Washington today, we are holding this hearing virtually in compliance with the regulations for Remote Committee proceedings pursuant to House Resolution 965. Remote hearings certainly are not the same as sitting together in our Committee Room and you should know. The new authority has allowed us to continue to do our work a behalf of the American People, while keeping our staff, families and broader communities this is the First Official Virtual Committee hearing in the United States house of representatives. As we begin this historic proceeding, i want to underscore that i plan to continue this committees long tradition of collegia collegiality and substantive debate even as we conduct our business from afar. I will continue to work with Ranking Member and his staff to make sure that all Ranking Members are respected in the knew virtual format. Before we turn to todays important topic, i want to remind members of a few procedures to help us all navigate this new platform. First, consistent with regulations, the committee will keep microphones muted, will limit background noise. Members are responsible for unmuting themselves when seeking recognition or when recognized for their five minutes. Second, members and witnesses must have their cameras on at all times. If you need to step away from the proceeding, please leave your camera on, rather than logging out. Finally, i understand that there will be votes today as early as 1 30 p. M. However, it is my intention to continue with our proceedings and avoid recessing. If your time for questioning occurs while you have left to vote, we will come back to you when you return. Thank all of you for your patience as we navigate the technology as we serve our country in this time of need. With that, i will turn to the important topic of todays hearing, the disproportionate impact of covid19 on communities of color. It became a National Public Health Emergency like none we have seen in modern history. Our lives have been turned up side down by a virus that we are still trying to understand. Tragically, 100,000 americans have now died of this disease and millions more have lost their jobs. From sanitation workers in cities to teachers in suburbs to ranchers and farmers in rural areas, everywhere are experiencing the pain of uncertainty that is associated with this virus. The Health Consequences of the violence are not felt evenly throughout the society. Covid19 has shown a light on the centuries old legacy in this country of inequality. While the factors driving the inequities are complex and multifacetted as we will hear shortly from the witnesses. The impact on Health Outcomes has been clearly documented. For example, black pregnant women and indginous die at a higher rate. Latinex populations have lower rates of Health Insurance coverage than other ethnic groups. Even though my state has the highest rate of on Health Insurance in the country, the predominantly black community of rock bury has of the back bay which has a average life expect answery of 92 years. Now, existing inequities are placing communities at greater risk of contracting and dying from covid19. For example, less than 22 of u. S. Counties are disproportionately black, and account for 52 of covid diagnosis. Los angeles county, the death rate for Pacific Islanders is 12 times higher than it is for whites. And the infection rate among Navajo Nation has now surpassed the state of new york, the center of the pandemic in the u. S. , reaching 2680 cases for per 100,000 people. That is why we have convened this hearing today to unpack the circumstances and begin to unravel the roots of history that have brought us to this point. These conversations can be difficult. We are at a crucial stage in our countrys response to the virus, and as communities begin to loosen social distancing guidelines these days paisparit will worsen if Contact Tracing approaches are not accessible to and trusted by people of color. That is an outcome im not prepared to accept. Many of these communities are in desperate need of resources for testing and Contact Tracing support and managing the daytoday response. And looking ahead, Demographic Data needs to be used effectively so resources reach the communities to help them recover and rebuild. Although these groups have the highest rate of positive tests and mortality, they have less access to testing and treatment. This is unacceptable. We can save lives by understanding what these communities of color need and then take appropriate action. Part of our efforts must include minimizing some of the information that surrounds the virus. These untruths can compound disparities and outcomes and lead to further distrust of vital interventions. For example, Asian Americans and Pacific Islanders are facing increasing rates of hate and racism as misinformation circulated about the coronavirus. These are difficult and unprecedented times and im proud to that our committee again is play ago central role in responding to the crisis that we currently face. We must remain focused on the massive Public Health challenges and the resulting economic turmoil that millions americans are currently experiencing. Over the past few months, congress has successfully come together to pass substantial Bipartisan Legislation responding to the covid19 crisis. I have confidence that we can work across the aisle and with our Senate Counterparts to do this again, in coming weeks. The heroes act includes many good ideas and Proven Solutions that we can all get behind. I want our nation to reopen, i want americans to get back to work and for our economy to come back to life. And i believe that all of my colleagues share these goals. Discussions like the one we are having today will help had us better protect the health of all communities as we begin the reopening process and it will improve the odds that all communities can participate in and benefit from a return to work. For the americans who can choose whether or not to go back to work, that choice should not be between life and death. And we cannot forget that many in our country dont have that choice at all. Front line work ers named essential have been risking their lives on the job this whole time, and too often earning barely enough to survive. So many of the people are people of color and women and are carrying a tremendous burden through the crisis and deserve better. Theres so many issues that demand our attention and we will continue to work relentlessly to support all americans through the crisis. Today is the first of many discussions to come. So thank you to our esteemed panel of witnesses for joining us and this important discussion. And now let me recognize mr. Brady for the purposes of an opening statement. Thank you, chairman neal, let me begin by urging our democratic colleagues on to reopen the house, theres so much work to be done, the senate is in session and the Trump Administration has continued to work throughout this crisis. Establishing an unconstitutional proxy Voting System like the one congress banned in 1990s, due to blatant corruption in place of phased gradual reopening of the operations of the u. S. House is a disservice to our skconstitues and our country, if truckers, nurses and supermarket employees are considered essential, how does Speaker Pelosi think we are not. This has required an unprecedented response and who knows how many lives and livelihoods would have been saved if china had not covered up and misled the world, to the deadly characteristics of covid19. America has struggled with Health Disparities for people of color. In Booker T Washington in 1915 convened the conference on the improvement of Health Conditions of africanamericans in alabama, this committee today shines a bright light on this continuing, unacceptable disparity. This is no time to be planning politics. You cannot ignore the Racial Disparities that predate this virus of more than a century. People of color in this nation deserve serious solutions, not sound bites, especially from those in washington who simply hate this president , who by the way was taking action to fight the virus and limit travel from china while democrats were still focused on impeachment. This virus seeks vulnerable, the immune compromised. Yet people of color are impacted more, reveals what we know for too long, the Health System does not serve all and meet the unique characteristics of all americans. We know this challenge is both health and economic related, although all minorities in the lowest unemployment on record thanks to president trumps tax reform, we know these groups are hardest hit as state and local leaders lock down the economy and some continue to. In applying pressure on the covid crisis, our job is to make sure that the 39 million americans that are temporarily unemployed are not permanently unemployed. We have to make sure that the economy reopens safely and local businesses can reopen build their workforce and make workplace safe for employees and customers. If we fail, people of color will bare the brunt of the economic delay, and all americans will face the consequences of longterm unemployment. More dprug and alcohol abuse and shorter live stans. Today, we have to Work Together to identify strategies and improve the health of minorities in america, fiscal and economic health. Knowing these groups have gotten the short end of both for more than a century. I worry that our important Medicaid Program does not follow the poor around their wealthy states. Medicare dollars are supposed to help. It rewards shifting the focus away from those that need it the most. It does not make sense to pay 50 more for a healthy working adult, rather than the poor disabled elderly who works next door. Im frustrated that the days parts have been made worse by the 32 states who today are refusing to share the cares act emergency aid with their small and Rural Communities as congress intended. The highest rates of concentrated low income americans reside in Rural Communities. They are ones that are harmed by the refusal of too many state capitols to pass these relief dollars on to small and Rural Communities. Im proud chairman neal established a task force to address Health Care Challenges for rural and under served communities is important. Its unacceptable for states to hoard the cares emergency aid that was sent to small, rural cities and counties. Im splupporting legislation revoking the aid to states that did not use as it was intended. To help all americans over come the virus and eliminate disparities in our communities, Congress Must continue to ensure accesses to care for all. To keep Health Providers doors open. We have to continue investing in testing and Community Banks to health care facilities. We have to continue to support Small Businesses. Including those owned by americans of color and help the jobless return to work. Those are Things Congress can do immediately. In the longterm, we need to focus on increasing access to health care and prosperity in these communities, that is where i hope we focus our conversation on today. With that, thank you chairman, neal. Thank you, to our distinguished witnesses for taking time to appear before us today. To discuss these very important issues. First, i have the honor of welcoming dr. Ebrom x. Kennedy. Of the research and policy center, American University in washington, d. C. Next, we have dr. Rano samoa, at city of hope in los angeles and a former covid patient. And dr. Thomas dean seaquest, from mass general brigham hospital as well as a professor at harvard medical school. And a professor of medicine at the university of california, san francisco, and an internist at the Zuckerberg San Francisco general. And we have dr. James hildreth, the 12th president and ceo of maharry Medical College, the nations largest private independent historically black health and science center. And finally, we have douglas president of the American Action forum. Each of your statements will be made part of the record in its entirety and i would ask that you summarize your testimony in 5 minutes or less and to help you with that time, please keep an eye on the clock that should already be pinned to your screen. If you go over your time, i will notify you with a tab of my gavel, dr. Kendy, will you please proceed. Mr. Chairman, Ranking Member and members of the committee, my name is dr. Ibram kennedy, im a National Awardwinning had historian of racism and antiracism and a best selling author of four books. As a historian, i must take you back in time to 1896, to a major racial text issued that year. Im not talking about the legislation that legalized jim crow, im talking about frederick hoffman, race traits and tendancies of the american negro, a book that helped to legitimatize he showed higher black death rates and that black americans were more infected with syphillis, and tuberculosis, and other diseases with death like we are seeing in covid19. I was one of those to call on the release of covid data. We worked with the covid tracking project to build racial data tracker. The nations most comprehensive resource for covid, race and ethnicity data. As of monday, black americans are dying at nearly two times the National Population share. In 5 out of the 6 counties with the highest death rates, black americans are the largest racial group. In alaska the Asian American case rate is doubled their population. In hawaii, native hawaiians and Pacific Islanders make up 10 of the population but 17 of the cases. In arizona, native american case and death rates are five times their population. In d. C. , and 41 States Latino americans are disproportionately testing positive for the coronavirus according to the covid racial data tracker. This is the racial pandemic within the viral pandemic. Older than 1896, as new as covid19. But why such a pandemic of Racial Disparities . The pages of this work give but one answer. Hoffman concluded in 1896, it is not in the conditions of life, but in race and hereditary that we find the explanation of the fact to be observed in all parts of the globe, in all times and among all peoples he said, namely the superiority of one race over another. Of the arian race overall. The two explanations available to hoffman remain for explaining Racial Disparities, either that theres something superior or inferior about the races, the racist explanation, or theres something wrong with society. The antiracist explanation. In april, Many Americans were choosing the racist explanations. Saying people of color were not taking the virus as seriously as white people. Until challenged by survey data and majority white demonstrations to reopen states. Then the racist explanation zeroed in on black underlying illnesses due to unhealthy behavior. As if all races do not engage in unhealthy behavior. But according to the foundation for aids research, employment, access to Health Insurance and medical care as well as neighborhood pollution are more predictive of black infection and deaths than underlying illnesses like heart disease, and diabetes, we should be asking why are black and latino people less likely to be working from home . Less likely to be insured. Less likely to live in unpolluted neighborhoods. The answer is, racist policy. With the frederick hoffmans of today refusing to believe, will policy makers turn away as people of color suffer in their bedrooms, suffer on their hospital beds, suffer watching their loved ones lowered in to their graves all the while blaming them for their own suffering all the while adding to the racist history of their suffering . Or will policy makers be antiracist. Meaning, no longer blaming people of color for disparities and focused on pushing policy that leads to equity and justice for all. People of color want freedom. Im not talking about the freedom to get a haircut. Im talking about the most fundamental freedoms that have been denied for far too long. The freedom from infection, the freedom from death. Thank you. Dr. Samal, will you please proceed. Chairman neal, and Ranking Member brady and members of the committee. Im a Clinical Research endocrinologist at the city of hope. I help people in their fight to beat cancer. Please note this testimony reflects my own views alone and not the views of organizations that im currently affiliated. My father retired as a chief foreign officer for the u. S. Army. And instilled in me the importance of protecting all communities. Reflecting the commitment of the men and women to die in the defense of the freedoms that we so richly enjoy. I am here to report the devastating impact of covid on pis. As they have the highest cases in california, and Washington State and nevada and second highest in utah, oregon, arkansas and colorado. In Los Angeles County, the death rate for pis is seven times higher for latinos and five times higher than africanameric africanamericans. They have high rates of disease, that increases their risk of death with covid19. Pis are 80 more likely to be obese and 21 2 times more likely to have diabetes, when they dont have medical coverage compared to others, which delays their access to health care. They have fewer Financial Resources and live in large multigenerational households, densely populated neighborhoods. 24 work in jobs that place them at higher risk of infection. Call to action. In march 2020, i contracted covid19 because like so many in my community, im an essential worer. When i became aware of the alarming rates i searched out a way to volunteer. Theres no voice for Pacific Islander islanders voice on the National Level and we had no idea what the community was experiencing. A pi network fighting diabetes and cancer already exists, and navigating the obstacles faced by pis. Knowing our families are contracting and dying from covid19, we are not willing to stand by while others implement a course or response. The npcit is a group of researchers, physicians, elected officials and communitied a voe ska community and advocates for helping the population. New zealand has a lower rate of disease and has yet to report a single death of covid in the pi population. The difference between the u. S. And the cousins across the ocean is how well they engage vulnerable communities. The continuing rise in the rates of covid19, unfortunately suggest that the strategies have yet to reach the pi community. Our existing Community Infrastructure is the most effective means of ensuring the protection of pi populations from covid19 in america. Our Regional Task force was directly responsible for the data i present today. Data has identified how covid19 disparities are yet to be reported. All of it is progress, but theres considerable amount of work that needs to be done. Such as more Contact Tracing. According to be effective, they must Public Health officials. Theres a mistrust in seeking Health Care Services. Having the trust of the community, it has high potential for improved outcomes. This incorporation informs the strategy to optimize collaboration, the comprehensive strategy is located on the Pacific Islander care of excellent. Resources are needed to support this work, such as an electronic Data Collection system that speaks to headlight departmelth. And to conclude, i like to offer up two concrete steps congress can help to end the disproportionate devastation. First if, a comprehensive initiative to fight covid19 in pi communities. The convening organization has been working on an mou with the hersa funded health organizations. Second, we urge congress to fix a legislative oversight that has led to oversight of pis in america. People residing in the u. S. Are inje ineligible for medicate, denying access to basic health care. Lastly, let me close by giving a quick shoutout. A group of 25 Pacific Islanders joined a zoom call with hope to address the crisis. 300 volunteers from different states was the result. To my fellow pi workers, postal workers in utah, and those in arkansas, and orange county, thank you for risking your health, and the health of your families that serve the american public. I hope in return, america honors that sacrifice by granting you the tools to depend our communities and the affects of covid19. Thank you, dr. Seaquest, will you please proceed. Chairman neal, and Ranking Member brady and members of the committee. Thank you for the opportunity to address you today. I am a primary care physician and a professor of medicine at harvard medical school, as the chief Patient Experience and equity officer, i oversee Many Health Care operations for a large system in the boston area. Most importantly im a part of the tribe in new mexico, where my mother was raised on the reservation. I spent decades working with tribal communities to improve health. I would like to share with you today a story of two different communities that i had the privilege to work with. The Navajo Nation in chelsea, massachusetts, in these communities, an acute crisis has hit. Poverty has a different meaning there. 