Health Inequities Beyond Covid-19


In 2020, Covid-19 was the third leading cause of death in the US for persons over age 45, and the second leading cause of death for persons over 85.  There is no argument that Covid-19 represented a cataclysmic event for health, one from which we are now slowly beginning to see signs of potential recovery.

Taking a step back, since the beginning of Covid-19 more than 4 million people have died from all causes.  In any given year, almost 3 million Americans die, with the leading causes of death being heart disease, with about 650,000 deaths, and cancer, with about 600,000 deaths annually. As we begin to move beyond Covid-19, it becomes then important to ensure that we take what we have learned during this past year and apply it to US health going forward.

The disproportionate burden of Covid-19 borne by people of color has brought to a fore the centrality of health inequities, the unfairness that underlies health inequities, and has produced new urgency to address systematic forces like structural racism and underinvestment in ways to improve the social conditions that create health as a means of tackling these inequities. But these same forces are relevant not only to the deaths due to Covid-19. The deep and entrenched racial and socioeconomic inequities that drove Covid-19 influence nearly all other deaths in the US.  In a recent analysis, sociologist Elizabeth Wrigley-Field estimated that 400,000 excess white deaths would be needed to raise white mortality to the best ever black mortality; it would take 700,000 excess white deaths to narrow the Black-white life expectancy gap. This analysis of course suggests that the scope of death from Covid-19 is comparable to the scope of the Black-white gap in mortality in general, every year.

So, as we look to move beyond Covid-19, and the health gaps exposed by Covid-19, it seems important not to lose sight of what now has become apparent to all—the health gaps that existed long before Covid-19 will continue to do so without clear-eyed and focused action. The Biden administration has made promising first moves in this regard, empowered by public conversation created by the pandemic moment.  Can we now use this moment to think creatively about ways to bridge intractable racial and socioeconomic health gaps? Can we use this point in time to argue for foundational investments in, for example, universal livable wages for all, Black reparations and similar efforts that can close racial wealth gaps, universal access to healthcare, or wholesale investment in affordable housing that leaves no one group behind? Some of these ideas may have been politically untenable before Covid-19. We should not let the opportunity pass, forgetting the health inequities that captured so many headlines in 2020, and that characterize another 3 million deaths annually.


Michael Stein & Sandro Galea

As we re-emerge from the pandemic, 2021 stands to be a turning point year for public health. In The Turning Point’s weekly essays, we reflect on what we learned during 2020, and what we are learning during 2021, that can guide us to the creation of a better, healthier world.