The emergence of the COVID-19 pandemic has especially uncovered the detrimental effects of systemic racism and discrimination on health and healthcare disparities in minority populations. According to the CDC, there are 5 social determinants of health that contribute to the healthcare disparities prevalent in racial and ethnic populations: 1) Neighborhood and Physical Environment, 2) Health and Healthcare, 3) Occupation and Job Conditions, 4) Income and Wealth, and 5) Education. These social determinants of health, influenced by discrimination, highlight the distressing challenges and oppression of minority groups caused by socioeconomic stratification. Health and healthcare disparities are closely tied to social, economic, and environmental disadvantages which limit the overall benefits of quality care and general health outcomes between groups.
Neighborhood and Physical Environment. Studies have found that neighborhood and physical environments show substantial correlation to health. These locations determine the type of housing, the access to transportation, healthy food, and parks, and the safety from violence and exposure to dangerous diseases and environmental conditions such as poor air quality and unclean water. With socioeconomic discrimination, many African Americans and Hispanic Americans live in overpopulated, unstable housing estates with poor living conditions because they are unable to afford better housing. Particularly with COVID-19, individuals who live in these neighborhoods are also less likely able to maintain COVID-19 regulations of social distancing against overcrowding, making them more likely to be exposed to COVID-19.
Health and Healthcare. The differences in health outcome and healthcare quality between minority groups and white Americans is mainly attributed to overlaps all 5 social determinants of health. Minority groups have fewer access to health care because of geographic locations. Studies that examined racial residential segregation in NYC and Boston found that public hospitals for the city’s low-income residents received significantly less federal aid than private hospitals while COVID-19 test sites were also heavily located in wealthier, White communities. Many lack health insurance and the finances to seek care and treatment from healthcare systems. Furthermore, cultural and historical inequities, especially for African Americans, in medicine that have not been resolved perpetuate distrust of healthcare systems and the government. A study found that COVID-19 disproportionately impacts historically marginalized groups such as Blacks, Hispanics, and Asians with hospitalization rates and death rates per 10,000 respectively 24.6 and 5.6 for Black patients, 30.4 and 5.6 for Hispanic patients, 15.9 and 4.3 for Asian patients, and 7.4 and 2.3 for White patients. COVID-19 is known to produce more severe symptoms leading to hospitalization and mortality in individuals with chronic diseases such cardiovascular disease, type 2 diabetes, and respiratory diseases. A study conducted by the National Health Care disparities reports that African Americans have a 44% greater chance of dying from stroke, 20% more likely to have asthma, 25% more likely to have heart disease, 72% more likely to have diabetes, and 23% more likely to be obese when compared to non-Hispanic Whites. Due to higher prevalence of pre-existing poor health and comorbidities in minority groups, the hospitalization and mortality rate for COVID-19 is much higher in these communities. To further support this notion, data from the same National Health Care disparities study reports that from 21 out of 30 states reporting COVID-19 data, people of color (POC) accounted for a higher share of COVID-19 cases than their representation within the population. Additionally, in 19 out of 24 reporting states, POC’s accounted for higher death rates due to COVID-19 than their percentage in the population.
Occupation and Job Conditions. At the peaks of COVID-19 cases and the controversial approach of lockdown, only essential jobs were allowed to remain in operation while remote work was promoted. According to a study, only 1 in 5 African American and 1 in 6 Hispanic workers work remotely compared to the 1 in 3 white American workers. Furthermore, minority workers comprise a large portion of low-wage jobs such as retail, home healthcare, mass transit, and plant factories where social distancing is almost impossible. Meanwhile in NY hospitals, 79% of the lowest-income healthcare workers are Black or Hispanic. Majority are women. Half of them earn less than $15/hour and a quarter are uninsured/on Medicaid. They also have a 6x greater risk of death compared to the highest-income counterparts. Even within the field of medicine and healthcare, racial discrimination and unequal allocation of PPE between the highest-earning and lowest-earning healthcare workers promote a segregated system.
Income and Wealth. Large contributors of health and healthcare disparities among minority groups are income and wealth. A low income and wealth can severely impact an individual’s ability to seek and pay medical bills, purchase healthy food, afford quality housing, and manage expenses. Without the financial resources to leave impoverished communities, many minority individuals are confined to poor, isolated communities with only access to low-pay jobs that offer little to no work or health benefits such as paid sick leaves if tested positive for COVID-19. The stressors to achieve the basic standard of living such as placing food on the table, paying bills, and dealing with mental and physical problems while facing racial discrimination and the lack of economic opportunities can greatly impact the health and wellbeing of minority individuals and communities. Even if medical attention is sought, inadequate medical supplies and equipment lower quality care due to low budget and the shortage of critical care physicians also advance healthcare disparities. Especially during the COVID-19 pandemic, these differences can make COVID-19 even more fatal, attributing to the higher COVID-19-associated mortality for African Americans and Hispanics than White Americans.
Education. An essential component to economic success and personal growth, education is the key to facilitate a strong relationship with society. However, the inability to access high-quality education can lower literacy and numeracy levels that are needed to gain college degrees and job opportunities. With the lack of education, minority groups remain in a continuous cycle of poverty. They are unable to afford better quality housing in a safer environment that has access to quality healthcare, fresh food, economic opportunities with higher income, and a decent education system. Education can also lead to better lifestyle choices that lower the risks of heart disease, respiratory problems, diabetes, and other comorbidities that are particularly vulnerable to COVID-19. The importance of literacy and numeracy also promotes better understanding of how to navigate the health system and correlates with fewer reports of poor mental health such as chronic stress, anxiety, and depression.
Despite the substantial evidence of structural and systemic racism and discrimination on health of racial and ethnic minorities pre-COVID-19 and during COVID-19 era, the challenges of addressing health and healthcare disparities remain difficult. A key initiative to eliminate the healthcare disparities and to reduce health disparities involves major recognition and efforts from the Department of Health and Human Services to provide a wide range of programs and assistance focused on these disparities. To do this, federal, state, local, and private organizations must understand the 5 social determinants of health which are composed of the social factors that impact health. To meet public health goals and to increase housing and socioeconomic stability of marginalized communities, we need to cognize the racial inequity and risks each racial group faces within society. Only with racial awareness can we strategically locate funding towards programs that will help these minority populations achieve better health and healthcare, especially in the times of COVID-19.
Parallels of the COVID-19 Pandemic to the HIV Epidemic
Just as with the HIV epidemic, the COVID-19 pandemic is having a disproportionate effect on African American communities by exposing class- and race-based vulnerabilities that are rooted in structural disparities. Residential segregation was noted as a large driver of broad health disparities, especially in the context of COVID-19 and HIV. The residential area in which one lives determines access to healthy foods and green space along with the amount of exposure to environmental hazards. Further, African Americans who have the same income as white Americans are more likely to live in poor and polluted neighborhoods with higher rates of incarceration. These disparities can potentially be alleviated by increased testing and outreach efforts to communities that are made up primarily of minorities.
Published: April, 2021