1 3 of residents do not have access to clean Running Water or electricity. The Covid Infection rates surpasses new york and high. How do you battle a pandemic effectively without Running Water on or electricity . Curfews and lockdowns have been instituted to stem the tide of infection. Yet the peak is still to come. Chelsea is a city of 40,000 people in a two mile square plot of land in eastern massachusetts, its one of the most densely populated cities in the state, with a majority hispanic population that does not speak english as the primary language. Like the Navajo Nation they have a disproportionate death toll. The situation is dire for thousands of people in the navajo snagz nation and chelsea who are fighting for their lives and digity. What went wrong . To understand the crisis in the communities we must acknowledge the embedded racism. Theres two important questions for us to ask, first, why are there so many infections in these communities . Racism, not race has been the risk fact for for disease spread. The congestion present in chelsea makes social distancing nearly impossible. Multigenerational housing is common place in both peoples. While it allows the passing of culture, such crowding is forced by poverty. And many of the residents do not have the privilege to stay home as our Public Health messages advise. They must leave their homes to work. Or on the Navajo Nation simply to get clean water. Second, why have the clinical outcomes been so poor in the communitie communities . The high burden likely contributes, however, this did not happen by accident. The Navajo Nation has 13 full Service Grocery stores in an area that would nearly cover massachusetts, New Hampshire and vermont, we have to change the National Dialog from one that describes healthy diets as personal choice to one that recognizes the limit of personal choices to determine the health outcome. And access to health care drives outcomes. Health care workers are in short supply had in the Navajo Nation, and chelsea. In a system already hard to access, we have directly messaged patients to stay home, how many will suffer at home a stroke or heart attack out of fear of mistrust. It will Impact Communities of color disproportionately. The hundreds of years of conflict and betrayal experienced by the Navajo Nation creates a understandable mistrust of the system. How do we move forward . We cannot slip back, the circumstances that have created the crisis in the two communities existed long before covid, and will persist long after unless we take action starting today. I leave you with three recommendations. First, Fund Programs that support work at the interface of Health Care Delivery and Community Help to take on the social risk factors. Hospitals like mine have tried to step up during the pandemic. But this is neither sufficient nor sustainable. Second, increase funding of the Indian Health service and Fund Infrastructure improvement in under served native and nonnative communities. It is not acceptable in the greatest nation in the world in 2020, that so many are without Running Water or that broad band and Cellular Access is not available. The electricity was out for a pro longed period, and when it returned the broad band was still not sufficient for the hospitals to function. This is true in chelsea, where we have tried to have virtual visits for those in the pandemic. And third, the covid pandemic has shown us theres not enough Health Care Workers available in the communities. In closing i would like to take a moment to thank all the people who continue to work every day on behalf of native and other communities of color across the country during the pandemic and to these communities. Please know, are you not forgotten and we see the heroic efforts you are undertaking, we can and must be do better. We can stand together to make sure that Health Equity is treated as an emergency and no one is denied the highest quality care because of who they are and where they came from. Thank you. Thank you, dr. Seaquest. With that, please, have dr. Fernandez proceed. You need to unmute. Dr. Fernandez. You need to unmute. Good morning, can you hear me . I can hear you. Good morning chairman neal, Ranking Member brady and members of the committee. Thank you for this opportunity. My name is alicia fernandez, im a physician and a professor of medicine at ucsf and i practice primary care and internal medicine at san franciscos possible hospital, Zuckerberg San Francisco general. My research focusing on latino and immigrant health. Prepandemic an important ucsf study that i describe fully in my written testimony, found that viral prevalence in a local diverse neighborhood in the hispanic neighborhood was 5 and among the white neighborhoods was zero. 90 percent of those testing positive were unable to work from home, compared to half of the sample. The most common occupations were restaurant and janitorial jobs. Covid19 has revealed the great Health Impact of how we work and live. The need to leave home to work, either working in an essential business or low wages, is a highlight of covid disparities. And second multigenerational living, and hence a working Family Member may bring home the virus to vulnerable elders. In our cases, economic necessitates living together. I believe theres four important points to consider. First, require comprehensive data on hospitalizations and death by race, ethnicity and preferred language. Socalled real data. Race and ethnicity is essential and we must require data on preferred language. Language is already mandated for collection and Health Care Settings and offers guidance for Health Departments targeting prevention and testing. Next, we should protect industries, Small Businesses and workers by mandating self distancing and use of appropriate ppe at work. This will protect crucial industries, and it will protect workers, their households and a broader community. Small businesses play a particularly Important Role in many immigrant communities. Preventing them from in addition, i believe we should extend the cares act, paid sick and family leave, economic provisions to Small Businesses. Health care workers and large corporations. Wage replacement is necessary to support mandatory isolation in quarantine. Without wage replacement, many low wage workers will continue to work as will may asymptomatic contacts that should quarantine themselves. Isolation and quarantine are key measures that protect us all. These funds must be available to all low wage workers regardless of immigration status. Finally, effective Contact Tracing is key and it depends on trust. Contact tracers call, and say, tell me everyone you have been in contact with starting two days before you became ill. For many individuals this question evokes fear, they may wonder should i share the names of others who may be working informally. What will the authorities do with this information . For immigrants from latin american, prior experiences with authoritarian governments may hesitate them from respond. My research and that of others has found that trust, comprehension and medical outcomes are much easier to achieve when the clinician and the patient speak the same language. Reports of trust and physician are lower when they do not share a language. Conversely, blood sugar control among spanish speakers with diabetes improves when they have a physician that is a spanish speaker and we need to train and deploy, Community Health workers. Trust will be enhanced if contact tracers can attest that all information will be kept separate from immigration authorities and law enforcement. In conclusion, covid19 has demonstrated not for the first time, but with painful clarity how we work and live has enormous impact on our health. Reducing Health Disparities will require longterm effort to address the social inequities. Yet, theres steps we can take now that will help us be more effective in response to the pandemic. We should require the collection of real data, make workplaces safer, and extend wage protection to those who are quarantined and ensure an effective covid19 workforce. These measures could reduce the impact of covid19 on vulnerable communities and keep all of us healthier and safer. Thank you for your attention. Thank you. Doctor, will you please proceed. Thank you chairman neal. And members of the committee. I would like to thank Lamar Alexander and tim scott, these are long time friends of americas hcvus, we find ourselves in a strange world with an old familiar problem. The poorest and disenfranchised americans are dying from disease. Every resident of the country is vulnerable. The color of our skin, the money in our wallet and color of our skin does not protect us. Do we want to protect all americans by protecting those because of their jobs and health risk are the most vulnerable. After Ongoing Communications with the white house and members of the congressional black caucus, im convinced that we do. If we as a nation have the will, i would like to propose the way. It begins with americas four hbcu medical schools. Founded in 1876, they have trained thousands of africanamerican primary care doctors serving across the nation. Five years ago, i chose to take the helm because of the places it serves. The college, as well as howard medical school, moorehouse medical school, are filled with professionals who are singularly armed to address our Current Health care crisis. And we have a plan. We propose to establish the consortium of black medical schools. It will provide critical services. Expanding testing. Contact tracing. And training of front line workers and Drug Development to address the need to those that are disproportionately impacted. They have the history and relationships and credibility to scale up immediately. This school and already a leader in the fight. I have worked with the city of nashville to establish policies and collaborated with the cdc to track data and advised sports leagues on their plan. We are trusted in the communities we serve. Which have a history of abuse at the hands of americas medical establishment. We understand the subtle yet critical cultural differences that long have been overlooked by mainstream providers. Creating deep fear and mistrust. The same is true for our sister medical schools, for example, earlier this month, and with the best of intentions, the state of tennessee sent the National Guard in to Public Housing to test residents. Not surprisingly the People Living there were appear were apprehensive and stayed in doors. Testing sites are d disproportionately in white neighbors. But can lead to key areas not being tested. If going forward, the consortium is given the mandate and the resources to test in the neighborhoods, i can assure you that all citizens will be safer. We can deploy it quickly. We know where to go and we will be welcomed. Over my past 30 years at harvard, Johns Hopkins and uc davis, i see how institutions are funded. If theres a need, funding is provided to these institutions and they are asked to provide answers. Consortium ask that the same rule be applied in tackling this National Crisis that the rule be applied to our work. We are uniquely qualified to address this pandemic and vulnerable population. We anticipate that the cause for implementing our plan is 5 billion over the next five years. This is less than a mere tenth of 1 of the total stimulus package. I urge you to act now, too many Vulnerable People have died already. More are dying as we sit here and many more will die tomorrow if we do not act. All we need is your endorsement and a small fraction of the nations resources to make a pro found difference. Let us join the fight, we are well prepared. Well trained and we must be well armed. Please arm us. Thank you for your time. Thank you, let me recognize dr. Douglas holt aiken, a frequent panelist for the ways and Means Committee. Thank you chairman neal. An honor to be here today to discuss this important topic. The covid19 pandemic has generated numbers that are hard to grasp. A loss of 100,000 lives and it has produced numbers on the economy that i simply never thought we would see. In the past two months we have witnessed the record decline and the confidence of americans, a record one month decline in the retail sales that they purchased. We have seen in one month, 20 million americans lose their jobs. Ten times bigger than the previous largest loss of employment. They came with the demobilization act with world war ii, we saw unemployment go three times bigger. We saw in one week, six million americans apply for Unemployment Insurance benefits. Again, ten times larger than the worst year in the Great Recession back in 2007, and 2008, we have seen the Congressional Budget Office put out a projection for the economy that anticipates that in the Second Quarter of 2020, gdp, National Income will decline by 11 . In the worst year of the Great Depression, 1932. National income fell by 12 . We are going to experience the worst year of the Great Depression this spring in america. Congress has moved rapidly and dramatically to try to alleviate this enormous down draft. I applaud both of the efforts they have been just tremendous. But despite them, there was an enormous amount of economic and personal damage that has occurred. As the previous colleagues at the witness table virtually have pointed out, this has not been felt equally. The existing disparities among racial minorities have widened across the economic scale and the Health Outcomes. My written testimony documents this. I will not belabor it. It has had a clear and dramatic rise in the disparities. A, from the direct Health Effects to which the others are better to speak. And from the panelists are bett speaking. Looking forward, then, it seems to me that one of the things that can be done is to try to as quickly as possible get the economy back to something close to what it once was. When we saw those 20 million americans, 18 were listed as temporarily laid off. We need to do Everything Possible to make that be true and to have those individuals get back to work. What will that look like . I would argue it will look very different than what was done in the c. A. R. E. S. Act which was a noble attempt to give enough cash to individuals, businesses to weather the worst of the pandemic and essentially hide from the virus and put the congress in suspended animation. We will have to work in the presence of the virus. Well have to give people the confidence to go back to work. That confidence is an important part of this. And that will require, again, pushing the Public Health mission as a top priority, testing, therapeutics, vaccines are an essential part of better Economic Growth. Its going to give people the confidence to open their businesses and have people enter and have employees work safely there. That confidence has to occur on both sides. I think were going to have to think more than short term, stimulus and the kinds of things that are easy to do in writing check and is the like. You look at the Congressional Budget Office analysis. If you go to the end of 2021, it anticipates that gdp will not have turned to the level in january of this year. There have to be strategies that are durable, that give businesses to undertake the adjustments to their workplaces that allows social distancing, that permits working safely, thats going to be a costly endeavor and one to me that is reminiscent to the realistic threat of terrorism after september 11th, 2001. We have a new threat and we need to learn to operate the economy in the face of that threat. Congress can do an enormous amount to support that effort and i encourage you to do so. Thank you for giving me the chance to be here today. Without objection, each member will be recognized for five minutes to question our witnesses. We will not observe the gibbons rule in this remote setting and will go to the order of seniority, switching between the majority and minority members. Members are reminded to unmute yourselves. Youre recognized for five minutes. I will recognize myself. Dr. Fernandez, thank you for joining us today. Your testimony highlighted the issues around access to coverage, Language Access and congregate living. One of my concerns with covid and the epidemic is that the language has been a barrier to accessing care and treatment. I recently wrote to dr. Azar discussing this point and the need for the department to do more on this front. Could you discuss some ways that the federal government in better support addressing the barriers brought about by language . Thank you for this important question. I think that there are many ways a federal government could help, including funding the programs and other programs that help the pipeline to diversity the pipeline and a more diverse workforce, a more Diverse Health workforce also will be very helpful. But second, i think we need to go a step higher and insist that the communities and Public Health departments and the cdc all put out Public Information in target languages and in the affected communities. It makes no sense to have an affected community with the majority language may not be english and not have support there. Finally we need to do much more to integrate Language Access better into telehealth. Telehealth is beginning to replace routine medical services. Its difficult to integrate Language Services there and thats a place where the federal government can make clear what the rules are. Thank you. Dr. Kendi, the rates of infection and deaths in Nursing Homes are astonishing and heartbreaking, accounting for more than 50 of the deaths in some states, including my own. The New York Times reported last week that the single most important predictor of which Nursing Homes have covid19 outbreaks and deaths are residents who are people of color. That is at least double the rate of facilities where black and latino residents make up less than 5 of the nursing home population. Demographics of the residents were more predictive of covid19 cases than the quality rating of the nursing home, the article found. Dr. Kendi, based on your extensive experience, could you speak to the intersection of race and history and discuss what you believe to be the factors driving this trend that we are seeing in Nursing Homes. Well, thank you very much, mr. Chairman, for recognizing how this virus is affecting people in Nursing Homes. I just think in general we should be also focused on people, like people in Nursing Homes as well as incarcerated people, undocumented people, and others. But i think when it comes to Nursing Homes, i think Nursing Homes in many ways are a reflection of the larger society. And so you have many Nursing Homes that are majority black or latino that are existing in urban centers where theres massive outbreaks, massive outbreaks as a result of some of the factors that many of the that ive mentioned and other sort of witnesses have mentioned. So i think what is unique, obviously, about Nursing Homes is because the people within them are much more vulnerable to obviously serious illness as a result of covid19. And so if there was a specific aspect of the black and Latino Community that we should be first and foremost seeking to provide relief, seeking to answer this very question, it certainly should be people in nursing home. This is one of the most shocking and glaring Racial Disparities in existence. Thank you. Dr. Sequist, thank you for your decades long work advancing solutions to the urgent Health Care Challenges in native american communities. The model that you have led clinicians in partnership with the Indian Health service is remarkable. I know your testimony includes recommendations for the next steps forward to protect the health care for native americans in the covid19 era. What is a critical option that the Congress Might play to give assistance to that argument . Thank you so much, chairman neal. One of the most pressing things that we need to address on the health care side is the ability availability of Health Care Workers on the front line. Physicians, nurses, health care technicians, many Indian Health Service Facilities have the equipment. If we talk about the ventilator supply, they may have the ventilator, but not the people who are experienced with using that equipment. We have to take really drastic steps to improve the Health Care Worker supply in these communities. The Indian Health service regularly reports that 30 vacancy rate for these physician, nursing, pharmacy, dentists roles. How the federal government could help in this space is as dr. Fernandez was alluding to, increased the pipeline. We have to increase the pipeline because we know that these diverse students, when they become physicians, nurses and other Health Professionals will return to their communities. Right now less than 0. 5 of physicians in the country are American Indian. But when we survey Indian Health service providers, over 20 of them are American Indian. Thats not a statistical coincidence. T recognize the Ranking Member for five minutes. Im pleased the Trump Administration has been pursuing an allgovernment approach during this pandemic. I would like to enter a record from the health and Human Services outlining the specific efforts to help groups disproportionally impacted by covid19. So recognized. I think after a great deal of hard work in the u. S. , you see that testing is up. Daily cases are down. Infection rate continues to come down. In texas, we continue to reopen safely. Since Governor Abbott began a phasedin approach, focused on increasing testing and Contact Tracing, testing the hot spot areas including Nursing Homes, prisons and several meatpacking plants in west texas, in what weve seen since the reopening is very positive. Infectious rate excluding antibody tests are down twothirds since its peak in april and down nearly 20 since the state started reopening. Hospitalizations are down 19 since may 5th. The facility rate in texas per capita is the lowest among the top 11 states in the United States with cases. For example, new york regrettably is seeing a covid fatality, 1 in every 656 residents. In texas, were fortunate, our rate is 1 in every 18,855 cases. Thats not to say that we let up the pressure on the coronavirus. But certainly now we can see the light at the end of the tunnel where customers are beginning to place orders again. Businesses now believe they have a chance to survive this pandemic of keeping their workers on the payroll and helping them ride this out to the other end of it. We do know as well that testing in my experience has been strong in our minority communities. For example, in a historically Africanamerican Community near where i live, when local officials have cried out for more testing, our office, the county, Texas Department of Emergency Management not only set up testing one day, but returned two more times to make sure residents of that community were getting the testing they deserved. I know too in texas, around 42 of deaths from covid19 are hispanic or latino americans. That is slightly more than the 39 of population it represents. But weve got to do better for all texans and i look forward to hearing ideas from todays panelists on tarpted, bipartisan solutions. We know this isnt just a Health Crisis, its an economic crisis as well. As you know, people of racial and ethic minorities are more likely to be in jobs that increase the exposure in highly congested inner cities, in lowincome neighborhoods, Rural Communities as well, often unable to avoid mass transit and other challenges. Their jobs increase exposure and jobs are still be performed. More likely to be a job that gets cut as a result of the economic downturn. I believe one of the best things we can do for these communities is to help reopen the economy safely in a way the jobs and workplaces are healthy and safe for customers and workers, how do you recommend we begin . Thats a very important and hard question. I think its important to recognize that its not a light switch, on off. The economy has never been fully closed. We know people who have been essential. Theyve gone to work and faced the potential for infection every day. But despite the large amount of lockdown, you know with the large amount of lockdown, weve seen the Enormous Economic price thats been paid. We have to find a way to safely work, minimize that Economic Loss so the people dont suffer the Health Fallout of that Economic Loss. The number one thing that really is the confidence of people. Governors wont reopen, mayors wont reopen. People will reopen their economies. And theyre different all across the county. We have 400 metropolitan areas. Each is a separate labor market and are based on the conditions in those labor markets. Thank you, mr. Brady. Thank you, sir. Unfortunately our friend mr. Lewis cannot be us today. Without objection, his statement will be included in the official record. Let me recognize the gentleman from texas, mr. Dogget. So many lives lost, so much unnecessary suffering as a result of denial, delay, and ongoing deception. And the death and the suffering has been disproportionally borne by our people of color. Despite extraordinary efforts by Public Health leaders and despite considerable interference by the governor of the state of texas and a lack of national leadership, these efforts in our local communities have been very important in responding. And i think the disparities are very evident, despite those efforts. In san antonio, while africanamericans only make up 7 of the population, theyre a fourth of the covidrelated deaths. In austin county, while a third of the population is latinx, they account for threefourths of the hospitalizations and a majority of those who tested positive. Local efforts are under way to ensure that always materials are available in multiple languages, that efforts make use of minority Media Outlets and funds are dedicated to closing gaps to nonprofit