The COVID-19 pandemic has highlighted health inequities within our community. As we continue to re-open the state, we have an obligation to look at the health impacts of the decisions we make to identify how to create more equitable environments for everyone. Health equity is far more complex than current policy addresses.

Throughout the course of the pandemic, the State of Colorado has taken necessary steps to lower exposure and infection rates and to keep our communities safe. In this unprecedented time, we have had to make quick decisions to mitigate exposure and flatten the curve. Thanks to these quick actions, the state never exceeded hospital or ICU capacity and many people were protected.

Everyone, regardless of age, race, ethnicity, sex, socioeconomic status is susceptible to Coronavirus. Though we face an uphill battle re-opening the state, we have had more time to prepare for what that might look like. In the next phase the pandemic, it is important to address the public health implications of our decisions. As new data surface regarding the virus, we can utilize this information to make better informed recommendations and more calculated modeling for cases and hospitalization rates in Colorado.

A public health perspective

As public health professionals, we deeply understand the need to identify strategies to decrease exposure rates and slow disease transmission to keep our communities safe and our hospitals below capacity. We understand how difficult these decisions are to make. In addition, we are keenly aware of the health disparities that cause portions of our communities to experience this pandemic differently. We have been presented an interesting public health opportunity in the face of this pandemic. As we collectively experience the impacts, including similar infection risk, business closures, and stay at home orders, we have an obligation to recognize how different our experiences truly are and to make meaningful change to ensure health equity for all community members.

For example, we need to take into account the public health impacts of:

• Social Isolation and loneliness due to physical distancing and stay at home orders
• Loss of health insurance and income from job loss
• Having no housing or unsafe housing during a stay at home order
• Educating children from home while working from home
• Managing difficult mental health complications with fewer resources
• Experiencing health disparities prior to COVID-19 and how the pandemic has exacerbated those concerns

There are public health impacts on all sides of the issue and the pandemic has provided an extremely complicated landscape to navigate. At Changing the Narrative, our goal is to End Ageism Together. As we investigate the challenging public health impacts of the pandemic, we do so in light of advocating for older adults. We also recognize the intersectionality of age, race, ethnicity, gender, socio-economic status, and health status. This analysis is intended to advocate for all older adults, incorporating the needs of all communities.

One size does not fit all

Throughout the pandemic, we have struggled with the health impacts of the “one size fits all” model. As the state begins to reopen, the new Safer at Home and Protect our Neighbors phases recommend that Coloradans 60 and older continue to stay home. Recently, the Colorado School of Public Health also released recommendations for all Coloradans over the age of 60 to continue to stay home. While we feel these recommendations were made with good intentions, we feel obligated to call attention to the inherent ageism. The recommendations state:

“If Colorado moves to lower levels of social distancing (55%), older adults will need to maintain social distancing at the level seen during Stay at Home in order to avoid exceeding hospital capacity. If only half of older adults adopt high levels of social distancing under a 55% social distancing scenario, the state is at risk of exceeding hospital capacity this summer. We recommend that policy measures continue to emphasize the need for older adults to adopt measures to minimize their close physical contacts outside of their homes, thereby reducing their risk for infection, hospitalization, and death and preventing exceedance of hospital capacity.”

The proposed model ensures limited COVID-19 exposure and infection rates for older adults following the recommendations. Unfortunately, the proposed model does not account for people living in long term care facilities or other congregate living arrangements, which have improperly biased Coronavirus case data for older adults. The proposed model also does not account for the heterogeneous health status of individuals older than 60 or the high risk and impact of social isolation to older adults. Additionally, the proposed model does not account for employment or volunteering implications for people over the age of 60.

Devaluing older adults

Ageism is wired into our society, so much so that we often do not even see it. We live in a society that perpetuates stereotypes that cast aging as an entirely negative experience. This messaging can become internalized, causing individuals to become prejudiced against themselves for simply growing older. When we believe that aging is negative, it leads to increases in physical illness and mental distress. Conversely, individuals with positive views about aging live 7.5 years longer than those with negative views. The collective devaluing of older adults’ contribution to our community leads to cyclical health inequities for older adults.

There are many examples to illustrate the cyclical devaluing of older adults. Consider a possible outcome from current policies:

1. The state of Colorado announces that people over 60 (5 years below the arbitrary retirement age) continue to stay home. The state also announces protections for at risk populations not returning to work.
2. An employee over the age of 60 decides to stay home. Her employer decides she cannot adequately complete her job from home and decides to let her go. The recently laid off employee loses income and potentially her health insurance.
3. The recently laid off employee struggles with the mental health impacts of losing her job. Social isolation and loneliness from no longer communicating with clients and co-workers lead to serious, chronic health impacts.
4. The concerns about losing her home, paying bills, buying food, and not being allowed to visit with loved ones are all consuming, increasing stress and anxiety levels.

While this example may seem extreme and negative, we want to highlight how complex this pandemic is. There are public health trade-offs to both sides of the stay at home recommendations. It is necessary to understand all public health impacts of the “one size fits all” model.

Health equity is complex

Credit to: http://vitalysthealth.org/

We’ve seen considerable media coverage about the rationing of care for our older population, implying older lives are less valuable than younger lives. Devaluing someone based upon their age not only contributes to negative health outcomes, it ultimately impacts all generations. As we analyze why we’ve seen such egregious ageism throughout the pandemic, we would be remiss to not discuss the intersectionality of social determinants of health and how they contribute to health disparities.

By presuming older adults have the highest risk of contracting Coronavirus, we neglect communities experiencing other health disparities. Communities of color face disproportionate infection and death rates because of several social determinants of health. These include essential work, higher rates of chronic conditions, congregate living, inconsistent health care, and increased stress. By not acknowledging this burden, we neglect to create solutions for the health disparities faced by communities of color.

A more equitable approach – recommendations

As a community, we need to be considerate and thoughtful about everyone’s needs during this pandemic. The Colorado School of Public Health’s model shows great promise surrounding collective mask wearing and physical distancing. It is important to take care of ourselves in order to take care of our communities. We recommend a more individualized approach to re-opening Colorado.

Our recommendations include collective, systemic policy changes to decrease the burden of health disparities. We can even the playing field in how our communities are impacted by the pandemic by addressing issues like affordable housing, poverty, chronic health conditions, racial inequality, ageism, education and job security,  We have the opportunity to improve upon the health disparities exposed by the pandemic. By not actively working to address these disparities during this collective pandemic, we risk widening the health gap.

Web Brown, Director of the CDPHE Office of Public Health put it perfectly in the Health Equity episode of On the Same PAGE:

“Equity is when everyone regardless of who they are or where they come from has the opportunity to thrive. This requires eliminating barriers like poverty and repairing injustices and systems such as education, health, criminal justice and transportation. But a simpler definition is that equity is when your identity has no impact on your outcomes. In other words, it doesn’t matter who you are, your race, your religion, your sexual orientation, ability level, etc. All of those social identities have no impact on your ability to achieve in life.”

By creating health equity for all, we grant the opportunity for individuals at every age to thrive.

Kristine Burrows, Director of Older Adult Services at Easter Seals of Colorado
Kris Geerken, Program Manager – On the Same pAGE Campaign

Read more about ageism and the pandemic.