The acceleration of the novel coronavirus (COVID-19) has revealed longtime health challenges among people of color in the United States. Ongoing disparities in social, economic, and environmental conditions continue to impact the health outcomes of these populations. This basic will highlight some of the many inequities that affect the health and well-being of marginalized populations and specifically how these disparities have exacerbated their higher rates of infection and fatality during this public health crisis.
Defining Health Disparities
Health disparities are the preventable health outcomes that are tied to social, economic, and environmental inequity. They adversely affect populations that have systemically experienced greater obstacles to health based on their race, ethnicity, socioeconomic status, gender, age, mental health, disability, sexual orientation or gender identity, or geographic location. These characteristics that define health outcomes are considered social determinants of health. Lack of employment, food insecurity, housing instability, lack of access to transportation and others create barriers to health and contribute to poor health care outcomes.
The Disproportionate Impact of COVID-19
The data released by several states and larger cities presents a COVID-19 infection and death rate that disproportionately affects African American, Hispanic, and Native American populations. The prevalence of underlying medical conditions such as hypertension, diabetes, obesity, and asthma within these populations has led to higher intensive-care admissions and death rates. Hispanic communities are also less likely to have health insurance, due to mistrust in the health care system and lack of social supports to assist communities of color in navigating health care options to determine eligibility for Medicaid, commercial, or Medicare coverage. Additionally, a greater proportion of African Americans live in states that have not expanded Medicaid, hindering their ability to access care.
Overwhelming evidence has also demonstrated that implicit biases in the nation’s health care system have been a driver of racial health disparities. Recent research from Harvard, Scientific American, Modern Healthcare and the Center for Disease Control (CDC) guidance have pointed to implicit biases as a significant factor that disproportionately impacts racial and ethnic minority groups.
Socioeconomic disadvantages are also highlighting the challenges of preventing the spread of the coronavirus. While social distancing practices are encouraged and enforced, it remains an unlikely option for many in these communities of color. Nearly a quarter of African Americans and Hispanics are employed in service industries that have been more impacted by the pandemic and are at an increased risk of contracting coronavirus. People of color are also highly likely to live in racially segregated communities and housing circumstances that are also disproportionately increasing their risk of infection. Racial minorities account for more than half of communities in urban counties and many live in crowded living arrangements and/or multi-unit family dwellings, further increasing their exposure to coronavirus.
Meanwhile, major metropolitan cities across the U.S. and some states have begun reporting concerning data on the disproportionate infection and death rates within these communities, specifically:
- In Chicago, more than half of COVID-19 cases and nearly 70 percent of COVID-19 deaths comprise of African Americans, although they account for only 30 percent of the population of the city.
- In New York City, Hispanics’ death rate is 17 percent higher than any other race.
- American Indian or Alaska Native (AIAN) people have made up 18 percent of deaths and 11 percent of cases compared to 4 percent of the total population in Arizona, 57 percent of cases compared to 9 percent of the total population in New Mexico, and 30 percent of cases compared to 2 percent of the total population in Wyoming.
- In Michigan, African Americans, who account for a third of positive tests, represent 41 percent of deaths, even though they make up only 14 percent of the state’s population.
- In Louisiana, about 70 percent of the people who have died from COVID-19 are African Americans, though only a third of that state’s population is black.
- Hispanic individuals make up a higher percentage of confirmed COVID-19 cases compared to their total population. The largest differences were reported in Iowa (17 percent versus 6 percent) and Wisconsin (12 percent versus 7 percent).
As the coronavirus continues to spread, assessing the impact and addressing the needs of vulnerable populations and communities of color will ensure better short and long-term health outcomes. While some data on infection and death rates have been reported, many states are still behind on equitable testing practices and are still not releasing racial and ethnic data. According to the CDC, race and ethnicity is missing or unspecified for nearly two-thirds of the CDC-reported cases. Further, data remains largely unavailable for smaller minority groups, including individuals who identify as American Indian or Alaska Native (AIAN) and Native Hawaiian or Other Pacific Islander (NHOPI), limiting the ability to identify the impact of the virus on these populations. Although the Indian Health Services (IHS) reports confirmed cases among IHS patients, not all AIAN people are able to access services through IHS.
Lawmakers have taken action to collect accurate data on the impact of the coronavirus on communities of color. In early April, leaders of the Congressional Tri-Caucus- which represents over half of the Democratic Caucus and includes the Congressional Hispanic Caucus (CHC), Congressional Black Caucus (CBC), and Congressional Asian Pacific American Caucus (CAPAC)-sent a letter to the Department of Health and Human Services seeking the collection and release of COVID-19 data related to race and ethnicity. Additionally, H.R. 6800, the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act would boost funding to increase data collection methods and infrastructure related to health disparities within federal agencies and state health departments.
Ensuring accurate data collection throughout the duration of the pandemic will provide public health officials and lawmakers the information needed to accurately communicate the effects of the virus to these communities and to address existing disparities in order to improve health outcomes.
Links to Other Resources
- Associated Press – Outcry over racial data grows as virus slams black Americans
- Centers for Disease Control and Prevention – Cases in the U.S.
- Centers for Disease Control and Prevention – Social Determinants of Health: Know What Affects Health
- H.R. 6800, the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act
- Kaiser Family Foundation – Growing Data Underscore that Communities of Color are Being Harder Hit by COVID-19
- Kaiser Family Foundation- Communities of Color at Higher Risk for Health and Economic Challenges Due to COVID-19
- Kaiser Family Foundation- COVID-19 Presents Significant Risks for American Indian and Alaska Native People
- Kaiser Family Foundation- Medicaid and American Indians and Alaska Natives
- JAMA Network – COVID-19 and African Americans
- National Institute on Minority Health and Health Disparities – Celebrating National Minority Health Month
- The New York Times – Black Americans Face Alarming Rates of Coronavirus Infection in Some States
- The New York Times – Does Your Education Level Affect Your Health?
- NYC Health – Age adjusted rate of fatal lab confirmed COVID-19 cases per 100,000 by race/ethnicity group
- Office of Disease Prevention and Health Promotion – Social Determinants of Health
- Pew Research Center – Most Americans say COVID-19 has changed news reporting, but many are unsure how it’s affected the industry
- Pew Research Center – Hispanics more likely than Americans overall to see coronavirus as a major threat to health and finances
- Politico – Health professionals warn of ‘explosion’ of coronavirus cases in minority communities
- Senate Committee on Health, Education, Labor, and Pensions- Health Disparities Letter to HHS Secretary Alex Azar
- House Tri-Caucus- Health Disparities Letter to CDC
- U.S. Department of Labor – Job Flexibilities and Work Schedules