Looking upstream: Promoting health equity in Philadelphia through novel partnership strategies

The coronavirus disease 2019 (COVID-19) pandemic has been cataclysmic, revealing the troubling depth of health inequities in the United States. Disproportionately higher rates of COVID-19 infection, hospitalizations, and deaths among Black Americans were documented in multiple cities throughout the United States. Upstream causes of these disparities are related to decades of discriminatory policies resulting in inequities among housing quality, economic opportunities, education, criminal justice, and health care. As a result, Black Americans are more likely to live in impoverished neighborhoods – environments associated with adverse outcomes related to COVID-19 infection. These communities were severely disadvantaged by significant barriers to testing in the early phases of the pandemic, by employment in sectors that required in-person interaction or suffered significant layoffs, and by living environments that were not as amenable to social distancing. The conditions in which people live, work, and play – or social determinants of health (SDOH) – deeply fostered the devastating impact COVID-19 had on these communities.