Quick response means moments of crisis. From first responders to communications professionals, responding quickly to a crisis is critical to the health and well-being of communities. But what about rapid response research?
COVID-19 is the manifestation of a complex crisis of infectious disease, food and housing insecurity, and emotional distress. Blacks, Latinos, Native Americans, and people living in low-income households are the most susceptible to these conditions. It is clear that the health and social policies enacted during the pandemic will affect the community for decades to come.
To inform responsive research and policymaking, my team at Boston University and I developed the US COVID-19 State Policy database — also known as CUSP — in 2020. This resource is intended to provide information on social and health policy decisions that promote health equity and focuses on policies that affect vulnerable and excluded populations. except in history. Now more than a year after our founding, we are evaluating what we have learned and we are nowhere to be found.
How did it start?
Countries have responded to the pandemic with a range of policies, from stay-at-home orders and business closures, to unemployment insurance and minimum wage changes. Many of these policies align with the Robert Wood Johnson Foundation (RWJF) health equity principles for pandemic recovery. With support from the RWJF Evidence for Action program, we launched the CUSP database.
As we see the pandemic exacerbating disparities rooted in structural racism and unequal policies, we want to document the policies so researchers can assess their impact on the populations most affected by COVID-19 and its consequences.
While Blacks and Latinx are more likely to die from COVID-19 than whites, in the database we captured a number of policy decisions that clearly disadvantage Blacks and Latinos . For example, the Advisory Committee on Immunization Practices has recommended prioritizing workers needed for vaccines, and most states have planned to do so. But after the federal government recommended prioritizing those 65 and older, most states have moved to prioritize age-based vaccinations. While 21 percent of the white population is over the age of 65, only 12 percent of Blacks and 8 percent of Latinos are over 65. Then, by design, age preference says Blacks and Latinos will be less likely to get vaccinated.
Tracking multiple social policies at once also reveals an exclusionary pattern. CUSP captured how state minimum wage policies systematically exclude some people as wage workers. These workers were predominantly black, Latinx, and Native American. We saw a similar pattern with unemployment insurance; Without federal intervention through congressional action, many people could be excluded from unemployment insurance because they earn too little to qualify or because they are independent contractors. A similar pattern of exclusion occurs in paid sick leave; Even in states with paid sick leave, this policy generally applies only to full-time workers and does not include contract or contract workers.
The CUSP database is designed to facilitate research to inform policy action around pandemic responses and beyond. By merging CUSP policy data with outcome data from datasets such as the Household Beats Survey, SafeGraph migration data, or the COVID Insights study in the US, researchers can assess evaluate and inform policies that shape lasting improvements in health. Because of systemic racism, it is especially important to evaluate outcomes disaggregated by race and ethnicity. Policies can be assessed far beyond COVID prevention, to policies that support food and housing security, paid sick leave and unemployment insurance. We regularly update the database, prioritizing the policies that best suit the health and well-being of the people in the current time.
Where will it go?
More than a year into the project, it became clear that the need for rapid-response research was greater than any other team could take on and manage. Public health researchers and economists must engage in thinking about how best to design policies that simultaneously protect people from COVID-19 and from economic uncertainty.
Now, greater focus has shifted to strategies to increase vaccine equity. Increased access to vaccines is of greater importance in the context of many people still unvaccinated and there are no OSHA (Occupational Health and Safety Administration) standards to protect high-income workers. low import by masks or other measures. According to our documentation in CUSP, some states also have workplace safety standards.
Researchers working on CUSP also continue to focus on policies that previously made people in our country vulnerable, even before the pandemic. For example, 3% of households experience food insecurity every year, and Black families in the United States experience food insecurity 2 to 3 times the proportion of Black households. white during the pandemic. CUSP data on state policies such as unemployment insurance amounts and dates and forms of eviction freezes can reveal the extent to which these policies reduce the number of households experiencing unemployment. food and housing insecurity.
Where we have to go
COVID-19 underscores that our health is inextricably linked to our neighbors, co-workers, healthcare providers, delivery workers, teachers, and communities. More than that, it crystallizes that our health and economic policies do not adequately or fairly protect our well-being as a nation. There is a need for continued and urgent research into which policies are most effective to assist citizens in informing federal and state actions. What we learn from the CUSP database and how we apply that knowledge to the federal dataset is critical to supporting a culture of health, eradicating racist policies. and build a future where all can thrive.
I invite you to explore the CUSP database and share it with members of your community. Together, we can ensure equality among policymakers in all decisions.
About the author
Julia Raifman, ScD, SM is an assistant professor at the Boston University School of Public Health, where she conducts policy research on population health and health disparities.
