A new study on Covid mortality underscores the importance of making health care more equitable now, before the next pandemic takes off.

Welcome to Not a Doctor. I’m Melody Schreiber, a journalist and the editor of What We Didn’t Expect: Personal Stories About Premature Birth. I’m not a doctor, or a scientist, or really an expert of any kind. I just like to ask questions and try to find the answers to them.

This week, I published an article for the Guardian about Covid mortality among working-age people (ages 25 to 64). I was struck by a few points:

1. Indigenous working-age people (or in more official terms, “Native Hawaiian or Other Pacific Islander” and “Native American or Alaska Native”) had the greatest increase in mortality — even more than their elders.
2. Black children and young people under the age of 25 accounted for more than half of the deaths (51%) in that age group, despite only representing 13.8% of the population.

Both of those facts are jaw-dropping.

As the demographer Elizabeth Wrigley-Field put it, the idea that “pandemic mortality is only a story about older people — that stereotype was really incorrect and has misled us about the extent to which this was a disaster that led to deaths very broadly across the population.”

I’ve lost track of how many articles I’ve written about Covid mortality. Most recently, I’ve written about how hard it is to count how many people died because of politicization and low testing throughout the pandemic, and the role vaccines play in preventing deaths while remaining shockingly difficult to access — even now.

Why do I keep writing about Covid deaths? In addition to one of the pillars of journalism — documenting what happened — I want to learn from the past and do better next time.

But my conversation with Dr. Utibe Essien, one of the authors of the new mortality study, reminded me that addressing inequality in health isn’t a future problem. Research like this doesn’t just show what we need to do in the next pandemic — it shows what we need to do right now.

Here’s more of what Dr. Essien had to say (edited and condensed for clarity).

“This study showed really striking disparities in mortality during the pandemic, which is, of course, something we’ve been talking about for four years. Traditionally, we thought it was just older individuals with risk factors and comorbidities who were dying from Covid. But we really find this working-age group, [ages] 25 to 64, experienced the largest relative increase compared to usual rates of death before Covid — especially in American Indian, Alaska Native and Hispanic groups. Really devastating, because these are individuals who could be contributing to our society and, more importantly, contributing to their families.

A lot of people are like, ‘Oh, this is good to prepare for the next pandemic.’ But really, how do we take care of our communities and societies today so that the folks who are still around, still alive, can continue to be healthy, especially those from underrepresented and minoritized groups?

Factors before the pandemic were responsible for the wide disparities in death. I’m a primary care doctor, so this is what I see every day — the really wide gaps in rates of hypertension, of diabetes, of obesity, which we know are some of the common risk factors associated with death from Covid. And unfortunately, those are risk factors that I’ve seen at disproportionately higher rates in minority groups compared to non-minority groups.

There are really wide differences in who has access to treatment, who has access to a primary care doc, who has access to insurance? A lot of people are uninsured or don’t have enough support to be able to get to the critical care they need, and a lot of these folks were constantly working, constantly commuting, and not having the opportunity to work from home like so many of us had. And thinking about who had access to vaccines once they became available. All those features were potential drivers of these disparities.

So many groups are, every day, being exposed to poor health. And this pandemic really shone a light on the inequities that are structural and are not due to genetics or poor behaviors or poor decisions.

This is kind of a tale as old as time. We saw it with the H1N1 flu pandemic, back in 2009-10; we saw it with OG [original] flu pandemic in 1918. Minority groups, or groups that are marginalized by where they live, always, unfortunately, are more impacted by bad strains of viruses. Unfortunately, we kind of expected this.

Now, how do we actually stop it? So now we’re not looking, 10 years from now, at another epidemic, and wondering why we’re seeing the numbers we’re seeing?

What can we be doing today — in our health systems, public health departments, federal government, state governments — to really make sure that people are leading the healthiest lives they can, so that they’re not exposed at such a high risk when a new pandemic happens?

We can fix this, we can solve this today, and not make it a pandemic-focused finding. It’s really a public health finding, it’s really a primary care finding. Those are the pieces I think we can do a good job fixing today without having to wait for a new epidemic or pandemic to happen.”