The Road From COVIDisparity to COVIDignity Goes Through Blockchain
DLT primitives and decentralization can alleviate the racial disparities of medical, social and economic determinants of Health
On June 2, Axios reported that according to Google Trends “George Floyd” overtook “coronavirus” as the most popular search (below), and that in the span of a week, our interest in health and economic pain, shifted to social and systemic pain.
However, I think Axios is mistaken. Our interests have not shifted. The news about demonstrations and the pandemic are one. Medical, social and financial determinants of Health are intimately linked, and as stated by Dr. Georges Benjamin, Director of APHA (American Public Health Association):
“…Racism is nothing short of a public health crisis…”
So without solving one public health crisis (racial injustice), we will continue to fail with our health and economic responses to the other public health crisis (future pandemics).
Let me explain.
#1: COVID-19 is having a disproportionate impact on Black Americans
The overall mortality rate from COVID-19 for Black Americans is 2.4 times higher than the rate for Whites, and 2.2 times the rate for Asians and Latinos. Stated differently, if Black Americans would die from COVID-19 at the same rate as White Americans, 13,000 Black Americans would still be alive.
Just to be clear, racial health disparities already existed in America — the COVID-19 just exacerbated them.
But the differences are startling. For example in Louisiana, where Black people make up about 33% of the population, they account for more than 70% of the state’s COVID-19 deaths. In Michigan, Black people account for 41% of COVID-19 deaths, even though they make up only 14% of the state’s population.
The reasons are multiple.
Pre-existing medical conditions like chronic obstructive pulmonary disease and asthma are linked to pollution, while obesity, hypertension, diabetes and kidney disease are linked to food deserts, lack of recreation spaces and insecure environments. Not surprisingly all these conditions are more prevalent in low-income areas (below).
But there are also COVID-19 specific reasons for the higher death toll among African Americans. Testing for Covid-19 has fallen along clear socioeconomic and racial lines, and one can only guess how vaccines will be distributed once available.
Correctional facilities and prisons known for the disproportionate representation of Black people, have become “hot spots” for COVID-19, and Black people are overrepresented in nine of the ten lowest-paid, high-contact essential services, including healthcare.
In other words, the very people that are most essential to help us all survive— are also those who are the least paid and most exposed to the risk of infection.
#2: The US Healthcare system is not broken, it needs to be replaced
I have written about how COVID-19 highlighted the non-sustainability of the US healthcare and its payment system here. However to be clear, the US employer-based insurance system is disenfranchising Black Americans by design.
If African Americans face systematic obstacles to getting good paying jobs and owner-occupied homes in Black neighborhoods are undervalued 21% on average, social determinants of health become dominant, and dependence on government-based services is inevitable.
Without a system redesign the impact of COVID-19 will only make things worse for Black Americans in 2021. Uncertain risk pools, and three out of four individuals recently unemployed due to COVID-19, will continue to struggle to find new health plans due to costs and limited availability (below).
#3: Now is the time for the Great Reset with Blockchain
COVID-19 has left us with serious long-term consequences for economic growth, public debt, employment, and human wellbeing. If rising inequalities will deepen (US billionaires’ wealth has increased during the pandemic) this will leave the world even less sustainable, less safe, and more fragile.
However, beyond acknowledging racism and strategically planning how new federal stimulus money can be used to create equitable healthcare, education, and employment opportunities, this is a time to re-think democracy, capitalism and social contract.
This is a time to redesign society as a sustainable, non-rivalrous ecosystem and learn about new out-of-the-box ideas, such as those found in Eric Posner and E. Glen Wyel’s spectacular book: Radical Markets.
In the context of COVIDisparity I suggest we all familiarize ourselves with three concepts:
(1) Quadratic Voting (QV):
QV is designed to solve the limitations of the one person equals one vote (1p1v) problem, that usually neglects underrepresented and vulnerable minorities. Exacerbated by the impact of the electoral college and gerrymandering, QV allows voters not only to vote for or against an issue, but also expresses how strongly you feel about it.
The idea is that each voter is given a number of “credits” (N) that can be used to vote for an issue. The “cost” of casting more than one vote for an issue is quadratic (N²), not linear (2N). and this ensures that only those who care deeply about issues will cast these additional “expensive” votes for them. This also limits the ability for a small elite group to “buy” too many votes and skew the results, because the cost of the votes are too prohibitive.
(2) Data as Labor:
One of the salient concepts in Radical Markets is the idea that in the digital economy, user data shouldn’t be treated as capital created by and for corporations, while observing consenting individuals. Instead data should be regarded as labor with the explicit agreement to distribute gains from the data economy with the users. This transforms data users into data producers and is key to incentivize value within a human-driven, rather than human-centric model. (I write about this here).
(3) Decentralized Social Identity:
Existing identity management systems are based on centralized repositories like registries or certificate authorities, where each serve their own root of trust. In decentralized identity management, individuals are free to use any shared root of trust. This allows people to have more than one identifier (personas), capturing better the richness of our multifaceted life (professional, personal, creative).
Final Thoughts: Immanuel Kant to the rescue
As I gaze through the window hearing chants: “justice now!” to the backdrop of police helicopters, I cannot stop thinking: What can I know? What should I do? What may I hope? and as I only have knowledge of things I can experience, I cannot “know” the deep-seated fear of being Black in America.
But 18th century German Philosopher Immanuel Kant does provide some guidance on “what to do” through his commandments of reason, his Categorical Imperatives.
Kant, unlike other philosophers of his time, believed that certain types of actions (murder, theft, lying) are absolutely prohibited, even in cases where the action would bring about more utility (like a “white lie”) than the alternative. The reason being that it is illogical to do them. Killing each other, stealing from each other, lying all the time to each other- simply makes no sense.
Therefore Kant created this commandment of reason, where there are only two questions we must ask ourselves whenever we decide to act:
(i) Can I rationally want everyone to act as I propose to act? If the answer is no, then I must not perform the act.
(ii) Does my action respect other human beings, rather than merely just using them for my own purposes? Again, if the answer is no, then I must not perform the act.
The imperative is simple. Never instrumentalize anyone. Ever. Period. It doesn’t make sense.
Finally, what may I hope for?
I hope we can insert Kant’s two-line code in all our future smart contracts, and start paving the way from COVIDisparity to COVIDignity.
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