As I take the reins of this 143-year-old nonprofit organization dedicated to building an effective and equitable health care system for every New Yorker, I do so at an inflection point in our nation’s history. A point where elected officials are declaring the biggest public health event in the last 100 years over, either explicitly (President Biden on 60 Minutes) or implicitly (Mayor Adams announcing the sunset of the employer COVID-19 vaccination mandate).
There are no set parameters for pronouncing an end to a pandemic, but our collective experience directs us to the moment when a critical mass of everyday folks exceeds their capacity for sustained vigilance and reverts to the ordinary activities of life without feeling unmoored. In short, it has meant becoming acclimated to living with a new pathogen because of tests, vaccines, and therapeutics that can mitigate deadly outcomes, and because many fewer people are dying daily.
A LESSON FROM 1918
Such was the case with the 1918 influenza pandemic. However, deeper inquiry reveals that this pandemic’s health and socioeconomic impacts extended far beyond the two or three years typically quoted as its duration. A 2006 paper in the Journal of Political Economy by Douglas Almond, from Columbia University and the National Bureau of Economic Research, elegantly quantifies generational ripple effects of the pandemic that affected all aspects of society.
He analyzed data from the 1960–80 decennial U.S. Census and found that “cohorts in utero during the pandemic displayed (future) reduced educational attainment, increased rates of physical disability, lower income and socioeconomic status … compared with other birth cohorts (born immediately before or after the pandemic).” While all were affected, the poor, women, and Black people were hit disproportionately hard by the generational echoes of the pandemic.
His thesis reminds us that those without privilege don’t have the luxury of declaring a pandemic over without fear of generational repercussions. We have yet to fully understand the long-term physical and socioeconomic consequences of prolonged COVID-19, or the generational emotional trauma transmitted because of the disease.
Our safety net is not resourced to ensure a soft landing for those relying on emergency measures enacted during the pandemic or fully avert long-term destabilizing events once those protections end. Lastly, there is no road map for making sure that those disproportionately affected don’t slip even further behind in critical measures of health, such as premature mortality, infant mortality, and maternal morbidity and mortality.
MAINTAINING URGENCY IN TACKLING INEQUITIES
As I look at the horizon for what comes next for UHF, I reflect on what remains as the pandemic fades. Most significantly, it’s the challenge of maintaining urgency in addressing health inequities compounded by generations of structural racism. We cannot allow ourselves to fall victim to pandemic fatigue and the complacency that comes with it. Rather, we should make the most of an invaluable opportunity to not repeat history by being intentional in our equity work.
My career as a primary care pediatrician and a public health practitioner has taught me that health and health care aren’t just about hospitals and clinics; they’re about the fragile continuum of care between social services organizations, primary care, hospitals, and communities themselves in collaboration with public health. This constellation of entities working cohesively holds the most promise for sustainable, effective, and equitable health.
This next chapter will be marked by a more intense focus on addressing structural drivers of inequities in health by leveraging relationships with UHF’s trusted partners to improve the ecosystem of health for all New Yorkers. The ultimate aims are to ensure all of us feel we are living our fullest lives and to minimize those dying before their time.
UHF will double down on our legacy of educating, influencing, and transforming the health ecosystem in New York City, New York State, and beyond. We will continue to generate unbiased analyses that foster data-driven decision-making and well-informed health equity advocacy by our partners. Our legacy will be policy and practice that spurs actions to make our health care system more equitable and just.
This commentary appears in the fall 2022 issue of Blueprint.