COVID19 in Puerto Rico and more evidence of colonialism as a social determinant of health

I was worried about what could happen by the time the virus reached Puerto Rico since early in the development of the COVID19 pandemic. Historically, Puerto Rico has experienced the most negative outcomes that can result from a colonial relationship with imperialist and capitalist nations.

Furthermore, in less than three years, Puerto Rico has seen significant changes in its environmental and sociopolitical landscape. In September of 2017, Puerto Rico was severely affected by two major hurricanes that caused nearly 3,000 deaths, caused significant damages to the infrastructure, and triggered a substantial migration to the continental United States.

The response from the United States to these natural disasters was nothing but criminal. In the summer of 2019, governmental corruption and mismanagement fueled public revolts that lead to the resignation of Puerto Rico’s Governor and other members of his administration. And in the first trimester of 2020, a series of earthquakes severely affected communities in the south-west of Puerto Rico. The archipelago of Puerto Rico was in the worst conditions possible to deal with a pandemic.

By mid-March 2020, the government of Puerto Rico established stay-at-home practices, closed schools, and communicated an apparent strategy to maintain essential services open and to prepare hospitals to provide care to COVID19 patients. Moreover, the government established curfews to control the mobility of residents and announced the purchase of COVID19 tests to use broadly.

Initially, those initiatives seem consistent with good practices to control the epidemic. However, very soon, we were reminded that the government of Puerto Rico has limited economic resources to respond to any emergency, and the resources available are managed by an oversight board named by the U.S. Congress and the president without any saying from Puerto Rican. The lack of autonomy, the very inconsistent practices implemented by the government, the mismanagement of resources, and the lack of proper risk communication have led to a profound public health crisis, which includes the violation of human and constitutional rights.

As a Puerto Rican and a community health scientist in the diaspora, it has been tough to watch these challenges unfolding. It hurt me to see how the number of new infections in Puerto Rico continues to increase, the epidemiological data was too week to inform best practices, hospitals were firing healthcare workers due to economic constraints, and policymakers seemed to be drowned in political scandals. On the other hand, it was as painful to see how the colonial relationship of Puerto Rico with the United States was unfolding more devastating examples of the extent it determines Puerto Rican’s ability to stay healthy.

The Puerto Rican government was unable to make independent decisions about the arrival of commercial flights and had to enter a rough competition with states to access tests and medical equipment. Moreover, national U.S. data about the impact of the epidemic frequently erased information from Puerto Rico and reliable COVID19 information was not readily available in Spanish.

Even when an economic relief was enacted to help the economy, Puerto Ricans – who pay taxes as other citizens in the US – experienced a delay in receiving the money as the U.S. Internal Revenue Services treat Puerto Rico differently than the states.

Despite the frustration, I have learned many lessons while using my health promotion competencies amid the COVID19 pandemic.

I have learned that we all can have a roll in responding to a public health emergency; From capturing the historical moment, it represents, to researching and supporting communities and organizations. We are all called to assume our responsibility to advocate to ensure that we can have the best conditions possible to keep our populations healthy.
Public health is political, and I have to say that my training in health promotion gave me the tools to navigate a system that works by keeping populations vulnerable. We are all called to do our part. Staying silent in times when our humanity is challenged is complicit.

Carlos E. Rodriguez-Diaz, PhD, MPHE, MCHES®
Associate Professor of Prevention and Community Health, The George Washington University-Milken School of Public Health

REad other blogs in this HPP special series