organizations that are serving the vulnerable. I applaud the efforts of the hispanic Business Advocates on these issues and our need to do even more. Not surprisingly, the Trump Administration is yet to even appoint a spanishspeaking official or create a spanishlanguage website during the crisis, ignores millions of spanish speakers. With a virus that is so contagious arriving with so little preparation, most people recognize that we all have a stake in overcoming racism and prejudice to ensure that all residents, regardless of their language or citizenship, can access testing and treatment. Unfortunately in states like texas, this is not the case. Our state Republican Leadership continues to reject federal dollars to extend medicaid and astonishing ideological decision that disproportionately harms people of color. Nor do these disparities end with the composition of the covid19 Patient Population or the failure to make health care accessible. We must also confront the overrepresentation of people of color in our frontline jobs, including Nursing Homes, meatpacking factories, construction sites and other frontline jobs that are keeping our country open despite unsafe conditions in many of them. Essential workers need more than our praise. They need essential workplace protections, essential health care and essential compensation throughout this pandemic and beyond. Dr. Sequist, i would raise a question to you. We already know that one modest treatment available for some hospitalized virus victims, remdesivir, is being rationed by the Trump Administration in a rather irrational way. Given the disparities that already exist and the refusal of the Trump Administration to take any meaningful action to restrain prices of treatments and vaccines, despite billions of public investment, isnt there a real danger that many people of color will be put at the back of the line and unable to pay for costly future treatments and vaccines . Thank you, congressman, for your question. I think that anytime that we resort to needing to ration Health Care Services we run the risk of exacerbating Health Care Disparities. Remdesivir has a broad clinical application and the number of people who would be eligible for treatment by it, exceeds the number of doses of remdesivir that are available right now. I would say there are three things for us to focus on. One is that the federal government should be transparent about how its allocating the doses of remdesivir to each state. The second is, we need to ensure access to hospitalbased care for all of the patients in these communities because that is the location where you can get treatment for remdesivir. And the third is that, if there is a persistent drug shortage related to remdesivir that the period that we create, we have to take an equity lens to them and ensure that none of those criteria create a systemic bias against communities of color receiving this treatment. What do i mean by that . We cannot put in place clinical triage criteria that suggests that overall Life Expectancy is a way we could triage who gets remdesivir. As many people have cited, that overall Life Expectancy is something that is already ingrained in the instructostruc our society right now. It is fundamental that we limit the cost sharing of vaccines, that we make these vaccines widely available as soon as theyre available. If there is cost sharing or other elements of pay involved, it will limit the access to these communities. Thank you, doctor. Let me recognize the gentleman from nebraska, mr. Smith, to inquire. Thank you, mr. Chairman. And certainly thank you to our witnesses. Appreciate this opportunity. Its an important topic. I know many of the dynamics of this issue are not new but that the pandemic certainly brings new attention to some of the same problems and im hoping we can make some progress on these very issues. Ive been working a lot on teleHealth Issues. I think telehealth is a great approach to reaching underserved communities. Minority communities, rural populations and others. Obviously with evolving technology as indicated here today, i think this does pose some opportunities, but also we want to get it right. A lot of folks depend on this. I know that some legislation that ive worked on, the rush act, as its called, reducing unnecessarily senior hospitalizations, this would allow medicare to reimburse for telehealth that would replace the need to transfer a nursing home patient, for example, from a facility to an emergency room. A very fragile population that can be served through telehealth and im hoping we can update our Reimbursement Policies to parallel that of the technology that is available. I think the flexibility that can and should be offered in this respect, we want to do that. It will actually show a cost savings immediately. Not projected out several years, but immediately. Im hoping that we can get that across the finish line. I know that Health Clinics face regulations that are outdated, antiquated. We need to update those as well. Im glad that both sides of the aisle as well as the administration Work Together to advance some telehealth opportunities in the last few pieces of legislation two address covid19. And i hope we can celebrate that and perhaps even add to that moving forward. But let me also say that federally qualified Health Centers offer a great opportunity to participate in offering telehealth. I appreciate the efficiency under which they operate. In my home community, as an example, ive always been very impressed with how they stretch the resources to meet folks in very vulnerable situations. So i do want to bring some attention to that. I know that we have the urgency now cannot be overstated. And so im hoping, doctor, could you perhaps reflect a bit on your observations about telehealth and how we can more efficiently and more effectively, perhaps, deliver health care to underserved populations via telehealth . Thank you, congressman. Telehealth has been an important part of the story of this pandemic. With the declaration of the emergency, the hhs used its authorities to change a lot of the regulations that surrounded telehealth, moved reimbursement to the same as an office visit, allowed you to do telehealth from your home, and it waived penalties for accidental hipaa violations when using zoom and facetime and the like. All of this has dramatically increased the reach of telehealth and is something where weve learned how wonderful this can be in reaching those populations and improving the quality of their care, providing cost savings. All that has seemed to be one of the great a shining moments of the Health System to do that on a wrregular basis. It needs to be looked at carefully and obviously its difficult to get these things right. But its important to start now. Thank you. Do any of our other witnesses wish to reflect on telehealth topic . Dr. Fernandez . Thank you for the opportunity, congressman. I agree with you that telehealth has the opportunity to reduce disparities. It also has the opportunity to increase disparities. Let me explain why. Im a practicing physician and when youre doing telehealth, youre putting more onto the patient to triage themselves, to decide how serious something is, youre also putting more on them to selfmanage. Thats really hard in populations which may have low education or low health literacy. Its also really hard for many people to use to have the Digital Literacy to actually downloadcause on my phone i am able to do facetime or similar and quickly get access to telehealth. Telehealth is a tool. It is difficult to use it. In order to use it well, we need to reduce some of the regulations and make it more accessible to people to be able to use it from their home. Chairman neal let me recognize the gentleman from california, mr. Thompson. Rep. Thompson thank you, mr. Chairman, and thanks to all of our very excellent witnesses who are with us today. The disparity the witnesses hav very excellent witnesses who are with us today. I the disparity that the witnessea have talked about is certainly true in my district. In is the Hispanic Community accounts the covid 60 ofr cases while they make up only 27 of our population. In that same county, 95 of young people with covid are hispanic. Thats 54 out of 57 cases. Unfortunately, these heartbreaking numbers are nothing new. Ha as weve discussed before in dd this committee, racial and ethnic disparities have persisted for decades across our Health Care System. These disparities have been laid bear by covid19. Its critically important that i congress tackle this issue withh the urgency that it requires. Ouf i would like to start by talking about something that mr. Smith just raised and a couple of the panelists have mentioned. Ochairo thats telehealth and ealth ca telemedicine. The cochairerave and of the telehealth caucus and n ive been a big proponent of telehealth for my 20 years in congress and before that as a state senator in california. Te it was my legislation t was the expansion of telehealth and medicare that was in our first covid bill that we passed. While im pleased that more and more people are taking advantage of telehealth, i share some of the concerns that dr. Fernandez brought up. And, dr. Fernandez, can you tal a little bit more about those h barriers to telehealth that are faced by communities of color, including the Hispanic Community in california and more important, what are some of the specific things we need to do to make sure telehealth expansion m is equal and everyone is able to benefit from it . On of thank you. I think language is a huge barrier. Even though i was assisted by an interpreter, its difficult to adjust insulin when youre using an interpreter, you cant see the patient. Its extraordinarily difficult. Unfortunately the solutions to those are pretty are longer term. One is, to make sure that everyone has access to televideo which is better than telephone. Second to make sure that atient televideo to show that that would have helped my patient. Thank you, thank you very much. Dr. Kendi, can you talk a little bit about the differences weve seen in states that expanded hac medicaidom versus states that chose not to . In stat have communities of color faired better in the states that expanded medicaid under the Affordable Care act . O im not aware of a study that will be able to answer this question. But one thing we do know is that for instance, near you, a recent study was done that found that. Black patients weree more likel to show with advanced form of covid19 they were more likely to be hospitalized, three times. The rate of white and hispanic patients and were seeing that around the country in which gro black people are being if y hospitalized more than other o groups. And so eventually well look at the reason why. Health one of the reasons that is suggested is lack of access to insurance. If you look at the states that have not adopted, you can look at in kansas [ inaudible ] 6 of the population, but 31 of them died according to the datae tracker. In missouri, black people are 12 of the population but 38 of the people who died from covid and you look at the same disparities in south carolina, georgia, alabama, mississippi, on down the a line. Theres something there that we need to look at. Clearly one of the factors that more predictive of someone having a preexisting condition isismu very simply access to mel insurance. Thank you very much, i yield back. Thank you, mr. Thompson. Havn let me recognize mr. Kelly to inquire. Its good to see a lot of you, even though its only on our Small Screens here. As some of you know, i know john john, thanks so much reaching out early on. When i had the coronavirus and when i look back on why was it that i was able to get treatment early. As we talked today about the disparities, i think its pretty selfevident depending on where you live and the community that you live in, there are differences i live in a small town in western pennsylvania with a Great Health Care facility and a doctor that ive been going to for 20some years. Before that, i went to his father. He and i were schoolmates. How do we bring that down to where more people have better access and have a much earlier chance to get to some place where theres some health cares available to you. I got to tell you, one of the things that we havent talked about and what was one of the greatest efforts in the tax cuts and jobs act was the opportunity zones. I think all of us recognized, look, there are certain places that are underserved. They dont get the attention that other places get and why is that . Because people look at those places and investors look at those places and say, theres no sense in me putting money into Something Like that where i dont have a chance for a good return on it, but opportunity zones, as part of the tax cuts and jobs act, that was something that opened up a different window and said to investors, we need to take a look at these communities. We need to stop turning our back on them. We need to start creating opportunity in places where opportunity didnt exist anymore. The district that i represent is one of the poorest zip code in america. This is going to be hard to believe. Its right in the city of eerie, pennsylvania. 16501 is the poorest zip code in america. People say, no, that cant be. I cant be in the middle of the city. Yes, it is. Yes, it is. When i heard dr. Holtzeakin talking and i think that the return to a very robust and dynamic economy, isnt that the cure for a lot of things that we want to get done, isnt it bringing opportunities into those communities, bringing Educational Opportunities and then opportunities to get into a profession or a job skill that would allow you to have some success. I think the answer to almost everything were talking about right now is that every single american has the same opportunity as another american, regardless of where you live, the color of your skin, how you worship, your gender. Doug, if you can, as we try to come out of this pandemic, because the real key, i believe, is getting this economy up and running again, we were on such an upward trajectory, money being invested in places it wasnt being invested before, jobs being created, and then what we were able to do when we found out in america, we could be the Energy Leaders in the world, were talking about jobs. Those are all jobs. Doug, i listen to everybody. I got to tell you, listening to the doctor talking about the in a Navajo Nation, we need to have a wider look at where america is, people in america who we represent. Doug, if you can, the return to a dynamic and robust economy really creates opportunity, discuss does it not . I would love for this country to get back to the robust labor market that we saw in 2018, 19. The labor market that drew into work people who had not been attached to work for a long time, those with fewer skills and experience, that was the greatest accomplishment of that economy. That was one of the reasons the Federal Reserve continued to ease Monetary Policy because it was reaching people we have not previously reached. There will still be work to do. One of the things you mentioned was education. I just have to say to me, the most disappointing numbers i see every year are the National Assessment of educational progress which has shown for ten years that our fourth and eight graders cannot read or do math at their grade level. Those children, americas children, will be left behind. Education is the route to income. Income is correlated with your health, your location and all of the things we care so much about in this hearing. And so Educational Opportunities are at the core of much better longrun success. Thanks. And i wish we had longer to talk. Im going to yield back. Chairman, thank you so much for holding this and thank you for taking the time of your day your lives to come in and share your knowledge with us. Thanks so much. I yield back. Let me recognize the gentleman from connecticut, mr. Larson, to inquire. Mr. Larson . Hi, mr. Chairman. Are you all set . I would like to submit to the record an article that appeared in the connecticut mirror entitled frustration growing in majority communities over the governments response to the and greg lackey. It underscores the testimony that we heardo frounalm so man our witnesses. My home state of connecticut, africanamericans represent 10 of the population yet they represent 19 of the covid cases and 15 of the deaths. And so as troubling as we look at this, and i think the number of the witnesses touched on this, number one, i think that even before the coronavirus took place, there were these disparities that have existed and we didnt have to go back to 1896. But i appreciated the perspective that we put this in and to find ourselves still in the same situation. We should recall what Francis Perkins reminded fdr, when were dealing with the crisis, its not only important that we address the crisis, but as dr. Holtzeakin also said, we want to make sure after we come out of this crisis that structurally were in a better position than we were before. It seems to me, and i would like to hear from our witnesses, certainly, that as we look at this, especially having been through another crisis back during the Great Recession, that we found ourselves in a situation where peoples 401 k s became 101ks. The health of the nation and the health of the economy are tied and linked. That were not going to have one without the other and as much as 70 of gdp comes from consumer confidence. Without that. But one thing that occurs to me, this virus has attacked the elderly, specifically. And amongst the elderly, minorities and women specifically and especially as all of our witnesses have testified, people of color. So it would seem to me that one of the things to structurally address this is to make sure that when we come out on the other side of this, weve done something that will help and assist. Why not make sure that we do our job as members ofpdhd congress fix the Social Security program, something that hasnt been touched in 37 years, or address or enhanced in the last 50 years and do so in a way knowing that, for example, currently, more than 5 million fellow americans who have paid all of their quarters into Social Security, worked all of their lives, and then retired, will get a below Poverty Level check from Social Security. Nothing else stayed put. Their mortgage payments, their rent, their food, their cost of living all increased. But for them, they were stuck and these are the people that have worked all of their lives and i think we have a moral obligation to do so. I would love to hear from our witnesses what they think about that. And well start with the doctor. Dr. Kendi . Yeah, i completely agree. I think specifically we talked earlier about many people people of color in particular who are in Nursing Homes and people black and latino people, theyre in Nursing Homes jjy not only are they not receiving the economic the resources that they can to maintain their livelihood, theyre also harming being a result of covid19. For many of these people, its a storm. And at least check be economically during this crisis and i think we should be focused on elderly people in so many different ways. These are not throwaway people. The ageism in our country is just rampant. Even as a young person, i recognize the value of older people and they have worked all their lives. I want my parents when they collect Social Security to be able to maintain their lives. And i think its going to become the civil rights issue of the time. I think youre right, that we have to have a transformative change in light of the pandemic and one of the things that the agency medical school can do is change the nature of health care for minority communities across the country for some time to come. The infrastructure we would create would have that lasting impact. And, again, i think this would be something that will be very, very beneficial for the whole country, actually, given the capacity we have in all of these areas. So i agree with you. We need a transformative change and thats what were proposing. Let me recognize the gentleman from North Carolina. Thank you. One of the compounding problems many communities minority face throughout the crisis is the lack of access to proper new transition and care services. Not only are minorities more likely to have underlying conditions that make them more vulnerable to coronavirus, but theyre more likely to work in Service Industry jobs that cannot be performed from home. Child assistance and nutrition programs are essential to minorities during this crisis. From the beginning, nonprofits like the ymca in raleigh where i live and all in between have been on the front lines of efforts to support underrepresented communities in this national emergency. Over the past few weeks, the ymca of the triangle has served almost 50,000 meals to families across the region and provided childcare programs to over 1,700 Health Care Workers. In North Carolina, just about 30 minutes from my house, has the pool ymca and it has set up day camps for children and runs blood drives to assist the health care community. These programs not only support our essential personnel, but also provide food and care and stability for our hardhit communities. Despite the tremendous work that the ymcas have done in minority communities, theyve been left out of the federal assistance programs they need. Under the Paycheck Protection Program which congress enacted to help groups like this, in my opinion, affiliated organizations like the ymca cannot access funds if they employ over 500 people. As a result these two big ymcas in North Carolina furloughed over 95 of their staffs and theyre continuing to operate at a loss. So without emergency federal assistance, ymcas across the United States will no longer be able to provide these services. I strongly urge all of my colleagues to support an adjustment to affiliation rules for the Paycheck Protection Program to ensure that nonprofits can continue to serve those communities in need. So my question is for dr. Holtzeakin. In your testimony, you talk about ongoing Food Security issues even with the Additional Meal Service funding from the Families First act. My question is, how can we best work with nonprofits in the private sector to bridge this gap in underserved communities. First, congressman, i want to echo your call to modify the Paycheck Protection Program. Its a fantastic initiative. But there are some eligibility and other aspects of the program that could be improved to reach a broader swath of american businesses and American People. As far as Food Security, you know, in this emergency, the agencies have a lot of authorities to waive regulations. We have a lot of Food Labeling requirements that identify food as going to restaurants. Those restaurants arent open right now or going for a wholesale use. They cannot as a result immediately be send to these not for profits for distribution to american families. And the fda has done some things to relax those regulations but i think there should be ever effort to waive as many of those in this crisis as is possible. You want the food to be safe. And i would look into that. Thank you. Thank you very much. Mr. Chairman, i yield back. I thank the gentleman. Without objection, i will include in the record an article from the i i i i i i i i i i i with that, let me recognize the gentleman from oregon, mmr