Nearly two years since the first confirmed case in the U.S., the COVID-19 pandemic is still in full swing. National case numbers are rising. Only 59% of the population has been fully vaccinated.
Doctors, scientists and public health experts are working to soften the coronavirus’ impact through new medications. Booster shots are available to all vaccinated adults. Two pharmaceutical companies are awaiting approval of their experimental pills to treat COVID-19.
But until the U.S. addresses social, economic and racial inequities, the country won’t be ready to fight the next pandemic-inducing virus, warn experts like Dr. Sandro Galea, a physician, epidemiologist and dean of the Boston University School of Public Health.
“As the [next] pandemic hits, we are going to understandably be talking a lot about vaccines, about the need for therapeutics and about the need for stockpiling. But all of that is not going to be enough,” Galea said. “We also need to pay attention to the underlying social structures that determine our health.”
Galea will speak at the Park City Club in Dallas on Thursday, Dec. 2, in an event hosted by the World Affairs Council of Dallas-Fort Worth. He will address the systemic public health issues exacerbated by the COVID-19 pandemic and the ways they leave the U.S. vulnerable to future health crises.
Galea has spent years studying the components that create healthy populations. His work in rural communities across the world helped inform his new book, The Contagion Next Time, which outlines ways to “increase pandemic resiliency.”
The country has done well in treating illnesses and moving quickly to develop new medical technologies like the COVID-19 vaccines, Galea said. Where we’ve fallen short is in addressing the factors that determine health, he said.
What builds and supports “health is whether you have a livable wage, whether you’re living in a safe house, whether you’re breathing clean air, have drinkable water, nutritious food, whether you have the opportunity to exercise,” he said. “All of that is created by the world around you, by the conditions of where you live, work and play.”
COVID-19 has highlighted the differences in quality of life experienced by Americans based on race, income and social status. Low-wage workers, who tend to have lower pay and are less likely to be able to work from home, were hit much harder by the pandemic than people earning higher wages, according to research from the Brookings Institute.
A recent analysis by the Kaiser Family Foundation, a nonprofit health organization, found that Hispanic people represent a larger share of cases relative to their total share of the population, while Black people represent a higher share of deaths compared to the total population.
“We know that COVID has a more harmful effect if you have underlying medical conditions, and the groups that have underlying medical conditions are those that have had historic disadvantages,” Galea said.
These quality of life and health care disparities are acutely apparent in North Texas.
In a census tract just west of Southern Methodist University, the average life expectancy is 86.4 years. In a census tract just 7 miles south, the average life expectancy is 64.2.
Disparities in areas like education, income and housing are critical to public health, but aren’t always considered public health issues, said Catherine Troisi, associate professor of epidemiology at the University of Texas Health Science Center at Houston.
“It comes down to politics, doesn’t it, that we need to make sure that we are addressing all of these disparities,” she said. “It’s public health, but not the areas that public health typically has control over.”
Experts can’t be sure when the next pandemic will hit. Pandemics have been present throughout human history, and while the next one could be many years from now, Galea said, there’s no reason to believe it won’t happen relatively soon.
In his book, Galea suggests two broad changes needed to prepare for the next virus. The first is creating access to education, employment and other factors that are shown to improve health outcomes. This includes bolstering healthy neighborhoods and workplaces that offer people access to nature, adequate nutrition and livable wages.
The second, Galea said, is investing in public health infrastructure. “It can allow us to create rapid testing, tracing, screening, to isolate people as needed and to be responsible,” he said. “And that is something which we did not do this time at all.”
Galea hopes that the COVID-19 pandemic will serve as a catalyst for these changes.
“If we, as a country, remain less healthy than we should be, the next pandemic will hit and we will remain vulnerable,” he said. “So what we should be doing is investing in creating a healthy country — and that is not investing in medicine. That is investing in a world that generates health.”
