Which I don’t think works.”

Self-reporting Data

Jakeer encouraged members of the public to self-report race and ethnic data at points of contact with the health care system.

“One of the challenges, and I feel this deeply, is that Black, Indigenous, and POC communities are mistrustful of systems, and also mistrustful of the government, and so why would we want to give data that might be used to target us later?” Junkeer told The Skanner. “I hear that, and I hold that.

"And what I know is that without having accurate representation where we get to self-identify, people will identify us.”

She explained that she has seen cases where race or ethnic background was assumed by health care practitioners.

Jakeer added, “Ideally, people will be able to say ‘I want you to know how I identify, not so you can treat me differently, but so that we can get a better sense of the community's general health.”

Resources Available

Banks called on local communities of color to closely monitor any pre-existing conditions or chronic diseases they experience. She emphasized that Multnomah County’s health clinics remain open and are accepting new patients, and also offer telehealth appointments and COVID-19 testing.

“Let’s continue to bring the resilience and brilliance from Black, indigenous people of color, into the solution,” Banks said.

To enroll in county services, call 503-988-5558. For more information in a number of languages, visit multco.us/covid19.

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