Senate legislation raises the profile of the CDC’s social vulnerability index
By Dennis Archambault
Legislation currently being debated in the Michigan Senate would preclude the state from using the Centers for Disease Control (CDC) social vulnerability index to determine the volume of coronavirus vaccines administered to various communities. There is a concern that many people over 65 living outside Wayne County are having difficulty getting the vaccine due to supply shortages. At least, that’s the way the issue is being framed by Senate advocates for the legislation.
This controversy offers a learning moment regarding the social vulnerability index. The analytic process is used to determine which populations are eligible to receive relief resources/services due to a natural or human-made disaster. It considers what is referred to as the social determinants of health – housing insecurity, food insecurity, poor transportation, and other effects of poverty – in determining how resources are administered. Specifically, the index analyzes 15 factors in determining its prioritization. In the case of the coronavirus vaccine, a greater supply is provided to regions of greatest need.
Sen. James Runestad, of White Lake, in a Detroit News article expressed concern that this formula may allow people who are younger than 65 and not socially vulnerable to have access to the vaccine, while older residents in communities prioritized lower on the social vulnerability index would need to wait. He has phrased it in more stark terms that some people over 80 may be waiting for the vaccine while someone who “lives in lower-income housing” may get the vaccine sooner.
Sen. Adam Hollier, of Detroit, is opposed this reasoning. In referencing the high percentage of Covid-19 deaths in Detroit compared with the state as a whole, Sen. Hollier noted, “Much of the reason that we talk about the social vulnerability index is because there are different ways that you live when you’re poor … we should allow scientists and experts to allocate vaccines based on how they believe it should be done.”
Sen. Hollier was referring to the impact of social determinants and racism on the impoverished population of Detroit, which is overwhelmingly African American. This caused a disproportionate effect of the pandemic on the city’s population, not only in mortality but in the overall infection rate. An analysis of the 15 factors of vulnerability will likely demonstrate that Detroiters score high on the social vulnerability list, compared with residents of White Lake and most other areas of the state.
Underlying Sen. Runestad’s perspective is the double standard that Detroit and other areas with large African American low-income populations have faced. Initially, the pandemic was perceived to be a problem in low-income urban areas where people were unhealthy and likely living unhealthy lives. When the pandemic became a statewide issue, it became a perception of inequity – the inequity favoring those same urban areas that were disproportionately affected by death and the disease.
The CDC’s social vulnerability index is applied to all major disasters. It’s likely that impoverished communities are always going to need a greater share of relief resources. Perhaps the index unintentionally has a negative impact on the pockets of poverty throughout metropolitan and rural areas. But clearly, in this pandemic, African Americans in large urban areas like Detroit have borne a disproportionate burden.
Dennis Archambault is vice president of Public Affairs for Authority Health.