Infrastructure Law May Smooth the Road to Health Equity | Deloitte US has been saved
By Elizabeth Baca, M.D., M.P.A., specialist leader, and Jessica Nadler, Ph.D., managing director, Deloitte Consulting, LLP
While ‘health’ typically doesn’t come to mind when discussing infrastructure, the two are inextricably linked at the community level—with clear implications for equity. The construction of the interstate highway system in the early 1960s, for example, ran through predominantly Black neighborhoods in some cities and further divided communities. Health outcomes and life expectancy still map to the geographic boundaries established generations ago through the practice of redlining.
The Infrastructure Investment and Jobs Act (IIJA), which was signed into law in November, dedicates $550 billion to new infrastructure spending over the next five years.1 This federal funding infusion could remove some of those inequities and help ensure that everyone—regardless of race, ethnicity, gender, or sexual orientation—has the same opportunity to achieve their full potential in all aspects of health and well-being.
No one should be surprised that minority and low-income populations were hit particularly hard by COVID-19, as noted in a blog just seven months into the pandemic. Health inequities are apparent across a broad range of illnesses—from diabetes and heart disease to mental health. Predominantly Black and Hispanic communities, for example, are exposed to 60% more pollution than they produce. White communities, by contrast, experience 17% less pollution than they generate.2 Moreover, people who live in a low-income or minority-majority neighborhood might not have access to a grocery store, might not be able to afford healthy food options, or might live in an area that lacks green space or safe outside areas where children can play.
Heath inequities affect all of us
The average life expectancy in the US fell sharply over the past year, but the decline was sharpest among Black and Latinx Americans, according to a study released last summer.4 While the gap between Black and white Americans had been shrinking over the past two decades, those gains were erased by the pandemic. Health inequities tied to race and ethnicity translate to about $93 billion in excess medical care costs, and $42 billion in lost productivity, each year.5 This creates a strong business case for health equity on top of foundational moral and ethical issues.
Here's a look at three key elements of the infrastructure law and how new funding could help remove some inequities and help us build a healthier nation:
$65 billion to improve the nation’s broadband: About 30 million people in the US do not have broadband connectivity—high speed, reliable internet—while up to 162 million are not using internet at broadband speeds.6 The investment in broadband is expected to make internet access more affordable by requiring federal-funding recipients to offer a low-cost option. Improved broadband could make it easier for more people to attend classes, work remotely or access health care virtually. Prior to the pandemic, just 1 in 67 US jobs were remote. Today, 1 in 7 jobs are remote.7
- How can this improve health equity? Remote work or virtual health isn’t an option for someone who doesn’t have reliable access to the internet. Moreover, people who don’t have access to reliable internet might also have limited access to transportation. Better broadband connectivity, and therefore better access to telehealth, could be an alternative to physical office visits for people who find it difficult to get to in-person appointments.
$55 billion to upgrade water infrastructure: 2 million people in the US do not have access to running water. The law earmarks funds to replace lead service lines and pipes so that communities have access to clean drinking water.
- How can this improve health equity? Access to clean drinking water is essential to good health. As many as 370,000 Californians might be relying on drinking water that contains high levels of toxic chemicals, according to a recent report.8 The populations most affected are concentrated in poor, mostly rural areas. Droughts tied to climate change could make it even more difficult for people to access safe and clean drinking water. More than 2 million Americans lack access to running water, and 58 out of every 1,000 Native American households don’t have access to indoor plumbing.9
$39 billion to modernize public transit: Funding will be used to expand existing transportation systems, improve accessibility for people with disabilities, and provide money to state and local governments to buy zero-emission and low-emission buses. Subways, busses, and trains generate far less air pollution per rider than cars. Modernizing public transit could further reduce carbon emissions. An electric train, for example, generates significantly lower emissions than diesel trains.10 The legislation also dedicates an additional $17 billion to port infrastructure and $25 billion to upgrade airports.
- How might this improve health equity? Modernizing public transit can have a direct impact on air quality and climate change. Motor vehicles are the leading cause of air pollution in the US. Fewer driven miles could translate to fewer pollutants that can contribute to respiratory issues. Moreover, low-income communities rely on public transit more heavily than other communities. Lack of reliable transportation is a top reason for missed medical appointments or difficulty getting to work and school.
The infrastructure law could also have an indirect impact on health and health equity. Billions in funding will translate to good-paying jobs, which could make housing and healthy food more affordable. If those jobs include health insurance, it could ensure that people are more willing to have a medical professional treat an illness or injury.
Infrastructure extends beyond roads and bridges. There are many co-benefits from spending that directly improve health, health equity, and climate resilience. This package includes everything from affordable and reliable internet to clean water and affordable energy, to clean and reliable transportation. While new funding for infrastructure improvements is essential, ending health disparities will likely also require close collaboration among consumers, companies, communities, and governments.
This publication contains general information only and Deloitte is not, by means of this publication, rendering accounting, business, financial, investment, legal, tax, or other professional advice or services. This publication is not a substitute for such professional advice or services, nor should it be used as a basis for any decision or action that may affect your business. Before making any decision or taking any action that may affect your business, you should consult a qualified professional advisor.
Acknowledgement: Peggah Khorrami, manager, Deloitte Center for Health Solutions
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Endnotes
1. H.R. 3684-Infrastructure Investment and Jobs Act, Congress.gov
2. Study finds exposure to air pollution higher for people of color regardless of region or income, US Environmental Protection Agency, September 20, 2021
3. Infrastructure law could advance health equity, Pew Research Center, December 17, 2021
4. US life expectancy plunged in 2020, especially for Black and Hispanic Americans, New York Times, July 21, 2021
5. Disparities in health and health care: 5 key questions and answers, Kaiser Family Foundation, May 11, 2021
6. The number of Americans without reliable internet access may be way higher than the government's estimate—and that could cause major problems in 2020, Business Insider, March 12, 2020
7. 60 Minutes interview with Karen Kimbrough, chief economist, LinkedIn., January 9, 2022
8. Safe drinking water may be out of reach for almost 400,000 Californians, analysis reveals, UCLA Fielding School of Public Health, January 11, 2022
9. Closing the water access gap in the United States, US Water Alliance, 2019
10. Transportation and climate change, National Geographic Society
