The Fierce Urgency of Now: Federal and State Policy Recommendations to Address Health Inequities in the Era of COVID-19

The COVID-19 pandemic has shone a harsh light on existing disparities in health and health care in the United States. There is a “fierce urgency of now” for evidence-based policy solutions that either address the underlying systemic injustices or mitigate their impacts on poor health. As a nation, we are at a critical moment of reflection and decision about the state of our health care system, public health infrastructure, and the social and structural drivers of health. We can do better. This brief lays out a plan for how.

This comprehensive report begins by describing the link between social injustice and COVID-19 outcomes at the local level, including original analysis of economic and disease data for 11 counties with high Black and Latino populations that are among the hardest-hit counties in the United States. The second section of this report provides an action guide for health equity advocates, identifying short-term policy options that respond to the current pandemic and longer-term policy recommendations that federal and state policymakers should adopt once the national emergency declaration has been lifted. The policy recommendations are organized across five themes, broadly in order from “upstream” social determinants of health to “downstream” equity in access to COVID-19 treatment. The five policy themes are: (1) address the social determinants of health; (2) build strong financial incentives for improved health equity in our health care system; (3) organize and build national public health capacity both to fight COVID-19 and to reduce the burden of chronic illness in vulnerable communities; (4) ensure equitable access to affordable health coverage; and (5) expand access to COVID-19 treatment for vulnerable populations.