mr. Blumenauer. Let me say how impressed i am of how smoothly this historic hearing has gone. It is due to a lot of hard work on behalf of the staff and members, but its worked out well and its going to be a tool that well be able to use beyond the coronavirus. And i appreciate the efforts. This has been a troubling hearing as we have reemphasized time and again the grotesque disparities that we see in terms of africanamerican communities, certainly here in oregon, a problem that we face with latinx. The disparity in oregon for the Latinx Community may be even greater because of definitional issues. But i want to focus, for a moment, if i could, on native people. And dr. Sequist, i appreciate roots and pointing out the horrendous problems faced particularly with the Navajo Nations where a third of the people, i believe you testified, lack access to safe drinking water, basic sanitation and access to food, they loom large as we deal with these disparities. Native people, however, in particular are challenged. I note that theres been 8 billion that we set aside in our earlier legislation, but until recently less than half of that had been distributed to native people. And in pacific northwest, the treaty obligations that go back 165 years, have largely been ignored. Weve been fighting to have recognition of basic tribal rights in terms of historic fishing and first foods. Deeply troubling, compounding the problems that they face in this coronavirus. I wonder, dr. Sequist, if you could comment on what we should be doing to ensure that native people are given their due in terms of the response to the coronavirus and the investments that are supposed to be made on their behalf. Thank you very much for your question, congressman. I think there are two approaches that we really should be taking and how i divide them is, theres the approach today in the emergency that is going on in many of these communities and then theres our longterm approach. I think the approach today we need to recognize any delay in the funding that youre referring to impacts what is going on right now today during a cur few or lockdown that is happening. The infection is not waiting. Its spreading day to day. And the rates of infection are still climbing. We need to get the funding to these communities as soon as possible so that they can enact not only policy or programs that actually improve access to personal protective equipment that actually improve access to testing, but also that improve access to food. You know that improve access to water. These are basic life necessities that these populations are really lacking and in the time of a pandemic, it only heightens or furthers that need. On the longer term, i think the real solution here is that we in these communities need to create as referenced earlier, longterm Economic Sustainability. We need to support programs that allow for Economic Opportunity in these communities, that allow for the poverty rate to not be 42 . That allow for the Unemployment Rate to not be north of 40 in these communities. When you have that kind of scenario, you cannot promote health and wellness to the degree that we would otherwise want to. Thank you. Thank you very much, doctor. I appreciate that. Mr. Chairman, i hope that there can be special attention given to the challenges faced by native people. They have been disadvantaged because the federal government has not met its obligations that it entered into in terms of treaty rights, its unfair, and it poses a problem not just to native people, but all who they come in contact with. Thank you and i yield back. I certainly agree with the point that youve made. With that, let me recognize the gentleman from south carolina, mr. Rice, to inquire. Thank you, mr. Chairman. I would like to go back to dr. Sequist and what he was just talking about with the longTerm Solution. Doct doctor, can you expand on what you were just talking about, about how to solve these Health Issues for native americans in the long term . Yeah. If i just started with a couple of background facts, you know, its important we talk about education as the key to everything in terms of Economic Prosperity here. N more than 50 of the or about 50 of the population in the navajo reservation does not have that education that is needed, is not able to achieve that High School Degree and you said 40 unemployment, is that what you said . Unemployment rates, correct. And you said that the longTerm Solution to that is to promote Economic Sustainability . Correct. And you cant you said you cannot promote health and wellness without longterm Economic Sustainability . It is hard to address the social risk factors that were talking about today unless you have a plan where the Unemployment Rate isnt so high, where the education rate isnt so low, because then you will not be able to have a pipeline of people who can act in the Health Care Capacity let me ask you this. What was the Unemployment Rate just before coronavirus . That is not a covidrelated Unemployment Rate. It was 40 just before the covid hit . Right. I dont know what the covid what the Unemployment Rate is right now during the midst of covid. Okay. I just wanted to talk about i wanted to relate that back to my district. Speaking about the disproportionate effect of this disease on minorities, i certainly see that in south carolina. Ive reviewed the demographics and where africanamericans make up about a fourth of the population, theyre over 50 of covidrelated deaths. I think that is a huge problem that weve got to address. But i also believe that it doesnt have that much to do with covid itself. Because we have done so much with respect to providing access to health care with these relief packages that weve passed and provided extra money to hospitals, to precovid patients. Weve increased the medicare reimbursement. Any testing is free, whether you have insurance, whether you have aca insurance, medicaid, any kind of insurance. Testing is free. And we expanded telehealth and all of these things that im working o working on and others are working on. But i agree that these problems are endemic. Theyre not new and they result from, in my opinion, lack of opportunity and lack of Economic Sustainability which is what you said, dr. Sequist. Would you agree with that dr. Holtzeakin . Yes, congressman, i think thats right. Ive got three counties, yall heard me speak about them that are majority africanamerican. They havent really seen a higher level of covid than the National Average or the average of the state. I havent seen a demographic for those three counties specifically. What they have had is lack of opportunity for a long time and the thing that crushes me about all of this is that we have made so much progress along that line in terms of creating opportunity. When i came into office in 2012, the Unemployment Rated was almost 20 . Three months ago, it was under 4 which is an amazing and fascinating thing. We had made so much progress and providing an opportunity that would lift these disparities in health care and education and other things. And i just cant wait were on the downside. If you look at the slopes, the numbers are Getting Better every day, nationally, for weve bent the curve. I cant wait until we get past that so we can, again, focus on policies that give everybody of every race and every age more opportunity so that some of these disparities have been eliminated. Im absolutely open to hearing about any other solutions in the short term. But in my opinion, and i think in88888888888888 only longTerm Solution for this is to grow Economic Opportunities for everybody of every demographic, age, race and otherwise. I yield back. Thank you, gentleman. Let me recognize the gentleman from wisconsin to inquire. Thank you. And i want to thank all of our panelists for their testimony here today. This has been helpful and illuminating. Dr. Sequist, i represent a large rural wisconsin district. Ive been working closely with my Community Back home. Theyre still expressing high levels of frustration with the lack of comprehensive testing for their staff, their members, their employees. And also, shortages of personal protective equipment. Is this something that is unique in native country, or is this just consistent with shortages shortfalls that were seeing throughout the country right now . I think that what i we have shortages of personal protective equipment and covid testing in boston, in the system that i work in and the outreach that were doing. What ive observed with the Navajo Nation is that the shortage of testing there and the lack of personal protective equipment there far execeeds wht were seeing in boston. What happens when you see the shortage, you start reusing equipment that was meant for onetime use. Once you start doing that, it limits the we get into an unclear area of how effective it is anymore. So when you are cleaning and sort of homemade sterilizing your personal protective equipment so you can use it again, youre on a whole different range of shortage compared to what we see in some of the other urban environments. Thank you. Let me ask anyone else if they want to offer their opinion. Many of you probably saw that the Census Bureau showed that onethird of americans are displaying signs of clinical depression and clinical anxiety. Is this something thats particularly acute in the minority communities, minority households throughout the country or is this consistent with the population at large . We already know that Mental Health actually impacts these communities to a larger degree than other communities prior to covid. We know these communities have a large history of historical trauma. The source of the trauma is different depending on the community were talking about. We expect that there will be a wave of Mental Health need coming this summer thats going to follow this wave of infections. When you think about the tragedy, there are families the multigenerational housing that occurs in these communities, there are entire families that have either been infected with it or have had multiple deaths in the family all at once and thats going to create a traumatic thats going to be longlasting. Unless we come up with more Innovative Solutions and increase the supply of providers and ways to give Mental Health in these communities, i think telehealth is a wonderful opportunity for us to explore in that space. That will allow us to expand our capacity. But we have to be careful about how we implement telehealth. Does it address the needs that these communities have . And let me just ask if you want or anyone else wants to address it, obviously the longterm answer to this is the development of a vaccine but that could prove challenging depending on the form of the vaccine. But do you see any particular challenges trying to get minority communities inoculated once a vaccine is developed . If i might address that. Sure. Its imperative that people understand that the vaccine might be available in a short term, but thats not very likely. One of my biggest concerns is that the vaccines be tested across all populations to make sure that whatever vaccine is developed is effective in all communities. Minorities have been left out of some of the most important drug studies weve had. Not only should we make sure that the vaccine is effective in those communities, we need to develop a Distribution System that is fair and iequitable, otherwise its going to create challenges. The vaccine is going to come, but it may not come as quickly as we think. We have to make sure that people who look like me are part of the studies of those vaccines. Thats really, really important. Thank you dr. Hildreth. Dr. Sequist, do you have anything you want to add . Ton up access to the clinics where these vaccines would be distributed. We have to break down any trust barriers that have been exacerbated during this pandemic to make sure that people understand that this is a approach thats going to allow our communities to heal. Those are going to be important messages. With that, let me recognize the gentleman from arizona. I want to do two separate points. Doctor, thank you for focusing on the Navajo Nation. Being from arizona and having spent lots of time, you understand its geographic distances. But as we sort of walk through what were doing well and where were failing, i would love us to have a better understanding of in the phoenix area, i have a couple of suburban tribal communities. But their numbers are still different, yet, theyre right against one of the largest metroplexes in the country. Is that a access issue . Is it a failings of the Indian Health services and the way that model works . Is it some other Health Disparity and i provide this to you as something weve beenr zj thinking about. Its something we talk about a lot, their frustrations of being sort of caught in the government box of Indian Health services and how they believe they could be dramatically more responsive to Community Members if they were functioning in some ways given the money and allowed to run their own systems. Any sort of comment on both disparities in our native american populations but also the variance between my suburban tribes, my rural tribes, my what should i be looking at to understand . Thank you, congressman, for your question. Ill take a moment to highlight for the members that, its important to note that American Indians have a shorter life expecty. To your specific question, what i would say is, i do not believe that the extent of the pandemic is related to anything that the Indian Health Service Hospital facilities did or did not do. I think the spread of this communitybased and related to the social factors were talking about. The clinical response to the pandemic is a different question. To be a little bit more specific for the Indian Health service, we should think of it as i always think of it not as a hospital system, but as a Public Health agency. And as a Public Health agency, if we can enable it to move beyond the clinic walls, how can they facilitate Public Health work in the communities in participate with the Navajo Nation. I think thats where the power of the Indian Health service can take root for this pandemic. In terms of the suburban, rural and urban, spot on. The majority of the American Indian population is not living in what would be defined in rural environments. What youre observing there is less a factor, its not a factor of race being the specific thing that is causing the spread of covid among American Indians, but its going to be relate today the Housing Conditions and the crowding. Of these families that are located outside of the reservation but still may not have the social capital and the resources that may surround them in other families. Thank you for that. Thats actually very close. And for dr. Holtzeakin, if i came to you and said a year from now, what have we learned . What can we do better . And i will give congressman thompson and some others who mentioned this of expansion of things like what is telemedicine . Is telemedicine facetime on my phone or talking to someone, or is it the wearables that i may have on my body in the Navajo Nation, we have the broadband satellites that are starting to be launched. Every chapter house now could have access to broadband if we would just be willing to be more creative. What are we learning or failings are, what can we do better . I think one of the things learned is that the u. S. s approach to the internet specifically, Technology Policy in general which is to show some restraint in regulatory moderation has been enormously successful. Our capacity to hold this hearing, our capacity to do hel telehealth is much, much better than in other places. Thats a tremendous thing. In terms of things we can do better, one of the things we learned is that the american Health Care Delivery system, theres no system we have many, many, many. On the whole, was too inflexible to respond to simultaneously the needs of the covid population and the remainder of the Health Care Needs of americans. What weve done is essentially stopped doing a lot of medicine a lot of health care. Its been described as discretionary. You like numbers. The gdp the time of the gentleman is expired. Thank you, mr. Chairman. Thank you. With that, let me recognize the gentleman from new jersey. Thanks for putting us all together, and what a distinguished panel. Great people. Great people. I wish i was there and we were all together. But this will have to do for now. We knew about the cracks in our Health Care System. Each one of us on this committee. We knew that an individuals health is influenced by a wide range of factors. But this pandemic has turned those cracks into a chasm. The burdens of the virus have fallen like a ton of bricks on minority groups and the vulnerable populations. Last year i introduced researching and ending disparities by understanding and creating the equity act, the reduce act. Hr5256. The reduce act will improve our data on vulnerable populations by giving states and localities more resources to understand impacts on Public Health. My goal is to reduce Health Disparities and i hope everybody on this committee has the same goal. We need to look beyond the pandemic and closing the gap in our knowledge, research and translation is very essential to achieving Health Equity for all communities. You can draw a direct line from the structural and social factors that have made communities of color more at risk for infection and death and poor policy decisions that put these communities at risk. This causal relationship is crystal clear. In my district and in the state of new jersey, 13 of the states population is africanamerican. 20 of those who have died of covid19 in new jersey are black. To simply dismisses this or point to it as a structural problem rather than coincidence is not enough. John Hopkins University study found nationwide the covid19 infection rate is predominantly black counties three times that of predominantly white counties and the death rate is six fold higher. Lets take one of those communities and i got a question for you, dr. Sequist. More than 60 of Nursing Homes, lets take that vulnerable population. At least a quarter of the residents are black or latino and reported at least one coronavirus case. And that is double the rate of homes where black and latino people make up less than 5 of the population. My question is this, do you expect a similarly disproportionate impact on people of color in the 536 longterm care facilities in new jersey with at least one case . Do you expect that . Just so im clear on your question, are you asking, am i surprised by that finding . Im sure youre not surprised. But are you can we expect this impact and all 536 longterm care i got it, yes. I think youre highlighting one of the most tragic aspects of the covid pandemic which is the fact that weve failed to take adequate care of our elder i would say that the when these facilities are not receiving enough funding and are not able to maintain the Infection Control policies and practices that we really need to control the pandemic, i do expect that we will continue to see a widespread resurgence of this pandemic across that particular environment in Skilled Nursing facilities. I have one more question and its to dr. Holtzeakin. Youve done a great job in all of the times youve appeared before our committee. Your testimony today is very interesting. You go into specifics and the charts. You talked about the gdp. You talked about the perspective of what will happen years from now because of whats going on right now. I only have a few seconds left. You can pause on it, write to me, call me. Let me ask you a question. You used the word structural too. Structural change. Very interesting term. Were part of the structure, the congress of the United States. And were part and parcel of the inequities that exist in our society. Were part of it. Were not the total cause of it, but were part of it. And i want you to tell me what you mean by structure and how do you change structurally. Because if one group is making plans for everybody else and how were going to get to equity, it dont work. So what do you really think about it and i would like to know about that, if you will. Yes, i will ill get back to you in writing, sir. Thank you, sir. Let me recognize the gentle lady from indiana who i believe has driven from indiana and is still in the car. We want to recognize the gentle lady to inquire. Thank you so much, mr. Chairman. I want to say thank you to all the witnesses who are here with us as well. I want to thank our frontline workers that are across the country. Were a grateful nation for your heroic efforts to heal the sick, feed the country and serve those in need. In my district in northern indiana, we remain committed to doing our part to combat the coronavirus pandemic but understand that we need to reasonably open the economy and the country because getting focuses back to work safely maximums our health and wellbeing. We know that individuals with underlying conditions such as diabetes, hypertension, obesity and asthma are the most at risk for complications and even death from the coronavirus. In the medium to long term, it will be important to find ways to alleviate some of the issues associated with social determinants which were someones environment shapes their health. The act would help states and communities to create strategies to improve the health and wellbeing of medicaid participants. It would also provide grants and Technical Assistance to help state, local, and tribal governments to take innovative approaches to coordinate services and improve outcomes and cost effectiveness. We could pass the improvement act of 2019 which i introduced with my colleague, Affordable Housing for lowincome americans is a vital part of improving overall Health Outcomes. The legislation would modernize and streamline Affordable Housing credits to make it more effective and useful for communities across the country. When were looking at the entire picture of Health Disparities, do you think that should include social determining of health and how else can we look at this what would help address chronic disease . Thank you for the question. A lot of federal Health Policy is in the payment policy. We have to be careful about having the payment policy limit the way people practice. Simple example is, in medicare, the best thing you can reimburse is a ride to the Doctors Office to make sure that seniors get their treatments, stay on their medicines and are seen on a timely base. If you only bpay for things tha are health care, you limit that. Its an important part of the health phenomenon and require cutting across thesefsfsfsfsfsf silos that we have for housing, that we have for health, that we have for nutrition, and thinking about how to pay cohesively for better outcomes. Its one of the Biggest Challenges that i think that face policymakers in this area. It requires thinking more co comprehensively. Thats what i would focus on. I appreciate it. Mr. Chairman, i yield back. Safe travel. Before i recognize mr. Davis, consistent with community practice, we will now move to a two to one questioning ratio. Mr. Davis is recognized for five minutes. Mr. Chairman mr. Davis. Thank you very much. And i ask unanimous consent to submit for the record supplemental questions that i have. Thank you, mr. Chairman so ordered. Thank you. Let me thank all of our