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Commission for Health Advocacy and Equity shares ‘urgent concerns and recommendations’ for reopening RI

“While… inequities and unjust systems were in place long before any of us came to occupy our current positions, the lives of all Rhode Islanders, especially in communities of color which are most heavily impacted by COVID-19, are at stake with every decision that is made during this crisis.“ Provide more access to testing in communities of color, release vital
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Published on May 9, 2020
By Steve Ahlquist

While… inequities and unjust systems were in place long before any of us came to occupy our current positions, the lives of all Rhode Islanders, especially in communities of color which are most heavily impacted by COVID-19, are at stake with every decision that is made during this crisis.

Provide more access to testing in communities of color, release vital information in more languages, utilize disaggregated racial and ethnic data to guide interventions, and protect essential workers through hazard pay, PPE and expanded testing are just four of the recommendations presented in a letter to Governor Gina Raimondo, Speaker Nicholas Mattiello and Senate President Dominick Ruggerio from the Rhode Island Commission for Health Advocacy and Equity (CHAE).

The letter, sent on Friday, thanked Governor Raimondo and Department of Health (RIDOH) Executive Director Dr Nicole Alexander-Scott for their leadership during the COVID-19 pandemic. Though the letter did not call on the Governor to reverse or delay her decision to begin reopening the state on Saturday, it did express concerns and make recommendations “pertaining to racial equity and health justice during the current COVID-19 crisis response and recovery planning.”

[Note: This piece originally featured an earlier draft of the letter, and has now been updated.]

Key parts of the letter include:

“We… appreciate in your daily press briefings, the acknowledgement that numerous critical health inequities exist in our state, which the COVID-19 crisis has exacerbated and made more visible. The root causes of these inequities are systemic racial injustices. While these inequities and unjust systems were in place long before any of us came to occupy our current positions, the lives of all Rhode Islanders, especially in communities of color which are most heavily impacted by COVID-19, are at stake with every decision that is made during this crisis. More urgently than ever, we have the obligation, responsibility, and unprecedented opportunity to address inequities and dismantle unjust systems.

“As a thought partner and advisory body to the state, and liaison to the community, the CHAE offers the following suggestions for decisions being made now and in the future, grounded in principles of racial equity:

  1. Use access to testing in communities of color as a measure of readiness of the state to reopen. Suggested communities and locations are in the addendum to this letter.
  2. Make critical health and economic information and strategies more language- accessible. In addition to Spanish and Portuguese, key languages that are in need of immediate attention include Arabic, Cambodian, Cape Verdean Creole, Chinese, Haitian Creole, Khmer, Laotian, and Swahili.
  3. Continue to collect, disaggregate, and use race and ethnicity datato guide interventions. Engage the communities that are being most heavily impacted. Include Asian sub-populations and Indigenous people in disaggregation. The CHAE’s 2020 legislative report also contains useful measures for social determinants of health and identifying vulnerable communities.
  4. Protect essential workers, many of whom come from communities experiencing high rates of COVID-19 cases. Consider implementing policies which continue providing hazard pay, PPE, and expand testing for essential workers.

“During the reopening, recovery, and rebuilding phase, please consider the following:

  1. Embed CHAE members within workstreams to help establish and use guiding principles that employ a racial equity lens.
  2. Engage and support grassroots organizations that are doing essential work on the ground in communities that are most hard-hit by COVID-19. These organizations are working with community members who are in many cases isolated and most vulnerable.
  3. Provide sustainable funding and support for community-designed and -led, culturally-specific grassroots and Community Health Worker infrastructure to ensure vulnerable communities have timely access to critical information and services.
  4. Expand housing protections for people who are housing insecure, low-income renters, and people experiencing homelessness.”

Yesterday UpriseRI published an oped from CHAE commission member Fred Ordoñez, who made a strongly worded case against Governor Raimondo’s plans to reopen. Ordoñez wrote, in part,

The… fact is, people of color in Rhode Island are disproportionately infected with COVID-19.  This serious racial disparity with COVID-19 is not due to ignorance of safety suggestions and the need for their translations, but rather the structural racism which keeps black and brown people part of the working poor and struggling for safe housing and basic services. They are the service, factory, restaurant, warehouse, food market, and low wage employees, considered “essential” – which is code for “disposable.” People with this essential designation are forced to work because they cannot collect unemployment and/or stay home like the rest of us.  While many of us are able to stay home and order our groceries from Whole Foods, most black and brown folks cannot afford that privilege.

Governor Raimondo has declined to respond to questions from UpriseRI regarding these issues, instead turning the questions over to Dr Alexander Scott, despite both questions being directed to her.

Margie O’Brien: Steve Ahlquist of UpriseRI has a question to both the Governor and Dr Alexander Scott. What kinds of guidance are you getting from the commission on health advocacy and equity established to advise you on racial, ethnic, cultural and socioeconomic health disparities on your reopening plans?

Dr Alexander Scott: I very much appreciate that question, Steve. Our leaders in our Right to Health Equity Institute are working very closely with the leaders of the Commission on Health Advocacy and Equity so that we can assess together ways to place a racial and equity lens onto every element of our reopening. When the Governor walked through the triggers, for example, for moving into phase one, it was that effort that helped lead to why one of them includes making sure we have the capacity needed in our communities disproportionately impacted by COVID-19.

