Health care Equity

 Advancing Equity Newsletter, Issue April 2020
Cristina Padilla, ZSFG Equity Council Member; DPH Communications


We have seen that Latinos, among other groups, often bear the burden of issues of inequity. The COVID-19 pandemic is another manifestation of the stark disparities that exist.

In San Francisco (SF), the most recent data tracker statistics show that 25% of COVID-19 infections are among the Latino community. This means they are disproportionately represented, as they only comprise 15% of the SF population.

Even more important is that the on-the-ground experience at ZSFG shows a different reality –80% of hospitalized patients with COVID-19 are Latinos.

Perhaps the most striking of all is that this data is likely an underestimate considering there is only Race/Ethnicity data for 73% of the positive cases. So, what’s the story beyond the numbers?

It is not a mystery why this population is the hardest hit. From our vantage point, Latino patients with COVID-19 are struggling with the following barriers that may be consistent with living in an SF urban environment:

  • A lack of access to information, support, and health care that is bilingual and culturally appropriate.
  • The increasing SF rent means people share small living spaces, which does not allow them to physically distance themselves. “Some of our LatinX patients live with friends, family members, and sometimes strangers to make ends meet. It is not uncommon to share one bathroom among many people,” says Dr. Marlene Martin, ZSFG Hospitalist.
  • Latinos have high rates of health conditions like diabetes, heart disease, and asthma, which can be a risk factor for disease severity.
  • Finally, employment: Work among this group is often concentrated in agriculture, construction, manufacturing, transportation, janitorial, and service industries. These are essential jobs that allow our community to function, but they also increase their risk of infection. Some of the Latino community is employed in low-wage work, which means there may not be emergency funds. Also, many have been laid off and have no unemployment benefits or federal relief due to immigration status. Despite COVID-19, they have no choice but to work to ensure shelter and food security for themselves and their loved ones.
“I worry for the LatinX community, mi gente, my people, and I am not surprised by the data. This virus doesn’t discriminate and only perpetuates what we already know. The vulnerability of the LatinX community is due to institutional racism, which has had a profound impact on accessing health, employment, and stable housing.” Aiyana Johnson, ZSFG Chief Experience Officer

As a member of the ZSFG Equity Council, and a City worker currently deployed at the SF Emergency Operations Center, I know the conversations about closing the gaps are as frequent as they are complex.

City efforts to support this population are underway. The SF Department of Public Health, UCSF, the LatinX Center of Excellence, the SF Latino Taskforce, and community-based organizations (CBOs) are working on better serving the Latino community through this crisis.

The City has been proactive about partnering with community leaders to ensure that these groups have what they need, especially as it relates to access to information.

At ZSFG, the Care Experience team is gathering community donations and partnering with clothing manufacturer Groceries Apparel to distribute cloth masks to our patients and the Latino community. We are hoping that these masks provide some safety when this group is working.

The most recent effort announced by the City is expanding testing capacity via a free testing site in the Mission for all residents of this area, regardless of symptoms. Testing will help bring treatment to those who need it – but is it enough?

This week, SF Mayor Breed also unveiled a new data map of confirmed COVID19 cases by zip code, with the most striking statistics in the Mission neighborhood, where a great number of Latinos reside.

Our most affected patients will need help beyond health care – food insecurity, stigma, discrimination, culturally appropriate outreach, and financial resources – will all be important factors moving forward. What is evident is that a pandemic will reveal the inequities from every angle.

“I work at ZSFG as a UCSF faculty member because I believe that everyone deserves high-value, equitable care. As a LatinX person myself, seeing the disproportionate effect of COVID-19 on my community — among people who look like my family members and me — is disheartening. This has been evident since our outbreak started and weighs heavily on my heart.” Dr. Marlene Martin, UCSF Assistant Clinical Professor, Director of the Addiction Care Team, and Hospitalist at ZSFG

Dr. Martin shared with me that she hopes we can use our partnerships with CBOs to learn from the affected individuals how to best support them, beyond just testing and education.

“I am grateful that UCSF and DPH have partnered with CBO’s to provide testing in the community. I am hopeful that this testing site will open the door for more consistent care. However, I know more is needed,” shared Johnson.

While the current efforts will be beneficial right now, in the long term it will also be important to support economic and other impacts on Latino individuals and future generations. We know that a virus alone doesn’t discriminate on ethnicity. The most significant thing to recognize is that this impact on Latinos is only a symptom of a larger issue– that is, the inequities that exist beyond this pandemic. Health disparities, income inequality, and structural racism are affecting populations and locations in SF, and this health emergency is just exploiting the barriers we’ve been facing.