distinguished witnesses whose testimonies have been profound. As a matter of fact ive been amazed and astonished. Dr. Hill dred since you grew up in arkansas and went to school in harvard and i grew up in arkansas and went to school at the university of arkansas at pine bluff, just a few miles from camden and had classmates who lived in your town, and i wanted you to know that all of us are extremely proud of the work that you have done and the work that you continue to do. As a matter of fact, we always finally say that arkansas is a wellknown state, it is the only state in the bible. Noah looked over his ark and saw. We talked a bit about Contract Tracing and we know that to be one of the effective ways of preventing and treating diseases. Weve had many discussions here about it and weve had some agreements and some agreements and some of us believe that there are some categories of individuals who probably might be in a position to do a better job at doing the actual work than others. Is that a concept that you subscribe too . And if so, why . Thank you, congressman. And happy to know theres a fellow arkansan sitting in that seat. In order to protect the lives of the most Vulnerable People in our population, without a vaccine and without a drug, the only thing we have left is to keep those populations protected from infection in the first place. Thats why testing and Contact Tracing are so very important. And the Contact Tracing is to identify all the persons who come into contact with someone who is positive. And theres an element of trust as youve heard before involved in Contact Tracing, because youre going to be calling individuals and asking them to divulge some personal information. If the contact tracer is not someone who is trusted in those communities, there may be a challenge there. Youre absolutely right that its very likely that cultural competence and sensitively will be as important as offering medical care. Thats why i think the four black medical schools would be ideally suited to be the ones leading the fight against covid19 in minority and disadvantaged communities. Weve talked a great deal about africanamericans, latinx americans, native americans, older americans, americans who live in inner city ghettos, rural areas, have frontline jobs, that are often low income. If you were to have a prescription that could help remedy the problems for many of these groups at the same time and you could write an order, what would that be for america . Well, i would go back to what i said previously. Theres a shortTerm Solution that is needed and a longerTerm Solution that isvvvvvvvt only that theres certain groups in our population who are more vulnerable to severe disease and death. Why dont we focus on solving that problem and as has been said by some of the panelists, surely having people have a more stable Economic Future is very important because thats a factor in determining our Overall Health. But we have to focus on the here and now. And here and now, many, many people, many thousands of people, hundred thousands of people are going to be subject to severe disease and death. We dont intervene at this moment. Theres an urgency here that i cannot overstate that we need to be doing these things now. And to go back to what i said earlier, four historically black medical schools are really well positioned to do this. We partner with churches, local organizations like wycas, partner with local schools, businesses. We can do this. So the shortTerm Solution has to be lets keep people alive by testing, Contact Tracing and doing those things that need to be done. But clearly, an economic overhaul is necessary. To me, thats going to require a longer conversation. Even in that, a black medical School Consortium will play an Important Role. Chairman, i yield back. Thank you. Without objection i want to include in the record an article from the New York Times dated may 21st, covid19 Nursing Homes, a striking racial divide. With that, let me recognize the gentle lady from california, ms. Sanchez, to inquire. Thank you, mr. Chairman, for calling this critically important hearing today. I also want to thank our witnesses for their testimonies that highlight the historical disparities and inequities that this pandemic has further exacerbated. All of our communities have faced heartbreak and economic stress during the pandemic. Some of us have lost friends, families and neighbors. Why we all may be experiencing the same storm, we are not all in the same boat. The numbers in Los Angeles County show that when cases are broken down by race and ethnicity, Latinx Community is do proportionally impacted by covid19. There were three times as many cases in the county among latinx members compared to white counterparts. The data shows that in particular, latino workers have been especially hard hit by the pandemic, 1 in 5 latino workers are out of work. They also have one of the highest uninsurance rates for health care which makes it harder for them to access Critical Care when they get sick. Many latino families live in multigenerational households which can create exposure risks for those who are deemed essential and cant work from home. And their elderly Family Members who are more susceptible. A disproportionate number of latinos are essential workers deemed to be in a Critical Infrastructure but theyre not getting the government assistance that others are receiving. This is happening to many of latino families. Latino and other minority essential workers are on the front line of the pandemic. Yet they dont get hazard pay. They dont get sick leave. They dont have access to Health Insurance. Naturally theyre the fit to fall. [ inaudible ] to ensure that workers on the front lines are protected to keep our communities safe and economy running. Without a proper response, its going to take years for the community to recover. The fact is, our nation is stronger and safer when everyone is, especially communities that are hardest hit, have their specific needs addressed. Dr. Fernandez, i want to go to you first. You touched on this briefly in our testimony. How does fear and mistrust in the government particularly in the immigration system, impact the spread and the [ inaudible ] and have you seen misinformation or access to information play a role in that . Thank you, congresswoman. Yes, fear is a huge issue. We talk about the three pandemics, the covid pandemic, the pandemic of poverty, and the pandemic of fear. And fear is a huge issue both when it involves Contact Tracing or even when it involves coming forward to be tested or coming forward to seek services. U. S. Immigration services did a made a statement which was very helpful saying that seeking testing would not be subject to public charge consideration. However, it has not extended that to either getting treatment or to receiving Services Related to covid. I think it would be extraordinarily helpful if all contact workers could state that their information would not be shared with i. C. E. And it would be extraordinarily helpful if i. C. E. Could extend protection from public charge allegations to Health Treatment and to essential services for isolation and quarantine. Thank you, dr. Fernandez. And i have to say, im hearing this from my communities. Theyre not getting the Small Businesses [ inaudible ] theyre not getting the unemployment benefits, many of them dont have access to health care or theyre losing their Health Insurance because theyre being laid off. So the disparities are just getting worse. And i cant understand why a federal response would not take into account everybodys health. Everybodys health in a pandemic impacts everybody elses health. These are folk that is are on the front line in the food supply chain, in terms of health care, workers, Grocery Store workers, and this pandemic has just magnified these inequities that are that exist and we cant afford to leave any community behind. I wanted to ask dr. Hildreth, we get everybody back to work, thats going to be the best thing to help these poor immigrant and minority communities. Do you think that thats really going to help take away these inequities that exist . Well, certainly Everyone Needs to get back to work but we need to do that safely. Theres bias in a lot of the things that weve been talking about. But my goal is honestly, to not only save lives but to make sure we can reopen the economy safely and thats why the things ive been speaking about are so very important. To me, we are the economy. All of us. 100,000 people have lost their lives and according to economists, we value lives at about 10 million each. Thats a trillion dollars right there that weve lost. If were not careful, that number of could double easily. Its about doing what we can do to protect all of us. We protect all of us, were protecting the most vulnerable. Thats what im proposing. All of us are in this together. The virus does not respect boundaries, city boundaries, county boundaries, all of this. We have to protect each other by protecting ourselves and thats what i think we need to be focused on right now. Thank the and i yield back, mr. Chairman. Thank you. Let me recognize the gentleman from ohio. You have to unmute. Thank you, mr. Chairman, i appreciate the opportunity to be with everyone. This is a congress that can hopefully extend beyond my district is unique. Its in cincinnati, ohio. Its throughout rural ohio. And we see a lot of the same poor Health Outcomes in both the [ inaudible ] as well as the rural areas. And a lot of times its because the same higher incidence of certain [ inaudible ] and, mr. Chairman, putting together a rural and Underserved Task force in a bipartisan fashion to look at a lot of these issues. And this blends right into that type of a situation. In ohio, the Ohio Department of health is focusing on [ inaudible ] coordinate Minority Health strike force and this is beyond the coronavirus. So much to look at. And the administration put some emphasis on hot spots [ inaudible ] where its critical. We did a lot. Weve done a lot to expand telehealth. I do appreciate one of the comments in talking about how we operate in silos. If we really want to address in my mind the issues that come with poverty, we need to put nutrition, health care, and housing all into one area. People have to go all over the place to try to get their needs fulfilled. When it comes to telehealth, i would agree with one of the comments. I talk to students a lot and i say theres nothing more valuable than [ inaudible ] and letting them know that you care and building that trust. And so thats one of the things that i think is very important when it comes to the health care. Telehealth [ inaudible ] i think its a little bit better when youve had a relationship with the doctor that youre talking to. We have expanded that and thats going to be probably a positive. But going back to this situation, mr. Holtzeakin, how environments and rural and underserved areas different, how do they lead to similar Health Outcomes so often . Could you repeat that. I had a very hard time hearing that. How do the environments in rural and underserved areas, while theyre different, they often lead to similar Health Outcomes or have the same challenges . So the basic issue, i think, is that were going to get access issues, so we have the same issues, Insurance Coverage and conditional Insurance Coverage, distances to facilities and insufficient access, and i think, you know, the critical access to hospitals as the key component of that is part of that. In terms of telehealth, i may not be understanding the question, it seems to me, thats an additional tool, thats a valuable tool, but its not a substitute for the rest of the health care the question wasnt really on te te te telehealth, per se. How do these environments have some of the same problems . Both underserved areas as well as rural. What is the common denominator . These are weak economies and they have difficulty supporting a vibrant Health Care Sector and that is, you know, associated with less insurance and the ability to support that. Those all run together. Improving the foundation for all of the economy would help provide better care. I see that dr. Hildreth has left. I wanted to ask him a question too. There you are. One of the things that ive been promoting [ inaudible ] we see a community where we have a lot of people who have gotten covid19 and have recovered. Ive tried to take the opportunity as a Public Service announcement, if youve recovered, donate your plasma, you can save the life of another. We had a story written in cincinnati and the patient was africanamerican who felt he was saved by the plasma. And i guess, how does that parlays into the trust factor and also the opportunity that exists [ inaudible ]. I think that the plasma is a great tool that we have to try to save lives. Were not quite certain that typical antibodies in the plasma are going to be neutralizing and slow down the virus. But conceptually it should do some. Thats going to help us all out. We have hundreds of thousands of people who have recovered. The opportunity for plasma or serum as a treatment is one that we should be considering. We would like to make that part of our efforts in the minority communities to do just that. Thats one of the things we would be focused on is trying to make sure that actually happens among things. I had a feeling you might already thank you. Thank the gentleman. Let me recognize the gentleman from new york to inquire. Appreciate it very much. The coronavirus and covid19 has revealed profound fragility in the American Health care system. Health disparities generally results in a lot of preexisting conditions with those preexisting conditions the most vulnerable to the worst and most lethal of covid19 are exposed. 100,000 americans are dead. 1,500 more will die today. We have no treatment for covid19. The best and richest country in kqq,pensive health care can do yvq care system. Drugsmnacquvn coronavirus moving forward to test both the safety and efficacy of Drug Development for covid19 but also generally speaking. Thank you for that question. Youre right. Theres no organization on the planet that compares to the nih when it comes to medical research. One of its longstanding problems is getting minorities into clinical studies. You may be aware of the large coheart of a million americans thats been put together to do a genetic pool and develop algorithms to predict disease. The Medical College played a great role in making sure that africanamericans were a part of that cohort. We would like to do the same with drugs and vaccines. The nih is trying hard to make sure that theres diversity in both the researchers and in the research. But its really challenging. Like all the other aspects of american life, theres bias in how grants are reviewed and theyre trying to address that. I think thats all the more reason why its really important to have the four africanamerican black medical schools involved in all of this, thats what were trying to do. Were trying to make sure that the whole population, no matter what you look like, where you come from, that youre part of the answer and that the problems will be addressed across the board evenly. And so the nih is doing a great job. We have a role to play to make sure that theres diversity both in the researchers who are doing the work, the clinicians who are doing the treatments and the participants in the studies. Let me also ask you this. The coronavirus is not new. The World Health Organization declared that the coronavirus was responsible for Severe Acute Respiratory Syndrome known as sars and mers. Covid19 is a coronavirus. So going back nearly two decades, two decades, had the federal government invested in the National Institutes of health to develop a vaccine which would have avoided all of this in all likelihood, had they invested two decades ago, would we be having this conversation today . I think there were opportunities to be better prepared for the covid19 virus. But in all honesty, you cant make a vaccine to a virus that youve not discovered yet. And theres sufficient differences between the covid19 virus and the sars virus to make me believe that a vaccine against sars wouldnt necessarily protect us against this coronavirus. They belong to the same family of viruses but theyre genetically distinct and its not very likely that a sars vaccine would have protected against a covid19 virus. Mind you, we hope and i think a lot of us believe that it might be possible to develop a Coronavirus Vaccine that would be cross protected. But there really was no way for anyone to have anticipated that this particular virus at this particular time was going to be a challenge. But i do agree that we could have done more to be prepared in terms of having a Pandemic Response team that could have shut the virus down before it spread around the globe. But i think given all that weve learned about it, i think were doing pretty well on the scientific front. Im more krconcerned about what were doing on the Public Health front. Thats where the consortium comes in. I yield back. I thank the gentleman. Let me recognize the gentle lady from alabama to inquire. Would you unmute yourself . Would you unmute yourself . Okay. Why dont we do this. Why dont we come back to you. Youre recognized to inquire. Thank you, mr. Chairman, and thanks to all of our witnesses for joining us. I really appreciate your time. Im from Washington State and we have we were hit early with the coronavirus in our region. We also have a large asianamerican and Pacific Islander population in our region and researchers at the university of washington looked at state numbers and found that primary language could play a big role of poor outcomes. In the data set that they collected of covid19 patients, this is across our state of covid19 patients that specified english as their primary language, 15. 8 were hospitalized and 7. 4 died. But those patients whose primary language was vietnamese, 29. 7 were hospitalized and 15. 4 died. Out of those who spoke, 47. 8 were hospitalized. You talked about the pi community and as we look at that community, what can we do to address the information and language barriers that really we see impacting these broader Health Disparities and specifically how do you think we should address thisco. Kif in t asianamerican community where there are so many more languages that are spoken and fewer Health Professionals who speak those languages . Thank you for the question, representative. So we like to think king county in seatt in seattle, washington, they were one of the first people who reported this data along with the california Public Health. They were the two reports that made us take a look at the rest of the country to see how disturbing the numbers were. Almost every county that shared their data including Pacific Islanders in this are in the worst most diseaseconfirmed cases. And so this was very troubling to us because a lot of the approaches that have been discussed so far like increased testing and Contact Tracing are being discussed around our community and we have not seen them. We have not seen them integrate into because of all the obstacles that youre talking about. One of them being language. These issues in regards to language and other cultural reasons why people dont engage in these Public Health initiatives have been around for decades, generations of us researchers and Public Health officials and doctors have had to deal with them and weve only gotten around them by partnering with the community. Theyve always had access because of the trust that a lot of these advocates already have, were able to identify areas that need more testing, but we utilize the trust equity within the community to say that its safe, that its this is a this will help you develop a Family Safety plan because when you ask someone from the Pacific Community about those sensitive questions such as who have you been in contact with, who is in your house, very personal questions, its very unlikely that theyre going to release them. And theyre going to need someone to sort of be the face of trust so that they can divulge that information and put it into a frame a reference that allows them to realize that youre not there just to pick on them and keep them in their homes. Youre there to keep them safe, their family safe and community safe. And these language barriers, a lot of the information are being translated and so i would strongly recommend a local Public Health department to reach out to these groups that have translated materials already but more needs to be done and that needs to be funded. Twvdxnbsq in terms of the cultural and correct. Its Contact Tracing is a foreign concept in pacific q1omn are you going to do . Are you going to do something staying are you going to do something iz i dont have enougtdkin food tod myir family . un what do sqaqt qo cr questionsn chairman. Mr. Utb÷ smith. Thank you, chairman. sak tryingzses that wereo inequities in American Society and our health disproportionate rates of illness and death from covid19. These problems are not impossible to overcome and we must work to address them. Many of the problems that lowincome communities of color face are the same problems that folks back home in Rural Missouri struggle with every day. Higher rates of unemployment, lack of access to Quality Health care, and increased rates of comorbidities like diabetes, hypertension and obesity. Lowincome americans, especially those living in disadvantaged communities are filling the brunt of this pandemic and we cannot continue to ignore the fact of the economic fallout from covid19 is only going to worsen these inequities. As mr. Holtzeakin noted in his testimony in april alone, our economy lost 20. 5 million jobs. Eliminating all of the gains we have made under the leadership of president trump. The Unemployment Rates skyrocketed to 14. 7 , the largest rate since the bureau of labor and statistics began recording in 1948. Much of this job loss is coming from lower wage occupations. Americans have heeded the advice of federal, state and local officials and have and have done their part to slow the spread of coronavirus. But now it is time to allow them to return to their normal lives. The government cannot and should not manage the risk for its citizens. We the people have to do that for ourselves. In terms of health care, we must build upon the actions of congress and president Trumps Administration to increase access to care in underserved communities. Telehealth policies has advanced years during this pandemic. And we must work to ensure rural and underserved communities are able to assess it. I advocated to cms that telehealth should be expanded to allow some visits to be conducted audio only and i was pleased they listened. This policy has helped mitigate one of the key problems with access to telehealth which is access to technology and broadband in rural areas in underserved communities. Congress must look to making some of these new telehealth policies permit to enencourage providers and stakeholders to make the investments necessary to utilize this flexibility and increase access to care. More concernsly, health care access, the u. S. Health care system lost over 1. 