May 24, 2016
Where is the sense of urgency?
In recent weeks, that is the question I continuously find myself asking as I read media accounts of Zika and follow the funding debate in Congress.
Somewhere along the way the focus shifted. What began as coordinating a response to Zika that is rooted in smart public health policy and caring for our fellow citizens became a funding fight on Capitol Hill in which many conservatives seem completely divorced from reality--particularly the reality of low-income women and children of color living in the South.
This disconnect is not due to a lack of information. Indeed, lawmakers know well that the Centers for Disease Control and Prevention (CDC) has found that Zika will likely wreak disproportionate havoc on the southern United States. Due to an increase in summer mosquito populations, the South could be a breeding ground for Zika transmission. Moreover, as the summer months approach, the CDC reports that the number of Zika cases is on the rise.
The Obama Administration certainly hasn't ignored the urgency of this moment. In February, the Administration announced a $1.9 billion plan to track transmission of the virus, increase testing, institute vaccine research, and prioritize access to health care for low-income pregnant women who are at-risk. Since then, the President has met with governors from each state and announced a coalition of public health experts and local and national decision-makers who will work together to address transmission of the virus. Yet proposals in the House and Senate both fall well short of what is needed to address the current public health threat.
As the CDC has made clear, the most common way to contract Zika is simply through bites from infected mosquitos. The virus thrives in warm environments with standing water, making low-income people in the South who live in homes without air conditioning, or lack door and window screens, particularly vulnerable. Additionally, people working jobs that require extended periods of time outside--such as farmworkers and other predominately low-wage workers--are more likely to be exposed to the virus. Zika can also be transmitted sexually by men to their partners.
In the South, poverty stricken communities overwhelmingly include people of color who lack access to the kinds of things that will help protect wealthier populations--like health education, livable wages, adequate shelter, and other social support services. Being economically disadvantaged also often translates to a lack of access to comprehensive health services, including reproductive and maternal health care and pediatric care. This is particularly important with regard to Zika, since transmission of the virus among pregnant women can lead to severe birth defects in fetuses, including a congenital brain condition known as microcephaly which can result in developmental disabilities in children.
There is currently no treatment available for microcephaly. Over time, the direct costs associated with caring for a child with the condition could easily exceed hundreds of thousands of dollars for a family--including costs for child care, health care, and lost wages due to providing for a child with a disability. Expenses like these will increase hardship for low-income families who are already living on the brink.
That is why low-income women need comprehensive counseling and access to the full range of contraceptive methods to prevent unplanned pregnancy right now. Both male and female condoms must be made widely available. When pregnant women test positive for Zika and want to carry their pregnancies to term, timely prenatal and postnatal care are critical. Low-income women of color are more likely to delay care and medical treatment for many reasons, including a lack of access to healthcare, no paid leave at work, or inadequate childcare options. In the event that a woman has to make the decision to terminate her pregnancy, safe abortion should be part of the full continuum of reproductive health care options made available.
With funding for these urgent needs currently held up in Congress, state and local public health responders have been slow to scale plans at the community level. Many local health systems are already operating under strained or inadequate resources, both programmatically and financially, and they need the federal government to step up and respond to these pressing public health concerns. It comes down to this: we simply do not have time to waste.
What will it take for Congress to recognize the urgency in addressing Zika? We have the opportunity, resources, and plans to protect the American people from this virus. However, without access to necessary comprehensive health care and social support services, low-income women and families could be looking at even deeper levels of poverty and poorer health outcomes on the horizon.
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