Social determinants of health account for 80-90 percent of the modifiable contributors to an individual’s health. That means socioeconomic barriers such as unstable housing, food insecurity, or low income have a significant impact on an individual’s health outcomes—an impact made only more severe by the COVID-19 pandemic.
Why COVID-19 Disproportionately Affects Racial and Ethnic Minorities
The Centers for Disease Control and Prevention (CDC) suggests that serious illness and death disproportionately affect racial and ethinic minority groups due to the following social and economic factors:
- Living conditions. Members of racial and ethinic minorities may be more likely to live in densely populated areas, further from grocery stores and healthcare facilities, and in multigenerational households.
- Work circumstances. People in racial and ethinic groups may be considered essential workers or have a lack of paid sick leave.
- Health conditions and access. Individuals in racial and ethnic minority groups may not have health insurance, have a lack of health literacy or access, and may have higher rates of chronic conditions.
Data from the Kaiser Family Foundation shows that individuals in communities of color have a higher likelihood of serious illness if infected with COVID-19. American Indian/Alaska Native non-elderly adults are among the highest risk of serious illness at 34 percent.
Despite having one of the strictest stay-at-home orders in the country, Navajo Nation—spanning parts of New Mexico, Arizona, and Utah—surpassed the infection rate of both New York and New Jersey in mid-May. Factors that may have contributed to this increased spread include families living in multigenerational homes, a lack of running water for 30-40 percent of residents, living in a food desert, and higher rates of underlying chronic conditions (such as diabetes).
Additionally, one in 2,000 black Americans has died compared to one in 4,700 white Americans. In California, Latino individuals make up nearly 54 percent of cases despite making up only 39 percent of the state’s population. Racial and ethnic minorities in New York City, Chicago, and New Mexico have also been reported to have higher numbers of positive cases and deaths.
Individuals With Low Incomes Face Higher Health & Financial Risks
More than 38 million people in the US have filed unemployment claims since the beginning of the pandemic. The Kaiser Family Foundations found that adults ages 18-64 with lower incomes are at a higher risk of serious illness if infected with COVID-19. This is likely because unemployed or low-income adults are more likely to have underlying conditions such as heart disease, respiratory conditions, cancer, diabetes, or difficulties in physical functioning.
Additionally, low-wage workers are often employed in service industries that have been impacted by unemployment or experience a loss of income. Those that continue working are often in close contact with the public or working directly in healthcare—which means they’re facing health risks of contracting coronavirus.
The unemployment rate, reduced hours, and unstable income brought on by the pandemic can throw fuel on the fire by leading to a lack of health insurance, food insecurity, and even homelessness.
The Challenge of Food Insecurity
For many individuals and families, particularly those living in low-income areas or communities of color, accessing healthy food means traveling long distances or paying high prices. In fact, nearly 30 million people live in areas with limited access to grocery stores. There have been dozens of studies directly linking access to healthy food to health outcomes, such as obesity risks.
In 2017, the food insecurity rate in the US was 12.5 percent. With the high rates of unemployment and lost income brought on by the pandemic, this struggle becomes even more challenging. By the end of April, one in five US households, and two in five with children 12 and under were considered food insecure.
How Homelessness Can Worsen the Spread of COVID-19
“Homelessness poses multiple challenges that can exacerbate and amplify the spread of COVID-19. Homeless shelters are often crowded, making social distancing difficult. Many persons experiencing homelessness are older or have underlying medical conditions, placing them at higher risk for severe COVID-19–associated illness.”
Taking a “whole community” approach while planning can help slow or prevent the spread of coronavirus among people experiencing homelessness. This type of approach includes involving key partners, identifying resources needed to provide homeless services, communicating clearly with everyone involved, and making updates to layouts and procedures as needed.
Providing meaningful and quality care during and post-pandemic also requires a community effort, especially as we begin to see spikes in utilization or worsening conditions after weeks or months of postponing important issues like behavioral health, substance use disorder, and yes, social determinants of health.
On June 2, 2020, join Deborah Jean Parsons, Ph.D., Director of Integrated Care as Aspire Health Alliance and Brian Patel, MD, FACEP, Chief of Emergency Medicine and Occupational Health Services at Sturdy Memorial Hospital to learn more about meeting the needs of complex patient populations.
For more about social determinants of health, take a look at these resources:
- Article: Healthcare Providers Can’t Afford to Ignore Social Determinants of Health
- Infographic: Social Determinants of Health at a Glance
- Case Study: Building Bridges to Improve Patient Outcomes for Vulnerable Populations
- Article: Collective and California SB 1152: A Pragmatic Vision for Collaborative Support of the Homeless
- Case Study: Coordinating Care for Vulnerable and Complex Patient Populations
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