4 million jobs in the month of april alone. While many are optimistic these jobs will return once elective procedures begin again, there are concern about longterm damage to the Health Care System. Mr. Holtzeakin, rural and underserved communities are already struggling with access due to Health Care Workforce shortage. In your testimony, you mentioned that you do not expect our gdp to return to precrisis levels until 2022. Do you expect the u. S. Health care system to bounce back quicker than that . What are the longterm negative impacts that you see hitting the Health Care Industry . I think the Health Care Industry will look like the economy as a whole. If you use the forecast as a typical forecast in these very uncertain times, it shows a sharp decline at a 40 annual rate in the Second Quarter and a sharp rebound in the Third Quarter and then much lower progress thereafter with the result that even by the end of 2021, were back to the levels we had in the beginning of this year. The Health Care System will probably do the same thing to some extent. Congress has done a remarkable job of moving quickly to provide Financial Support for hospitals and other providers in the crisis, to make sure that they do not suffer such a cash flow crisis that they have to close their doors. We will see now a of other care for covid care, im not sure you want to call those nonessential. Theyre deferrable and theyve been deferred. And theyve been deferred on an enormous scale. Half of the fall of the First Quarter gdp was health care that people stopped doing. Over the longer term, what well have to deal with the fundamental issues that weve seen in communities for so long, access to providers and coverage. Thank you, mr. Chairman. I yield back. With that,w me recognize the gentle lady from california, ms. Chu, to inquire. Thank you, chairman, and thank you for holding this critical hearing illustrating the grave disparities that communities of color are facing as a result of covid19. Its an issue of incredible importance to the asianamerican Pacific Islander community and i appreciate the opportunity to discuss the impact that covid19 is having on aapi communities. I would like to submit for the record a written statement from the health forum which details the impact to our communities. So ordered. And, doctor, thank you for your testimony. I am so sorry that you contracted covid19 yourself. But i am so thankful that you recovered, especially since you are an essential worker. And let me say that in my home state of california, i am alarmed because Pacific Islanders have a mortality rate that is nearly triple their population proportion. In washington and utah, the mortality rate is double the respective population. This is a critical disparity that we only know because these states have elected to share their Public Health data by race and ethnicity. But we know this is not the case everywhere. In fact, i just look at the cdc website on hospitalizations and guess where they put aapis and native hawaiians and native americans, even, under the category of other. Were lumped in as others. Can you discuss the importance of separating data by race . How does identifying the impacts of covid19 by race and ethnicity help us fight the virus from a Public Health perspective and should the cdc be required to disaggregate covid19 data the way that states like california, utah and washington do . Thank you for the question, representative. I absolutely think its necessary to disaggregate data. These vulnerable communities they are impacted significantly and its almost as if we pick up a new state every time we look. Our preliminary results in regards to illinois show that Pacific Islanders are high there and in North Carolina as well. Although these were there were rumblings in the community before these reports came out because we knew our Family Members were dying in these areas. There was an article that was recently published talking about highrisk communities in rural areas, in the south and midwest. We knew about these because our recent wave of Pacific Islanders who moved into those areasv were dying. And they their numbers werent beingcfbb reportedsvp departments to; g disaggregate data. A÷y3x r t hah . viu ;6[snll testing. Vulnerable groups are being tested more. We have very Little Information in regards to a breakdown of plae linguistic capabilities of intervening groups because that has a big play on whether or not you have the capability of intervening. So all of these are reliant on information, information that needs to be disaggregated for us to reach into those areas. If not, these high numbers that the in a were seeing, because i understand everyone is being impacted. But these numbers are alarming. And like i said, there are places where we have a high number of us in texas, oklahoma, where the data is not disaggregated yet. We can only guess and theres no attention being brought to those communities. And so i think for that reason, its really, really important. Clearly we need to have a National Standard for disaggregating data from the cdc and let me just also mention that we really need to make sure that those individuals surely need access to medicaid which is indeed in the h. E. R. O. S. Act. J and the military installations on their islands. So thank you for that and i yield back. I thank the gentle lady. Let me recognize the gentle lady from alabama to inquire. Thank you, mr. Chairman. Im hoping you can see me now and hear me. I can always hear you, dear. First i want to thank all of the panelists. I want to thank you, mr. Chairman, for having this very important hearing. As cochair of this committees rule in Underserved Health task force, im grateful that the full committee is doing this virtual hearing on such an important topic that is so dearly personal to me and my constituents. The district i represent is my home district of alabama. It is a majorityminority district and as my home state of alabama is relieving restrictions, our cases are our number of confirmed cases have skyrocketed. Only 26 of alabamians are africanamerican, we account for 41 of the cases and 43 of the states deaths. This spike will have an impact on the communities that i represent and the most vulnerable communities. These rising numbers of confirmed cases and deaths [ inaudible ] these are our neighbors, church members, coworkers and even our families. The covid19 has been indiscriminate but it has has a disproportionate effect on africanamericans and as so many of the panelists have said, it shines a spotlight on disinvestment that we have made in communities of color throughout. My question, first, is to dr. Kendi. I want to commend you on your thoughtful articles and your writings in the atlantic. I was particularly moved by the piece that you wrote about our colleague, Elijah Cummings in which you colleague, Elijah Cummings. You said the more i learned about the gentleman, the more my chest burned for his family and many families. For all the black families for the black families buried their loved ones this weekend caskets. inaudible if you had a magic wand and an unlimited checkbook, how would you address the Racial Disparities and health care that is so highlighted by the covid19 . First and foremost, thank you for mentioning that peace. I wanted to make the case in that piece that White Privilege one of the greatest deprivations for black people, native people, people of color, is we are being deprived of life itself. In terms of question, i believe, like other americans stated, that health care is a fundamental human right. Everyone should not only have access to health care, to preventative care, but then also we should have high Quality Health care for every single american. To give an example, my wife is a pediatric emergency doctor. She is from albany georgia, southwest georgia. Southwest georgia has some of the highest death rates in the country. In southwest georgia like other areas, has a sizable black population. A few of the counties that are around georgia are called trauma deserts. Meaning they dont have a high access to high quality lifesaving emergency care. While atlanta may have that access, nashville, charlotte, we need in rural, particularly low income communities they should be able to have access to world class hospitals and world class doctors. We talked a lot about new york city being the outbreak of the pandemic. The only good thing there that happened in new york city is the people had access, for the most part, world class access to the best hospitals. You had these massive disparities. In the case of covid19, hbcu medical schools, i think is a brilliant inaudible how the consortium can do a great job of executing the Contact Tracing and testing, and the importance of trust in our community when it comes to collecting important data inaudible can you hear . You are on. Surrey. I think the question was about the consortium and i would be effective . One of the things that will make it effective is the trust the capacity to train individuals and how to do Contact Tracing. One of the things that makes it really powerful are the organizations that we partner with. Churches schools, community organizations. Partnerships along with the cultural sensitivity and the technical capacity we have are the things that will make them will make the consortium very effective in a minority population. Not to mention thank you so much. Let me recognize the gentleman from texas. Can you are new terse elf . Can you hear me now . Thank you mister chairman and the Ranking Member. Its an important discussion and a serious one. I appreciate the insights and the time and commitment by the witnesses. I also want to say its an honor to serve with terry and other members on this task force where we are trying to solve some of the structural challenges and access to rural for folks living in Rural America, and making some of these policy changes that have been made in the interim permanent, why they are making a difference in creating that access. In this case, and i appreciate everybody. Doctor, i was really impressed with the consortium and efforts in your community to tackle the challenges. Covid has definitely revealed problems that have preexisted and we are highlighting them. You took charge there with your communities and medical school. I appreciate that. As i listen and study the outcomes in health and underlying issues of the exposure to the virus and certain jobs and certain jobs being more vulnerable to being cut People Living in densely populated areas, etc. It seems a lot of these factors are really affecting a Broader Group of people then just based on race and ethnicity. Its people in poverty. People that are struggling to survive. It doesnt matter whether you are black, white or hispanic. This is about underserved areas in economically disadvantaged people. Granted, an African American community, 21 are living in poverty as opposed to 10 of white americans and hispanics at 18 . We certainly need to discuss the issues of why the higher rates, but the Health Disparities is affecting people of all colors and ethnicities. Would you agree with that . That seems to be the framing that would incorporate more of an approach to this inequity. Any comments on that . I totally agree with you. The virus is agnostic to race, gender, how much money you make. If you have a protein in your body, which we all do, the virus can affect you. The problem is that while we are all equally susceptible to the virus, we are not all equally susceptible to the effects of the fires. Your protests weve taken so far, the Population Based approach, in which weve tried to reduce the average risk for everybody. That assumes we are all at equal risk. Unfortunately, that is not the case. The time has come from pivoting to a popular based approach to a more targeted approach, which means lets try to protect those who are most vulnerable. Rural communities, where they have both white and black people. The higher burdens of these and they will die equally, whether they are black or white. I agree with you. All im advocating for is that the vulnerable population that is do what we can from keep them from getting infected. We do not have a vaccine or drug. The best thing we have is to keep those communities protected. I totally agree with you. This transcends race, age, all of those things. Im with you. I totally agree. I appreciate that. I think and agree with you and the others we need to prioritize Vulnerable People of all kinds and we need to make sure they have the tools and resources, whether there are urban, worldwide, hispanic, so that we take care to ensure that they have the tools and resources, whether it is recovering or it is relief and response at all states. I have such a short time. There are so many great things that have been mentioned. The first, by doctor sequist, about a dietary issue that is also underlying the comorbidities and i cannot quote you exactly, but we worked on a bill in 2018. I was on the act committee. We talked about incentivizing healthier choices and trying to make sure that federal funding for the Supplemental Nutrition Assistance Program actually went to provide Nutritional Foods for people to stave off some of these underlying conditions. Do you have any thoughts about how we might do that better . Im sorry we are out of time, mister chairman. Thank you for the opportunity. I yield back. Thank you, gentlemen. With that, let me recognize the gentlelady from wisconsin, miss moore. Bank you mister chairman. inaudible mister chairman . This is an exceptional hearing. I am especially impressed with all of the doctors who have appeared on this. Im really grateful that the rules have enabled me to attend for this very important work that we are doing. Im so proud that this is the first hearing of the house of representatives and we are doing it on a subject that is near and dear to my heart district of the covid 19 on the communities of color. That being said, i think its important i want to say that im impressed by our frequent flyer, doctor. Hes been thorough with his data. He talks about job losses. Jobs about the disparities. Among people of color and other indicators. I think that is very useful, and i will read that a lot more thoroughly going forward. What i want to start out with is by asking a question to doctor sequist. When we look at the disparities among negative americans, i was wondering if you thought that it would be helpful to create some equities with regard to the services that native americans are eligible for. Unlike the national Health Services grants and scholarships, they are not tax free. Im wondering if you think, im hoping that the committee can lean into that for a longer Term Solution to be able to recruit people to provide services in the area. Absolutely. The data shows, if you look at college and School Students a higher degree of that and less family contributions, they also graduate and medical School Programs disincentivizes to pursue higher education. Iiziziziziziziziziziziziziziziz1 the pipeline, one of the most important things as well, is to expose the students and needs communities to career opportunities. Many of them do not have the social capital or network. I did not know any physicians growing up. I did not have someone to look up to and say this is who i want to be like. I dont understand. I always tell everyone that we are asking them to play a game but weve hidden rules from them. Exactly. We have given the rulebook to everyone else. Exactly. That is just one of the structural sorts of problems that we do not even often think about. I do want to say to doctor samoa and dr. Fernandez, we are experiencing this explosion. We are one of the first cities that saw the disparity impact among African Americans, and now we are seeing it just heated, hot in the latin american community. But we also see is that the National Guard, this is a point that dr. Hildreth made, we are seeing the National Guard was offering to those services in the National African community. They will leave because the African Americans are paranoid about the testing. It is not culturally competent. There are soldiers there administering tests. It really speaks volumes about the need for cultural confidence. I want to lean a little bit into you, doctor. You talked about the Unemployment Rate among African Americans. Being lower now during the pandemic than it was before the pandemic. We are, in fact over represented in those service industries, so that we Start Talking about getting the economic back on track. We were always employed. We are the persons people stalking those grocery shelves, delivering amazon and changing the bedpans in the hospitals. 30 of Nursing Homes, residents are black women. We start looking for getting the economy back on track. I think that we have seen people working in factories, putting themselves at risk. I think this hearing is elucidated the desperate sort of exposure that people of color have. I want to ask you doctor hildreth and doctor kendi, a question. I cannot see the clock but ive got to ask this question, mister chairman. It is about black jeans. We heard doctor kendi talking about mr. Huffman, talking about these disparities are genetic imperfections that black people have. There are even African Americans who are saying that our jeans have been damaged by racism. I was wondering if you could address that. There is no basis and fact that the virus all of us have this protein in our bodies. There is no facts that we are more susceptible because of our jeans. That is incorrect. Thank you so much for that. Mister chairman, thank you for your indulgence. I am a team player but i have to ask that. I cannot see the clock. I will get better. I will recognize the gentleman from michigan. Thank you chairman. I would like to ask the unanimous consent that recent new york time a pediatrician Public Health entered into the record. The article outlines how without intentional policy nerve engines, covid19 disproportionate impact on communities of color and low income family will have a long lasting the the article is says im sick of asking children to be resilient. We all know as to hearing points out that this pandemic is having a disproportionate effect on the low income, communities and particularly people of color. Michigan, my home state ranks fourth among the states with crows coronavirus cases. Tennessee county, my hometown, has 240 covid 19 fatalities. County and 16 of the states, despite the smaller population. Tennessee county, African Americans account for 42 of overall cases. Almost 50 of the fatalities, despite representing only 20 of the counties population. This devastating loss in this crisis is very personal if you know someone who has been lost in the pandemic. A lot of times we focus on the data, but the reality is, this is personal for a lot of people. For me, ive lost three friends. All of whom are from my home town in flint. The former uaw secretary of treasury. A friend and mentor. A doctor, who is flints american superintendent. He took me under his wing when i was an 18 year old teenager elected to the school board. Doctor berkeley was a remarkable educator. You can now peacock one of my high school for 45 years. All three of these gentlemen. As we approach when these hundreds of thousands of deaths, it is important to recognize that these are individuals with their own stories. Disproportionately affecting African Americans. I hate to keep it is important to keep in mind inaudible i wonder if i can turn to dr. Sequist. The cdc recommends that americans wash their hands with soap and water. It is a Pretty Simple way to prevent the spread of this highly contagious disease. But many communities, and im sure you know im going to say this. They lack access to clean and affordable water. In your testimony, doctor sequist, you stated that many tribal communities do not have access to Running Water. Can you talk a bit more about how access to in portable water leads to disproportionate impact with regards Health Implications that north of most of us just take for granted. Thank you for your question, congressman. It is really critical to recognize that something that we take for granted is actually a critical resource for these communities. It is an unthinkable barrier to adequate Infection Control. Heres a couple of things that are at play here. One is we need the water to do the basic Infection Control principles like you highlighted, like hand washing. If you cannot access clean water in your home, many people are traveling to public spaces. More people need to travel to public spaces to access water, which is against some of the Infection Control principles that we have been trying to advocate for. When you put that on top of that, the availability of clean water is a basic Public Health premise, even outside of covid, which leads to a lack of access thereof, leading to many other infectious conditions and other medical illnesses. If you put all that together, and this is one of the most critical problems in both urban and many rural environments. Thank you doctor. Thank you mister chairman. I yield back. Thank you gentlemen. With that, let me recognize doctor ferguson from georgia. Thank you to all the witnesses that have come today. Doctor hildreth, i was interested in your opening comments. I had a good conversation with doctor rice. We shared similar ideas that you had expressed about expanding education. She was particularly interested in southwest georgia. Its really one of the hardest hit areas in the state of georgia. Thank you for your work on that. I found that the conversation with her was very enlightening and encouraging as well. I think you are on to something there, going into underserved regions, not just communities but underserved regions, and i think that that is an area that we can be more successful and. Thank you for that focus. I look forward to having future discussions with you on those topics. Again, i think it is a golden opportunity and i will leave it there. But thank you again for that. As we go through this. I was a dentist in a rural 77 77 77 77 77 77 77 77 77 77 77 77 77 77 77 77 77 77 77 77f 25 years. When i went to work, every single day, i saw patience of every social economic background. They came from all different types of communities. Clearly, going back to then, we saw a real challenges with different groups, and not just accessing health care, but in a lot of the things, the practices that they had every single day, particularly around preventive medicine. All too often, what we found were people that lived in poverty operated more in the crisis at the moment as opposed to thinking about the long term. It is the nature of as we look at a lot of the data and the numbers, one of the things im curious about is, have we looked, and this is for any of the panelists that may answer this question. Looking at the data, if you are in a rural community, if we looked at obviously, we see the data on impacts, particularly in georgia on African Americans, but if we look at it from an income strategy as opposed to simply a racial thing, do you see similar comorbidities, fatalities and problems with African Americans, latinos, if each of those and each of those different races are in a higher income strata, does a financially successful African American family have a lower risk of infection, then one who lives in poverty . Im asking the question because im real focused on the poverty side of this right now. And looking at the economic status. Doctor hildreth, i will start with you if you dont mind. It is clear that economic and financial status for