Leveling the Playing Field for the Next Public Health Emergency

“Your uncle is in a New York hospital because of COVID-19” read a text from my father in January 2021. It is difficult to grasp that it has already been a year since the first official COVID-19 case was identified in New York City. For the majority of this past year, I saw how COVID-19 pitted my different identities against each other. On one hand, I am a public health student at one of the most prominent institutions in the world, and on the other, I am a Bangladeshi-American watching my community struggle to stay afloat under the weight of the pandemic. Public health emergencies, such as the current pandemic impacts various communities simultaneously.

However, the ability for communities to prepare for and withstand a public health emergency is currently not on a level playing field. For the Bangladesh community in New York City, there are many obstacles making them less prepared and more vulnerable to an unprecedented emergency such as the COVID-19 pandemic.

A perfect storm of social determinants and health disparities was already brewing for New York’s Bangladeshi community for decades, chipping away at their preparedness for a potential public health crisis. Minimum wage jobs, high rates of chronic diseases, and barriers to healthcare and government resources such as unemployment benefits and rent assistance have made this population more vulnerable than others.

Despite the Bangladeshi population in the city increasing by 82.9% between 2008 and 2018, not much has been accomplished to address the needs of this community. This population is poorer and less educated than other South Asian immigrants and thus, more likely to be in public-facing jobs such as taxi drivers and restaurant workers, which makes them more susceptible to SARS-CoV-2 exposure and infection.

In 2015, the Bangladeshi community in New York City had a higher average household size than the average NYC household and were less likely to have health insurance, making it harder for those within the community to social distance and seek healthcare. This community also has high rates of preexisting conditions such as obesity, hypertension and it has the highest prevalence of diabetes compared to any other group in the five boroughs. These factors compound to make the Bangladeshi community more exposed and less prepared for a public health emergency such as COVID-19.

The disparity among the cases and deaths due to COVID-19 within New York City's Bangladeshi community is not surprising to me as a public health student. But as a Bangladeshi-American it is heart-wrenching. Stories of family members impacted by COVID-19, like my uncle, have become a daily occurrence in the neighborhoods of Jackson Heights and Jamaica. As of March 2021, one out of every 10 people in Jackson Heights was diagnosed with COVID-19 and one out of every 199 people died as a result of the virus. This statistic is in stark contrast to neighborhoods such as the Upper East Side, where one out of every 27 people was diagnosed with COVID-19 and one of every 1,052 people died as a result of the virus.

It is one thing to learn about health disparities in my courses, but to see it within my own community and the broader city is a constant reminder that my public health training is not just for the betterment of my career, but I actually have a whole community relying on me.

Frustrated by these disparities and barriers to community preparedness, I am compelled to work towards addressing the structural obstacles that propagate these inequalities and to make my community better prepared to withstand the next public health emergency. Currently, I am a John D. Solomon Fellow for the Office of Emergency Preparedness and Response within the New York City Department of Health and Mental Hygiene (DOHMH). As a fellow, I take part in the city’s COVID-19 response while trying to also understand the needs of the Bangladeshi community. It is important to understand the needs and structural barriers that exist, such as why this community has higher rates of diabetes and how characteristics such as lower rates of education impact their level of preparedness. A more complete understanding of the community's needs and barriers will allow us to create tailored outreach and engagement plans, and thus increase their readiness for future public health emergencies.

The next public health emergency is just around the corner and unless we address the specific needs of the Bangladeshi community in New York City and other marginalized groups and better equip them to face the next crisis, we will continue to witness disproportional impacts. I still struggle with the dichotomy between my different identities of privilege and oppression, but that struggle brought me to public health in the first place, and it continues to fuel my passion to understand, question, and advocate for immigrant health especially within my own Bangladeshi community of here in New York City.

Sheikh Rubana Hossain is a 2021 MPH candidate in the Department of Sociomedical Sciences. She received her Bachelor of Science degree in Biology from James Madison University.