Using Disadvantage Indices to Address Structural Racism and Discrimination in Pandemic Vaccine Allocation and Beyond: Defining the Shape of a Novel Paradigm to Promote Health Equity

新冠肺炎揭露了有色人种不公平的医疗保健机会和不同的健康结果，这些都是 由于结构性种族主义和歧视(SRD)--但在一个前所未有的转折中，政策制定者也部署了 这是一种主要的新工具，用于在大流行范围内甚至可能在大流行之外解决SRD问题。迅速、广泛地采用 由美国大多数州的国家科学、工程和医学研究院(NASEM)提出的建议 (n=34)通过将劣势指数(DI)纳入疫苗分配计划来解决SRD问题。不在地方了- 基于贫困或脆弱性的统计测量，整合了人口普查数据，如收入、教育程度 或住房质量，对小到社区的地理区域进行排名。因为其中一个后果是 SRD的一个特点是，有色人种面临的经济和住房机会减少，所占份额更大 在弱势社区中，综合安全信息系统同时捕捉可持续发展的影响，并提供缓解工具。为 例如，在严重短缺的情况下，直接投资被用来增加弱势地区的疫苗份额，并通过 延伸，更多的有色人种。因此，调度员减少了传统分配框架导致的风险 SRD，即使不是故意的。尽管如此，快速的采用和广泛的用途仍然不清楚什么是最佳用途 在紧急卫生事件的范围内和之外，有许多分遣队。我们的目标是确定以下各项的优势和劣势 DIS在应对新冠肺炎中的SRD、未来的流行病、公共卫生和临床护理方面发挥了重要作用。 AS 混合方法--S 离岸 弱势群体 旁边 发病率， 差异中的差异 在……上面 使用 弱点 SRD 这个 医院 将要 弱势群体 一个高度跨学科的团队与社区咨询委员会合作，我们提出了一个观察性的 带着两个目标的研究。首先，我们将确定使用的影响、优点和缺点 在新冠肺炎疫苗分配中，以应对SRD并改善医疗保健获得和结果 有色人种社区：我们将评估3个最常用的DIS的影响 在新冠肺炎上新推出的疾控中心/HHS指数(少数民族健康社会脆弱性指数) 按种族和民族划分的住院率、死亡率和接种率，使用预测模型和 对各州实际推出的疫苗进行了分析。我们还将进行权威性的采访 与32个疾控中心辖区的疫苗分配和卫生公平领导者一起推动和阻碍疾病预防控制制度 弱势群体所占比例最大。第二，我们将确定可能的优势和 在非紧急情况下的公共卫生和临床护理中使用DIS，以解决 并改善弱势有色人种社区的医疗保健机会和成果：我们将使用 德尔菲法如何确定卫生部门股权专责小组负责人，以及股权中最大的领导 在相同的32个疾控中心辖区的系统，对从文献中确定的数据分发系统的具体使用进行排名。我们 用两项具有全国代表性的创新性调查补充专家观点--实验和参与 在有影响力的获奖小组讨论中的社区(一起选择-聊天) 问： L 。

Covid-19 exposed inequitable healthcare access and disparate health outcomes of people of color, that are due to structural racism and discrimination (SRD)—but in an unprecedented turn, policymakers also deployed a major novel tool to address SRD within, and likely outside of the pandemic. Rapidly and widely adopting a proposal by the National Academies of Science, Engineering and Medicine's (NASEM), a majority of US states (n=34) addressed SRD by including disadvantage indices (DIs) in vaccine allocation plans. DIs are place- based statistical measures of deprivation or vulnerability that integrate Census data such as income, education or quality of housing, to rank geographic areas as small as neighborhoods. Because one of the consequences of SRD is that people of color face reduced economic and housing opportunities and account for larger shares of disadvantaged communities, DIs simultaneously capture SRD impact, and offer tools for mitigation. For example, under severe scarcity, DIs were used to increase vaccine shares for disadvantaged areas, and, by extension, more people of color. DIs hence mitigated the risk that traditional allocation frameworks result in SRD, even if unintended. Still, the rapid adoption and wide rangeof uses leave unclear what the optimal uses of DIs are within and outside of health emergencies. Our goal is to determine the strengths and weaknesses of DIs in addressing SRD in Covid-19, future pandemics, public health and clinical care. As mixed-methods s DIs disadvantaged alongside incidence, difference-in-difference on with weaknesses SRD the hospital will disadvantaged a highly interdisciplinary team collaborating with a community advisory board, we propose an observational tudy with 2 aims. First, we will identify the impact, strengths, and weaknesses of using in Covid-19 vaccine allocation to address SRD and improve healthcare access and outcomes of communities of color : We will evaluate t he impact of the 3 most frequently used DIs a newly launched CDC/HHS index (the Minority Health Social Vulnerability Index ) on Covid-19 hospitalizations, deaths and vaccination rates by race and ethnicity, using predictive modeling and analyses of states' actual vaccine-roll-out. We will also conduct ualitative interviews facilitators and barriers of DIs with vaccine allocation and health equity leaders in the 32 CDC jurisdictions the largest shares of disadvantaged communities. Second, we wil identify the possible strengths and of using DIs in public health and clinical care outside of emergency settings to address and improve healthcare access and outcomes of disadvantaged communities of color: We will use Delphi method to identify how health department equity taskforce leaders, and equity leaders in the largest systems in the same 32 CDC jurisdictions, rank concrete uses of DIs, identified from the literature. We complement expert views with two innovative nationally representative survey-experiments, and engaging communities in impactful award-winning group deliberation (CHoosing All Together-CHAT) q l .