example, poor people are more likely to live in close quarters, so there is an opportunity for the virus to spread more quickly between them. If they are in a situation that where they can be socially distant and work from home most minorities cannot work from home, based on the nature of the work they do. If you look at black, hispanic, asian, if you have an underlying condition, you have a high risk of infectious disease. As weve said before, certain individuals on the economic status, they will be less likely to become infected in the first place. As for the susceptibility to the virus, it is the belittled to what happens when you get infected by the virus. The people have a greater chance of getting infected because of the type of job they do, where they live, using Public Transportation. The list goes on and on. Financial status does matter, but those other things matter just as much as well. As we look at this, and let us talk about the economics, particularly in Rural America. You talked about the types of jobs that different people do. It is one of the real challenges that we have in Rural America. Its the lack of access to having an Education System that aligns with that. All of the people that are in Rural America are incredibly creative and hardworking. But we have to get them connected to a different type of economy. I hope that what comes out of this discussion is a recognition that access to broadband in our Rural Communities is very important. Doctor, can you talk to how the economic disparity that happens in Rural America because of the lack of Broadband Access and also the health care component of that . Ill be brief, because you deserve a better answer. I will send you more. I do want to emphasize one thing, which is that, previously, a lot of people did not have broadband and was not because of the price. It was that they did not see a point. One of the things im curious to see ifs if there will be a new recognition of the importance of access to broadband. On the others, i will get back to you. Thank you. Chairman, i yield back. Thank you. Let me recognize the gentleman mr. Boyle. Thank you mister chairman. Its an honor to participate in this historic hearing. First in the history of the house and in the houses oldestcommittee that we held in this matter. It is fitting that this is the topic, because while the virus may be new, this story is as old as the republic itself. The disparate ways in which this virus is impacting African Americans and hispanic communities. I want to highlight something that should be obvious to most of us, but unfortunately, i feel it needs to be repeated. It is in the written testimony of doctor sequist. It is on page five. Simply two sentences. Quote, the rapid spread of covid among communities of color is not because of race or ethnicity. Excuse me, not because race or ethnicity is a risk factor of the disease. Racism, not race, is the risk factor for spread. So, i plan to cite many statistics of the ways in which this is having a disproportionate impact on African Americans and hispanics, but i do not think i need to do that, because so many of my colleagues on the committee have already cited those. Instead, let me turn to specific questions i have for the witnesses in terms of what our potential ways we can explore for answers. Ways in which we can perhaps be productive in terms of compacting this and fighting for this generation angel problem. One connection that many have drawn, myself included. I want to ask dr. Kendi about, since he is the historian. Weve talked about the ways in which African Americans and hispanics make a part of the essential workers. This is why it is impacting the communities so acutely. But another part of the story is where disproportionately, African Americans and hispanic americans can that isnt part because of the legacy of when i say legacy, it is not just what happened in 1950, its things that have happened as recently as 2015 according to an investigation which cited one specific thing. There are many different examples that i could cite. Doctor kendi, what consideration should we keep in mind and what strategy should we pursue as we look to dismantle centuries of red lining and create more housing opportunities for fellow americans who are minorities . I think first and foremost, we have to remember that particular communities, what redlining is. Which particular communities, specifically talking about urban, typically low and middle income black communities, in which you have people who wanted to purchase a home, wanted to get access to a mortgage. They were denied access and simultaneously denied the ability to move into the suburban neighborhoods that were being built up around their cities. They were then forced to not be able to get access to a home, and thereby built. Wealth. Even though those are able to build wealth through purchasing a home in a red line community, those homes were not worth as much as holmes and more predominantly white neighborhoods, because of all sorts of even racist ideas that people imagine that if you have more black people in the neighborhood, they will run down their homes, and are more dangerous. I think it is critically important to recognize that. If i can say very quickly, i think we are conflating race and income. I think it is critically important for us to recognize, when there is an economic disparity as there is with covid19, there should be economic solutions. When there is a racial disparity, there should be racial solutions. Then, when you have low income poor people sitting at the intersection of race and income, there should be a response that both addresses income or economics and race. We are talking about racial disparity, so we should be talking about racial solutions and recognizing past policies like redlining that has led to this crisis. Thank you. With that, let me reco ht az4t . Beyer. Think you so much for having this hearing. I would like to submit for the record, a joint economic report prepared by or brilliant economist on the impact of coronavirus on the working people. Thank you very much mister chairman. As we talk about race, we have to remember the lives of george floyd and armada arbery and christian cooper. Impact of this disease on people of color has grounded a racial history 400 years old. If we want to learn one thing from this crisis, this is already taken 100,000 american lives. We must honestly admit our manifold sense of racism and commit to an anti racist president and future. The New York Times posted on the front page a list of all the people lost. When it tells you is that our black and brown communities have been disproportionately impacted. Mister chairman, one of my greatest frustration has been the failure of the response and the failure of the cdc to do this job to provide simple truth and testing numbers. I would like to submit for the record a letter from march that eyelid with this request to the cdc. They still have not met. States, universities, Good Samaritans they give us the data that we would expect from the cdc. Doctor kendi, at the anti racist and Research Policy working with the covid project to build a covid tracker for covid race and ethnicity data, can you tell us why that matters . It matters because it did not exist. Federal government was not collecting this data and making it available at a National Level. Just as the covid tracking prior sets itself, that the federal federal government was not collecting or releasing testing data so we felt the need to create this National Resource so that people in every state and every community can really understand rich communities are which communities are the most vulnerable and create policies that can reduce these mister chairman, i will submit one more letter for the record that my colleagues and i wrote the Trump Administrations response. I get frustrated that they will not accept any blame and insist on shifting the blame elsewhere, for example china. China clearly made lots of errors. In early 2019 and 20, but that possibly did not make up for all the federal failures in march, april and may, 100,000 lives lost. In the interest of time, i big yes or no questions from three of our panelists. Doctor samoa, is china to blame for the difference between the experience of the Pacific Island community in the u. S. That in new zealand . Yes or no . No. Thank you. Doctor see quickest the Navajo Nation crisis . No. Doctor, is china to blame for the lack and investment on our Public Health and strict infrastructure that you so eloquently highlighted. No sir. Is china to blame for the lack of testing and contact testing for low income minority communities . Yes or no no. Thank you for bearing with me. When last thought. Before covid19, there was three months ago it showed that the average black family in america had a net worth one tenth that of a white family. Also it shows that after the Great Recession of 2008, 2016, white families had recovered their net worth plus 15 . For the average black families it was half what it was before the Great Recession. We are seeing the absolute disappearance of black Family Wealth in this covid crisis. Doctor kendi, what is the most important thing we can do to try to recover the wealth of people of color in america . I think first and foremost, we should not be blaming people of color for the loss of the wealth of their wealth. We dont blame people of color and that compels us to look at, what policies did we not put into place . What actions are what ways did we fail . Itself. It forces local officials to look at themselves as opposed to blaming these people. Thank you very much. Thank you gentlemen. With that, let me recognize the gentleman estes to inquire. Thank you to all of our witnesses and mr. Chairman. Our country is facing a Health Crisis that has challenged all americans across the United States, including in my district, the home state of kansas. Weve seen lost Economic Growth that we had achieved under president trump. The pandemic, minority communities are experiencing record low employments. We are losing businesses that theyve worked so hard to develop from restaurants to oil fields to now is the time for congress, federal agencies and local governments to Work Together for all communities to ensure that americans safely get back to work. The kansas meat packing workers were exceedingly affected by the virus, in part due to family Housing Conditions. Local governments worked with the Kansas Department of health environment, fema and the cdc to identify and solve the problem. Non congregate housing for those affected allowed healthy employees to be able to return to work while keeping themselves and their families healthy. This pandemic further exposed the need to increase access to Health Care Providers in both rural and urban areas. Unfortunately, the Economic Impact took a toll on hospitals in my district and kansas. Weve got one hospital closed, another before the closing of the hospital and kansas, there were 149 beds to serve roughly 40,000 people. Now there are fewer than 70 beds to serve the same population. We cannot keep allowing this to happen. The closure of rural hospitals increases the dispersion impact on low income families. Keethis means doing what we cao keep the existing Health Care Providers open, investing in the health worth workforce and an expanding and investing. Working with local communities and governments to get america open for business. This is the first step toward our return to Economic Growth and health care invention. Doctor, what role should the government play and identifying some of the problems that are causing the disparity impacts on low income populations . It is essential that we rely heavily on local governments. The reality is that, especially now, the impact of the covid pandemic is very different across the geography, so the Economic Conditions differ. The capacity to be more open differs dramatically, and local officials are best positioned to go forward safely when they can and no wind to be showing restraint. That is layered on top of what was a well understood dramatic difference in the population across the United States. One of the challenges is that the United States is a very large country. A lot of people with very different population Health Issues local officials are much better position on both fronts. On the Health Challenges and on Economic Conditions. I think a heavy reliance on this would work. In kansas we saw that implementation of the solution that the employees of meatpacking facilities working safely are there other types of barriers that we need to address . Are there other incentives to workers to go back to their jobs that need to be addressed right now . I think this is a question of confidence. Competence. The confidence of the American People is an enormous and powerful thing. Weve seen it in reverse in late march within the space of two weeks. We took away two months of positive Economic Growth and turn the First Quarter into a decline of 5 in annual rates. That was a crash in confidence. We need to reverse that. We need to have a combination, and i think it is always a mistake to single out any single one of these. We need aggressive testing. We need to have our foot on the gas for therapeutics and search for a vaccine. No single one is better, and an effort on all three fronts. We need to make sure that Small Businesses are willing to reopen. Many Small Businesses are concerned about their exposure legally and otherwise in this environment. Providing a standard for what you need to do in the workplace, to bring workers back. I face that myself. I dont know what i have to do to prevent my 23 employees theres a lot that needs to be done to improve confidence on all sides. Thank you. Mister chairman, i yield back. Let me recognize the gentleman from pennsylvania, mr. Evans to inquire. I want to thank you for being with us today and put a bill for racial data tracking. I come from a place where we have a group of African American doctors and churches churches it has providing free testing. I want to highlight this, because we talked about the need for data. To be able to combat these disparities. We have to talk about death rates and treatment, but testing gets lost in the mix. I have three questions. Im going to try to lead them all out. Can you talk about the value of universal testing when it comes to eliminating disparities . Is data on testing included in your covid racial data tracker . Oftentimes, we hear the problem is poverty or social economic status driving disparity, not racism. Let us take examples of testing in communities. Heres the problem poverty or racist . Let me give an example about racial Health Disparities. Racial Health Disparities typically cut across classes. One of the disparities that i think we mentioned earlier was how black and even native women are more likely to lose their babies or lives during childbirth than white women. It is also the case that wealthy black women are more likely to die, more likely to lose their babies then poor white women. So that is obviously not an issue of class. It is an issue of racism. More specifically to your question, i think we need widespread testing and we need data on that testing. Covid racial data tracker we have data on positive tests, positive case rates. But we dont have all types of racial data as it relates to testing. Negative tests, and so that of course, picture, would allow for people to have a much better assessment of the virus in a particular community. We have racial data at a state level. We need racial data at a county level, a zip code level. That would give you the ability in this consortium in philadelphia to really understand, what specific zip code is the most hardest hit in philadelphia . As a temporal University Graduate where i earned my phd, it is a place that i certainly hold dear. Hello . Hello . Hello . Yes. Hello . Yes. We lost the witness. We lost to. Repeat that last minute and a half answer. I kind of lost it. That is fair. Can you hear me . Yes. I can hear you now. With the last part of the answer was that you talked about sample testing . Yes i earned my phd from tampa university. I hold north philadelphia very dear to my heart. Okay. Any other comments . I just want to emphasize the importance of testing and testing data by race and testing data by race and class. We talked a lot about race and class, or race or class, and we should have data on that which would give us a picture that our communities of color that are more poor, with the be killed at a higher rate than others. We need data to answer questions that came up during this hearing. Thank you very much. Thank you mister chairman. Thank you gentlemen. Let me recognize mr. Schneider to inquire. Thank you mister chairman. I am particularly grateful that you chose to make this the first subject for our hearing as we move through this historic format. I want to thank the Witnesses Today for joining us. I appreciate you sharing your perspective. This is been very helpful to me through the challenges that we face in this crisis and in particular the communities that are confronting the disparate affects. Covid is not the cause of the disparities we are seeing in the crisis. Rather, some of you have pointed out today, existing inequities, the systemic pisces in our society created the circumstances that enabled the virus to rapidly spread in minority communities. A greater likelihood of negative outcomes when these communities do get sick. I represent two counties in illinois. They have more cases than any counties in the country. It covers three quarters of my district rent 23rd on that unfortunate list. The data shows that African Americans are four times and latino americans eight times as likely to get sick with covid19. Illinois, like the rest of the country is slowly beginning to open up at after more than two and a half months of the stayathome orders. We all want to open up as quickly as possible. There is no debate about that. But we also want to open up as safely as possible for everybody. I think that means we have to Work Together to make sure that as we open, we address the inequities that we talked about today. I believe the i appreciate the recommendations shared in the opening statements. I think we also have to recognize that this pandemic is likely going to play out over many months, if not years in a Health Economic consequences are going to play out for years beyond that. My question for the witness is, and i would like to start with the doctors, is what two or three things should congress be looking at in the immediate term in the next 30, 60, 90 days that will have the biggest longterm impacts in reducing inequities once we get past the crisis, once we have a treatment or vaccine . I will start. Its something i said earlier. We do not have a treatment or a vaccine. To save as many lives as possible the time is now, to do testing and Contact Tracing in a comprehensive level in our communities to keep people from getting infected in the first place. This is a tried and true Public Health approach. It is very effective. As i said earlier, the country has taken a Population Based approach to this. But we want to lower the risk for everybody, but the risk is not for everybody. We want to have a focused approach on those who are most vulnerable. Prisons, minority communities they should be the focus right now. That will have the greatest impact in the short term. Thank you, doctor sequist. We need to talk about the non covid illnesses that will sweep across our communities and diseases that are being ignored right now. Some of those elective or somewhat urgent cases that are now emergent. We need to be really considering those, because we will be hit hard by that over the next few months. We need to have the funding mechanisms in place. We need to have the policies that were put in place that enabled us to care for covid patients. We need that extended so we can manage the wave of illnesses coming at us. Dr. Fernandez. I agree with the doctors. I particularly want to stress that we do not really know the full impact of this pandemic yet. In terms of the impact on illnesses and chronic diseases. I think were going to have now a population of people who have lost insurance, are going to have breaks of treatment of covid disease and difficulties for many people coming back this i think is somewhere where we can take multiple steps to ensure that the Health System is ready to receive them and ready to get people back on track. Thank you. Doctor, if i can shift gears. You mentioned you had a ph. D. At temple. In the context of education, so many of our kids and communities of color are being squeezed on their Educational Opportunities right now. Many are only learning oncegvgva week. There are things we should be doing over the course of the summer to help with them on a path that once we get through this, they can catch up and get back to where they need to be. Without question. I think we have to recognize that when we create a virtual sort of educational class from, that some kids may not have access as we talked about in this hearing to the internet. What do they do . Or their parents may not have the ability to work from homes or home school them. What do they do . Then who ends up getting many times when it comes to education of our children,y,y9 out ways to empower and help parents and teachers. I think that is certainly something we should be focused on. Thank. You let me recognize the gentleman from new york. Thank you mister chairman. I appreciate you setting up this hearing and bringing the attention to this important issue. Theres so much noise out there today. It is important that we highlight the issue in health care scenarios to the long term problem weve had in america. It is not something new. It is just being highlighted by the pandemic. One small blessing is that we are paying attention to this very real problem for our nation. A big problem that we face in our country is that there is a lack of understanding of other people. It is hard for people from upstate new york to understand what it is like in downstate new york. Three of the six how hardest hit counties of america are facing this pandemic. It is hard for the folks in rural areas and the country to understand my district and hard for us to understand theres. There is a lot of lack of understanding across the country. I would like to explore a lot of my colleagues have been eloquent and talking about access and the problems related to access, lack of Health Insurance in different communities. I would like to discuss something that i think it was doctor fernandez and dr. Hildreth discussed, which is lack of cultural competency. I believe the Health Care Disparities that i learned when i was an executive of my home county, was that you could have an African American and occasion with the exact same Health Insurance, the exact same wealth status, exact same disease, but the outcome will be much worse on a person of color then it would be for the white person. A lot of that has to do with cultural confidence. I looked up during this hearing. In america, 13. 4 of the population is African American. 18 is hispanic. The number of African American doctors in america is about 5 for doctors. The number of hispanic identify doctors is about 5. 