New Executive Orders Shine Spotlight on Health and Racial Equity

February 04, 2021 | Mary Ann Cooney, Mattie Quinn

COVID-19 has revealed the stark reality of racial and ethnic health disparities that exist nationally. Black and Hispanic Americans were nearly three times more likely to die from COVID-19 than white Americans. Black and Hispanic Americans experience a greater prevalence of underlying risk factors such chronic disease and co-morbidities, access to health care, lower socioeconomic status, and others. The root causes of these disparities can be attributed to structural racism and the legacy of policies that perpetuates health inequities. As we commemorate Black History Month throughout the month of February, it is imperative that we work to correct the wrongs of the past and address structural racism and health inequities to build a healthier future.

Undoubtedly impacted by data showing the levels of racial and ethnic disparities laid bare during this pandemic, as well as the call for social justice in the summer of 2020, President Biden wasted no time in declaring the need to address systemic racism and equity in our country. In his first month on the job, President Biden has signed at least five new executive orders addressing structural racism and proposing a review of policies that impact the health and well-being within our country’s racial and ethnically diverse communities.

The full list with its public policy implications are:

Advancing Racial Equity and Support for Underserved Communities through the Federal Government

This order directs the Office of Management and Budget to work with all federal agencies to assess whether agency policies and actions create or exacerbate systemic racism, identifies funding opportunities to promote equity, promotes community engagement and develops plans to improve disaggregated data collection. This order also reverses a previous executive order from 2020 that limited trainings focused on diversity and inclusion.

Memorandum on Tribal Consultation and Strengthening Nation-to-Nation Relationships

This requires review of a previous order to establish regular and meaningful consultation and collaboration with tribal officials. Tribal sovereignty is not only honored through this executive order but also recognized as critical for community-driven solutions to achieve improved health.

Memorandum on Redressing Our Nation’s and the Federal Government’s History of Discriminatory Housing Practices and Policies

This order requires the Department of Housing and Urban Development to implement the Fair Housing Act’s requirements against discrimination and to examine the effects of the previous administration’s policies passed in August and September 2020 that eliminated protections for discriminatory practices.

Memorandum Condemning and Combating Racism, Xenophobia, and Intolerance Against Asian Americans and Pacific Islanders in the United States

Requires HHS to consider issuing guidance describing best practices for advancing cultural competency, language access, and sensitivity towards Asian Americans and Pacific Islanders in the context of the federal government’s COVID-19 response.

Executive Order on Ensuring an Equitable Pandemic Response and Recovery

This establishes the COVID-19 Health Equity Task Force to develop guidance to ensure equity in testing, contact tracing and vaccination in communities of color, tribal nations, and rural areas of social vulnerability.

Executive Order on Preventing and Combating Discrimination on the Basis of Gender Identity or Sexual Orientation

Requires all federal agencies to conduct a review of policies and practices that may perpetuate discrimination on the basis of gender identity or sexual orientation, including making recommendations to the U.S. Attorney General on any areas identified in the review that requires action.

Executive Order on Reforming Our Incarceration System to Eliminate the Use of Privately Operated Criminal Detention Facilities

This directs a review of policies and practices that impact the health and well-being incarcerated people and make recommendations on transitioning to a system from private to public operations of criminal detention facilities.

These executive orders demonstrate the beginning of an administration leading and promoting accountability to the past. They also represent a recognition of the health impacts that structural and systemic racism and other forms of discrimination and segregation have on health care access. These impacts can include:

• Increased risk for developing chronic conditions.
• Decreased mental health because of toxic stress and generational element found with genetic epidemiology.
• Malnutrition from chronic poverty and living in food deserts.
• Maternal mortality and the rates of infant death in first year of life, which is worsening in Black communities and tribal nations.

Federal agencies must now move ahead to closely examine and provide recommendations for action to reform our incarceration system; ensure greater access to affordable housing; work more closely with Tribal Nations to improve Nation-to-Nation relationships; address violence and discrimination against Pacific Islanders, and Asian Americans; and prevent discrimination based on gender identity or sexual orientation.

While the executive orders mostly pertain to federal agencies and their review of policies and practices to address discrimination and ensure equity,state, local, territorial, and Tribal health departments may model these actions in their own jurisdictions. They may:

• Work with state and local housing authorities and conduct similar reviews of practices and policies that perpetuate segregation and discrimination based on race, gender identity, and sexual orientation.
• Engage Departments of Correction within their jurisdictions and share data describing health outcomes and health care costs of public vs. privately run facilities, promote enhanced mental health and substance abuse services for people who are incarcerated or soon to be released to reduce the likelihood of recidivism, review health care delivery and health outcomes in correctional facilities, participate in policy, quality assurance and utilization reviews to recommend antiracism and cultural awareness trainings to reduce over representation of people of color.
• Engage with partner public health organizations to co-host listening sessions.
• Reduce lifelong negative impacts to physical and mental health outcomes for youth by drawing attention to juvenile detention alternatives, as well as promoting increased access to mental health and substance use disorder treatment and recovery services in schools and after school programs potentially delaying or avoiding entrance into the juvenile justice system.
• Work with state and local housing authorities to develop antidiscrimination policies that may for affordable housing. Housing data shows that LGBTQ+ and transgender people of color suffer from additional housing discrimination.

Challenges with COVID-19 and disparities will continue unless there is a thorough review of how we address policies that perpetuate these disparities. Public health officials can lead the way in building internal capacity to conduct reviews of policies and practices, along with partnering with community-based organizations to gather additional evidence on the barriers facing communities of color, identifying where stigma exists, and focusing on the root causes of the determinants of health. ASTHO will continue to monitor state and federal actions on race and gender equity as this is the way we can achieve health equity.