We also want to continue to work together on how we can incorporate that lens into our reopening. We’ve already begun thinking about how to make sure businesses within communities hardest hit are able to participate and engage with us in the reopening process. And we’ll want the Commission for Health Advocacy and Equity to continue to hold us accountable. Knowing how critical it is to make sure that on the other side of this, we have communities in every zip code in Rhode Island [unclear] forward to be stronger and more economically resilient at the end of this pandemic, so that we can all be prepared going forward together.

Margie O’Brien: Steve Ahlquist of UpriseRI has our next question. People representing Latino, Black and low income communities have expressed concerns about your plans to reopen, noting that the negative impacts of reopening under COVID-19 will hurt these communities more severely. Do you share their concerns?

Governor Raimondo: I’m going to let the Doctor answer.

Dr Alexander Scott: These are concerns that people are evaluating throughout the country. We know the communities that have been disproportionately impacted and are laser focused on making sure that those communities have what’s needed in terms of access to testing: activation of appropriate case investigation and contact tracing and the services needed for quarantine and isolation. And we’re going to continue to stay focused on this area. The governor shared yesterday the items that we are watching that says we can go forward. It includes making sure that for our communities most disproportionately impacted, we have the resources focused on what’s needed. We’re going to continue to engage directly with communities, continue to hear feedback, and have a strong team in place ready to make the adjustments that are needed. There’s work to do and it’s what we are focused on to help ensure that the communities hardest hit are addressed and supported during this time of reopening.

The CHAE letter ends with an “Addendum” that lists principles that State Leaders should adopt during the recovery and rebuilding phase”

“Please adopt the following principles during the recovery and rebuilding phase (summarized below):

  • Center Racial Equity – people of color are bearing the brunt of the effects of COVID-19. Centering racial equity must be at the core of this recovery.
  • Put People First – During the last recession, corporations were prioritized with massive bailouts. We can only fully recover by prioritizing people over profits.
  • Invest in Community Infrastructure – For an equitable and lasting recovery from this crisis, we must rebuild our physical infrastructure (i.e. food systems, housing, transit) as well as social infrastructure (the trusted network of nonprofit, cultural, philanthropic, and local institutions that help our communities function.
  • Build an Equitable Economy – the pandemic has also revealed our interconnectedness: we are only as safe as the least protected among us. Equity is our path to a strong next economy.
  • Protect and Expand Community Voice and Power – A top-down recovery will not capture the long-term knowledge, wisdom, and experience of residents and community leaders. Community engagement is important now more than ever as residents are uniquely positioned to be agents and owners of community change.

“Please consider the following specific recommendations to address the short and long term needs of and conditions affecting our most vulnerable populations.

Vulnerable populations include: Latinx, Black, Indigenous, and Asian communities; people with disabilities; incarcerated individuals’ people with limited English proficiency; refugees; people who are housing insecure or experiencing homelessness; and undocumented Rhode Islanders.

  • Work directly with CHAE members to employ the above principles and a racial equity lens across all continued work within work streams.
  • Continue to collect, disaggregate and use race and ethnicity data to develop a clear plan to address disparities in cases, hospitalizations, and deaths. Include Asian sub-populations and Indigenous people in the disaggregation.
  • Protect essential workers with policies that provide hazard pay, PPE, and testing.
  • Make free PPE available to residents, and ensure health and safety information is available in the languages spoken by our diverse communities.
  • Continue to rapidly expand testing accessible in communities of color with high case rates and with limited access to transportation. This includes zip codes 02828, 02860, 02904, 02907, 20908, and 02909. COVID-19 response centers should be set up in locations within communities of color that are known and trusted by residents. Examples include Thundermist in Woonsocket, Anchor in Pawtucket, the YWCA and Progreso Latino in Central Falls, Amos House, John Hope, Center for Southeast Asians, and Algonquin House in Providence. The existence of response centers should be widely advertised on Latino radio and through other community-relevant outlets.
  • Ensure that vulnerable Rhode Islanders have uninterrupted access to utilities. We recommend that you institute no shut-offs, no payment for restoration, and no penalty for missed payments. Consider using federal and state recovery funds to help people affected by COVID-19 to pay their utility bills. Philanthropic dollars are not enough.
  • Apply measures within the criminal justice system to prevent widespread outbreaks of COVID-19 within the incarcerated population and across the state. Incarcerated Rhode Islanders are particularly at risk. The state of Rhode Island should use its influence to assure that all people who are incarcerated are protected to the greatest extent possible. Work with federal ICE administrators at the Wyatt Detention Facility and state-level administrators to consider:
    • granting parole to eligible non-violent offenders, ensuring appropriate domestic violence and sexual violence criminal history screening;
    • allowing medical furlough for all medically vulnerable incarcerated people;
    • ensuring that the ACI will provide adequate information and supplies to those held in detention;
    • having state and local police departments work with criminal justice advocates to adjust approaches to policing that prevent widespread outbreaks of COVID-19 within the incarcerated population as well as across the Rhode Island population.

The letter was cc’d to House Majority Leader Joseph Shekarchi, Senate Majority Leader Michael McCaffrey, Senate Minority Leader Dennis Algiere, House Minority Leader Blake Filippi, Nicole Alexander-Scott, and Courtney Hawkins MSW, Director of Department of Human Services (DHS).

CHAE was established legislatively in 2011 to “advocate for the integration of health equity; provide direct advice to the director of health and other state leaders; develop and facilitate coordination to facilitate a comprehensive state health equity plan; set goals for health equity; and educate state agencies.”

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