8 of the doctors. What can we do to improve the cultural competency of the medical profession, not just doctors, but for all Health Care Providers, health care administrators. Especially interested in hearing from doctor hildreth when he talked about supporting the historical black colleges and universities and trying to get more African American doctors and getting them engaged in the analysis here as well. African americans have a seat at the table and what doctor fernandez talked about with Health Care Disparities and the importance of cultural competence. Doctor, can you go first please . Its a significant problem in the country. Cultural competency in the american workforce. The first thing we need to do is diversify the workforce. That would be a great start. As you pointed out, a number of African Americans, hispanic native americans physicians for example is much lower than it should be. There are 200,000 in the United States. Only 6000 are African Americans. Despite the fact that there are 65 schools and makes you wonder what are the other 64 percentage doing . The school should be responsible for the black dentists in this country. We have to diversify the workforce itself the existing workforce gets comfortable with having colleagues who do not look like them. Who can actually help them interacting with people who do not look like. Them doctor, what can we do and congress to help recruit more African Americans into dentistry and into the medical profession . Whatttttttttttttte that happen . One thing the needs to be done, is to lower the financial barriers to the minority communities and get them to professional schools. For example, the average american medical student has to pay 108,000 dollars. Minority students they bring with them by the time theyre finished, they have this huge burden of debt. That also of course, is the choices we make. To make sure the oncologist versus the scholarships and increasing the would be a great way to help us solve this problem. We have to fund the training of doctors better than we do know. Im very interested in thank you gentlemen. Time has expired. Let me recognize the gentleman from california to inquire. Thank you mister chairman. I appreciate the opportunity. First of all, based on something that was said earlier in this hearing, i seek unanimous consent to enter into the record two articles on how they needed Food Assistance my colleagues mentioned, are not reaching those americans in need. The first one was published yesterday titled Hunger Program slow start leaves millions of children waiting from the New York Times. The second article is dated april 26 2020, usda left millions of pounds of food right while food bank demanded so ordered. Thank you mister chairman. Thank you for having this hearing and Ranking Member for highlighting what we are seeing throughout not just this country, but throughout the world. I want to thank the witnesses for their time, the preparation, their expertise, their testimony to discuss and delve into the inequality that has just been enhanced by covid19. Your testimony helps many people, including many members of both sides of the aisle. What has been done to hurt populations that were already vulnerable prior to covid19. But also, what we can do to help these populations reduce inequities and improve Health Outcomes. Where i come from, what i represent on the Central Coast of california, we have a long history of diversity. We have a long history of immigrants. Populations who have come and taken the risk to come to this country to give their children a better life. To live the american dream, as i have come to know it. They have become an essential part of the American Fabric of who we are as a culture, as a community, and yes of course, as a country. The pandemic has highlighted one of those populations that is very very important to us on the Central Coast. As our farm workers. Obviously, how essential they are, but how crucial the work it is that they do. If that Domestic Workers will not do. How valuable they are to our Food Security, to keep healthy food on our tables, but also how vulnerable their personal security is. The deportation and yes, to this disease. Moderate county, 325 of the 413 cases are 70 of all confirmed cases, have been found amongst the Latino Community. Nearly half of those cases were found in agricultural industries. The population is obviously particularly vulnerable to covid19 for a number of reasons that have been listed by our Witnesses Today. Working conditions, transportation arrangements, environmental factors, immigration status, lack of Health Insurance, lack of help literacy. Also, overcrowded housing. Farmworker housing and single Family Housing as interchange intergenerational aspects to it. Making together these risk factors are a staging ground for covid19 to spread within the community and it could spread like wildfire. Fortunately in monterrey county, i believe we have seen not become a hot spot because we took steps early on. Farmers and farm workers. Local counties, we have got to get together and put together an advisory for agricultural workers, talking about what should be done for hygiene, cleaning, sick employees, training and changes and another of other aspects that have been emulated by others thanks to monterrey county. Unfortunately, much of these workers have been cut out of the relief packages, including the cares act, which prohibited families from filing for Economic Relief. It is also why i wrote a letter last week to leadership, cosigned by 75 members saying that if there is more funding through the usda, there must be funds to support farmworkers for testing, ppe, education. Its the least, i believe we can do for individuals who do so much for us, our families and our Food Security. Doctor fernandez, obviously, i want to talk to you, not just because you are in california and you understand what the Central Coast is about just south of where you are in san francisco, but do you think that those types of steps of what i just talked about, ppe, education testing, that they can ensure the safety of farm workers from covid19 and are there any other steps we should be taking to protect our farmworkers, our essential workers who work in the field from covid19 . Thank you so much, congressman for highlighting this crucial issue. It is extraordinarily worrisome that covid19 will take even greater hold in the Central Valley and threaten the food supply and threaten all of those people. I do think you outlined the key steps. I do not think that every county has a strong a Public Health department as the monterrey department, and i think we need to do a lot, not only within california, but from the position of the federal government to protect the key industry and the workers. Thank you doctor fernandez. Thank you mister chairman. I yield back based on my time. Thank you gentlemen. With that, let me recognize the gentle lady from florida, miss murphy to inquire. Thank you mister chairman. And thank you to the witnesses for your testimony. Let me start by offering my most sincere condolences to everyone who has lost a loved one to covid19, which has now claimed the lives of nearly 100,000 americans. In addition to taking so many precious lives, covid19 has upended the livelihood of tens of millions of americans. Small businesses have shuttered workers who have done everything right have lost their chops, and families are worried about their Economic Future. My heart really goes out to those who have been affected by the pandemic, regardless of race, creed or national origin. This pandemic has, in many ways, unified us and this idea that we are all in this together, it is not just an empty expression or cliche, it is something i deeply believe in and we are seeing it on a daily basis. When it comes to covid, anyone can test positive and anyone can become severely ill. In the sense, the virus does not discriminate. All of us have to take precautions to keep from becoming infected or infecting others. At the same time, the very fact that the virus does not discriminate is the precise reason why we should examine, why certain communities of color in this country have been disproportionately devastated by the pandemic, especially on the health care front. Let me focus my attention on the state i represent, florida. There are African Americans who make up 17 of the population, but nearly 22 of the covid19 deaths. This trend has been witness throughout the country and highlighted by many of my colleagues during this crisis. And florida, the disparity is even more pronounced in the Hispanic Community. Hispanics constitute 26 of floridas population. But 35 of positive covid19 cases. In orange county, which i represent, hispanics make up 32 of the population in a staggering 45 of positive cases. Behind every abstract statistic is a human and often heartbreaking story. For example, in orange county, there is an area called it is a covid19 hot spot. It is a working class neighborhood with a large puerto rican population. Many of those families moved from the u. S. Territory to orlando in recent years and search of equality and opportunity who are fleeing economic crisis or fleeing Hurricane Maria or the ongoing or even covid19. For many members of this community, social distancing, whether at home or outwork is difficult for nearly impossible. Often, it is a two bedroom home or two bedroom apartment that is shared by three generations of a family. This is in part because of his strong cultural commitment to care for ones elders, but also because of the housing crisis and Central Florida which makes larger Living Spaces unaffordable or unavailable. Many of these men and women are essential workers, the keep our Community Running during the pandemic. They rely on Public Transportation where it is hard to avoid crowds. Others work in tourism and Hospitality Industry which has been decimated. Because of floridas dysfunctional Unemployment Insurance some have struggled to obtain benefits and have to secure food from local food pantries. Forced to wait in line, unable to socially distance just to put food on the table. If these folks get infected, they go home to crowded houses where they spread the illness to their Family Members. Especially to who can be more vulnerable to the virus because of age or Health Issues. Many of these families like Health Insurance. Florida has not expended medicaid and has one of the highest uninsured rates in the country. Meanwhile, despite these efforts, despite efforts, there is just not enough information being provided in spanish. Mobile testing units were not built quickly enough for severely affected communities. This virus does not choose who will infects. If one community is ravaged, another will be. Congress has to acknowledge hotspots in the communities of color and we have to provide an appropriate response. Doctor fernandez, you are an expert and Health Disparities and hispanic communities. I gave the example of my district, suggesting reasons why it might be a hot spot. Can you discuss any other factors you think that could explain why hispanic communities are at higher risk during viral pandemics . Thank you. I believe you hit the exactly right, most compelling reasons that have to do with Living Conditions and also having to do with where people work and the fact that they need to lead to work. You have also highlighted the world of the Health Care System and some of the deficiencies of the Public Health system, and yet have not yet been able to address those communities with language can courted materials. I think there is enormous work that can be done unless we do it very quickly, because these are very real live people as you point out. Congress has enacted for bills to help individuals and communities during this crisis, but it is clearly not enough. If you could talk about a few things that you could recommend we do, what do you think they would be . I think we really need to extend sick leave protection to businesses at large and large corporations. If people really dont have sick leave protection, they will continue to go to work and that way, the disease will come back into the household and will infect more people. We also really need to make sure that all workplaces know how to protect their workers. All workplaces have the ability to protect their workers and that i think is something that can only be done from a federal level. Let me recognize the gentleman from california to inquire. Mr. Gomez . Can you take yourself off mute . Why dont we move to steve horsford. I got it okay. We are counting on you. Thank you jimmy. Thank you mister chairman. I want to thank you for hosting this important hearing, mister chairman. On the disproportionate impact on covid on minority communities. This is not something that should be a surprise to anybody. In the early days of the coronavirus pandemic, i was paying attention to the testing that was going on and where they were springing up, and i saw that it was first bringing up in the more wealthy areas of los angeles. I knew that was wrong. It was wrong because we were not doing enough testing in the early days in the poor working class areas of los angeles. The minority communities. The impact of covid is disproportionate because we have a disproportionate system that exacerbates health, Economic Opportunity, exacerbates access to opportunity. It is not one thing that caused the other. It is something that was already there, and this virus, this pandemic has just highlighted that throughout the country. It is unfortunate that it had to take a pandemic. It is unfortunate that we are here for this reason, but im still happy about it, because it is an issue that i have been fighting and working on for a number of years. These disparities we are seeing are of course a reflection of longstanding social determinants of health. Factors like your zip code. Income. Race. Ethnicity. Housing. Our language ability, all play a major role on Peoples Health care. The population, health, opportunities. We see the latinos are being disproportionately impacted by this, because they are on the front lines. Now the question is, what are we going to do . We have to deal with the symptoms or are we going to deal with the root causes of this in the short and long term . This is something that i think people should understand its not just about the Latino Community or that community. Its about the Overall Health of our country and the strength of our country. Let us think about nebraska. Nebraska, in 2000, a population of hispanic was 5 . 2010, 9. 2 . In 2020, it has come in a 12. 5 . By 2040, it will be 20 of the population of nebraska. Nebraska is not considered like california or new mexico. That should tell you that there are other states that have more minority, more latinos. If you do not deal with this disproportionate impact on these communities when it comes to all these issues, and you are not going to have a healthy america, a strong america. That is why i think it is important why people should care. Doctor fernandez, thank you for joining us. You described in our latinos performing disproportionate share of essential work that requires leaving home and risking exposure to the coronavirus. Can you please elaborate on what steps congress can take to address the systematic issues both in the short and long term . Yes, thank you. Congressman, i think potus can do a lot to strengthen the Public Health response and can do a lot to strengthen workplaces. They have to strengthen the Small Businesses to protect the workers to Economic Relief and Public Health guidance and it has to strengthen the ability or mandate for Large Industries which congregate many low wage workers that need to protect their workers. Some of this is completely foreseeable. We talk about the farmworkers, we talk about meatpackers and so on. It is completely foreseeable that we will keep seeing outbreaks in those communities unless we mandate workplace protection. I think that that is a role that congress could play. Congress could also agree that we need to collect this Race Ethnicity and language data that would allow us to track not just in the states but nationally on the federal level. The data that we need to see who is being affected and that also will give a lot of guidance for our Public Health efforts in terms of targeting testing and education. I believe that the role of congress has never been more important in protecting us off in this pandemic. Putting forth the health of each of us depends on the health of all of us. Thank you so much dr. Fernandez. I think its essential we continue studying social determines on health, our economy, and all populations, not just during the crisis but in the long term especially when it comes to the overall strength of our nation moving forward for the next ten, 20, 30, 50 years. Chairman, i yield back. I think the gentlemen. Let me recognize the gentleman from las vegas, nevada has. Thank you mister chairman for holding this timely and much needed discussion. I want to thank our epstein panel of experts today. The number of covid related deaths in the United States now exceeds 101,000. This virus has hit every segment of our nation and no one is immune from its effects but what cannot be denied is the disproportionate impact that covid19 on the black, let next, api and those in the indigenous communities as well as seniors in Skilled Nursing home facilities. In my district, African American nevada and make up about 11 of par counties populations that accounts for 19 of the covid19 cases and over 16 of the deaths. In north las vegas, where i grew up, African Americans make up about 28 of our community but represent 47 of the covid19 deaths. Additionally, according to the seven about to help districts, 27 of people who have been hospitalized with covid19 in Clarke County are latino, while the county itself is 31 . I contrast the six counties in my district have fortunately seen only one reported covid19 death. Now weve talked a lot a lot of words during this discussion but why disproportionate rates exist, but there is one word that hasnt been used extensively except for during the opening remarks by our student panel. Doctor kildee, i want to ask you, what is the q q q q q q q. Thank you. Doctor hildreth, that one word, if we are not sufficiently addressing it by confronting the history of race and racism, how are we avoiding addressing the changes that need to be made to our programs, practices, policies and the investment that we make to address this Public Health crisis . A shortterm my perspective of this is weve got a short term challenge, which will face a longer term challenge. Firstly i think we need to recognize that there are people out there that if we dont keep getting infected from the virus, they are going to get sick in some of them are going to die. Lets do the things we need to do now to protect them but canadass but build a structural social construct that is built on racism and bias that have to be addressed. Im hoping that by doing the problem that we want to be at, that this contortion, we will build an infrastructure that transcends covid19 to address some of the structural barriers that African Americans and other minority communities having full access to the amazing power that the Health Care System has. That is the first thing we have to do. Save as many lives as possible and build an infrastructure that can structural barriers and keeping us healthy in the first place. Thank you. I know that its not enough time. I did want to just give dr. Candy a moment. You are moment you reminded us a moment of frederik hawk man. His legacy atrocities against the black community and even the injustice committed against henry lacks who sales are now used worldwide to do research and find cures for cancer. Unfortunately, many people believe that behavior, genetics and dna are part of the reason why communities of color are suffering more. How can we rid ourselves of that misinformation once and for all . Well i think what i was really seeking to say in my comments was you have racist ideas and racist ideas suggest that the cause of Racial Disparities are because of particular races, its predisposed by nature to a particular disease, or a particular race is refusing to make good health choices. And so their behavior, their genetics or even their culture is leading to these Racial Disparities. Those are races ideas and i think we have to call them what they are and by contrast, they are anti . Racist ideas. These are ideas that state that there is no such thing as racial biology. Indeed there are black people who could be making Better Health choices but there are white people who could be making Better Health choices. There isnt any race that behavior ali is better or worse and so when you have rachel disparities, if its not the people, it must be society, it must be policy in that what needs to be changed. And thats what our chairman is seeking to do with this hearing. I appreciate all of my colleagues and the discussion that weve had today. I look forward to the solutions that we can bring forward and focus on society and not try to make the people that are being harmed the victims in this case. Thank you very much. And i yield back. I think the gentlemen. So i want to thank our witnesses this afternoon and our members for participating in this very important discussion and also to note that we made History Today as the oldest committee in congress. The First Committee to hold this sort of hearing under these circumstances. While i think we would all like to agree we would like to be in these rooms, and its absence until we arrest this pandemic. This will be part of the discussions going forward. I want to advise members that you have two weeks to submit written questions to be answered later in writing and of those questions and your answers will be part of the formal hearing record. With that, the ways and Means Committee stands adjourned. Tonight on American History tv, beginning at 8 pm eastern, a look at the lives of Eleanor Roosevelt and truman. Cspan in cooperation with the White House Historical association produced of series on the first ladies examining their private lives and the public roles they played first ladies, influence an image of features individual biographies of the women who serve in the role of first lady over 44 administrations. Watch American History tv tonight and over the weekend on cspan three. Every weekend. Coming up this weekend, saturday at 10 am eastern a discussion on the declaration of independence origins, purpose and global significance during and after the American Revolution. With the university of maryland history professor, richard bell. On sunday at 4 pm eastern, on real america, of a 1970 film, fresh colors detailing check political refugee and Award Winning animator paul, its first job upon arriving United States. Hired by the u. S. Information agency to create a film about the American Flag using his own narration, animation and archival footage. At 6 pm, on american artifacts, a tour of the museum of the American Revolution with president and ceo Michael Cohen discussing the museums history, design and what he calls the museums crown jewel. George washingtons camp tenth. Exploring the american story, watch American History tv this weekend on cspan three. Next, a discussion with republican senators on the national debt. They discuss Different Solutions for the growing problem. The National Security threat it poses and the impact itil
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