As the country careens towards a presidential election in the midst of a raging pandemic, the dueling headlines on public health and politics are a stark indication that, no matter who wins in November, this election will have profound, far-reaching consequences for your physical health and well-being. All this week, Elemental is running a series of stories detailing what’s at stake, from insurance coverage to plans for a pandemic still in progress. Here’s what you should know about the implications of the election on health for people of color and the LGBTQ+ community.
Social determinants of health — including education and access to opportunities, resources available in communities, and the safety and cleanliness of those communities — are all closely tied to politics, and have a significant impact on overall well-being. Because of racist policies and structural inequalities, resource-poor communities tend to be more heavily populated by Black and Hispanic or Latinx people.
As a result, overall health among those communities is significantly lower. According to U.S. Census data, in 2017, 10.6% of Black Americans and 16.1% of Hispanic Americans were uninsured, compared to just 5.9% of white Americans. Americans of color are more likely to be overweight or obese, more likely to die of heart disease or cancer, and more likely to suffer from a chronic condition such as diabetes, asthma, or hypertension.
While it’s the health care platforms and proposals of the presidential candidates that get the most attention, says Nadereh Pourat, PhD, professor of health policy at the UCLA Fielding School of Public Health, policies that have the most influence on social determinants of health are often established by local or state politicians. Policies and funding decisions aimed at improving early childhood development, improving living conditions, and ensuring minimum income standards and access to work have the greatest impact on reducing health inequity on the municipal and city level. When it comes to remedying health care inequality, platforms of candidates running in smaller races matter in a big way.
That’s not to say federal policy isn’t influential. In 2017 tax legislation, President Donald Trump acknowledged the plight of poor neighborhoods, and created “opportunity zones” designed to drive investment in those communities. So far, however, only the investors seem to be reaping the benefits, and there’s been little meaningful progress in health equity.
There are “a million subtle ways that politics impact health and the health care system,” Pourat says, many of which “are much less obvious than the ACA or health insurance.”
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Also at risk due to disparities and inequity in health care are members of the LGBTQ+ community — in particular, transgender people. According to statistics from the U.S. Department of Health and Human Services, LGBTQ+ people are more likely than the general population to be homeless, attempt suicide, use tobacco, alcohol, and other drugs, and suffer from mental health issues. Those rates are all highest among transgender individuals.
The Trump administration has attempted to roll back a number of protections for the health of transgender Americans, including penning a proposal to allow homeless shelters to turn people away based on appearance. In the first year of his presidency, Trump also rolled back a provision enacted under Obama to allow transgender students to use the bathrooms of their choice in schools.
More recently, Trump attempted to rewrite a section of the ACA that explicitly provides protections for transgender people, requires that health care providers and insurers treat people consistently with their gender identity, and says that employers cannot withhold or limit coverage for gender transition services. That case was heard before the Supreme Court, which struck down Trump’s proposed rule.
In the decision, written by Justice Neil Gorsuch, the court held that such a rule would violate civil rights law. “An employer who fires an individual for being homosexual or transgender,” Gorsuch wrote, “fires that person for traits or actions it would not have questioned in members of a different sex.” In a tweet about the decision, Trump called it “horrible and politically charged.”
Biden calls “violence against transgender and gender nonconforming people, particularly Black and Brown transgender women” an epidemic, and blames “dehumanizing government actions and rhetoric,” in addition to failures on the part of the government to address social disparities such as housing insecurity and unemployment.
If elected, Biden has pledged to enact the Equality Act, which would establish sweeping protections for members of the LGBTQ+ community, in addition to establishing programs to support transgender and nonbinary people in the workforce and health care systems.
The plight of marginalized communities, and the policies that negatively impact their health, Pourat says, should be of major concern even to those who aren’t directly impacted. “I think the basic principle of public health is that a rising tide lifts all boats,” she says. “The more people in the community that are healthy, the bigger the benefits.”