Wearing Masks

COVID-19 Health Disparities Among People of Color

9 minutes

Wearing Masks

Although the coronavirus is an equal opportunity threat, the COVID-19 pandemic has disproportionately impacted people of color. The infection rates, hospitalizations, and deaths among Blacks, Latinxs, and Native Americans are at two to five times higher than among white populations. People of color who live in over-crowded conditions, on the street, or on reservations; have comorbidities; or perform “essential” jobs are more vulnerable to becoming infected.

Data from the Centers for Disease Control and Prevention (CDC) reveal that Blacks, who comprise 13% of the U.S. population, make up 30% of COVID-19 cases. Latinxs who comprise 18% of the population, comprise 17% of COVID-19 cases. Additionally, people of color are more likely than whites to test positive for COVID-19 and require a higher level of care for positive test results.

The hospitalization rate for Latinx patients is more than four times higher compared to white patients, and the numbers among Black patients are over three times higher. Death rates for Blacks, Latinxs, and Indigenous people are three times higher than those for whites. Death rates for Asians are 1.2 times higher. Native American and Alaska Native people are 5.3 times more likely than whites to become hospitalized. The high COVID-19 cases among Native Americans is so grave that Doctors without Borders, an international medical aid organization, has deployed to the Navajo Nation.

Factors contributing to increased risk

The social determinants of health that increase the risk of infection, hospitalization, and death among people of color include:

Discrimination

Historic racism has led to inequities in health care, housing, education, criminal justice, and economic stability. These inequities increase the risk of contracting the virus.

Health status, access, and utilization

The higher rates of being uninsured compared to non-Hispanic whites, lack of transportation and child care, unpaid leave, language barriers, cultural differences between patients and providers, historical and current discrimination in healthcare systems, and distrust of the healthcare systems responsible for exploitation and inequities among people of color contribute to health disparities. People of color are at an increased risk for severe illness if they contract COVID-19 due to higher comorbidities, such as diabetes, hypertension, asthma, and obesity.

Occupation

The disproportionate representation in essential work settings such as healthcare facilities, farms, restaurants, hospitality, factories, grocery stores, and public transportation increases the risk of exposure and infection.

Educational, income, and wealth gaps

Inequalities to accessing high-quality education results in lower high school graduation rates and obstacles to college admissions, thereby limiting future employment opportunities and stable, higher-paying jobs. Many lower-paying jobs do not provide paid sick leave, and many individuals cannot afford to miss work when ill because they do not have adequate funds saved to buy food, pay rent and utilities, and other critical living needs.

Housing

Living in dense living conditions creates challenges for social distancing. In some cultures, it is common for family members of several generations to share accommodations. Additionally, disproportionate employment rates during the COVID-19 pandemic may result in a greater risk of eviction and homelessness. The prevalence of environmental pollutants in impoverished neighborhoods increases the risk.

Incarceration

As the coronavirus spreads through prisons, people of color are at a higher risk of becoming infected. Imprisonment for Blacks is six times the rate of whites, and imprisonment for Latinxs is three times the rate of whites. Incarceration for Native Americans is at a rate 38% higher than the national average. In 19 states, indigenous people have become overrepresented in the prison population compared to any other race or ethnicity. Long sentences have resulted in older, more medically susceptible populations in prison.

Behavioral health care disparities

Blacks and Latinxs have significantly lower access to mental health and substance use treatment, although the rates of behavioral health disorders may not significantly differ from the general population. Blacks and Latinxs have reduced access to necessary treatment, prematurely end treatment, and receive less culturally appropriate care. Blacks and Latinxs with mental health and substance use disorders become incarcerated and homeless at higher rates than the general population, putting them at an increased risk for COVID-19. Public health measures to mitigate infection is almost impossible to implement among the homeless and incarcerated.

The economic consequences due to the pandemic have resulted in lost health insurance, financial instability, food insecurity, and housing loss. Without a safety net of savings and family resources, Black and Latinx households experience extreme stress, depression, anxiety, substance use, suicide, and poor physical health. Furthermore, individuals with preexisting mental illness are more vulnerable to poverty, living in over-crowded conditions, homelessness, and incarceration. Further adding to the pandemic stressors are the police brutality incidents calling attention to systemic racism.

A recent survey showed that Blacks are three times as likely to know someone who has died from COVID-19 than whites. The loss of community members, in addition to social distancing, restrict social support systems. Remote communication presents challenges to many Blacks and Latinxs with limited access to smartphones and broadband internet, impacting their access to support and care.

Before the pandemic, emotional distress for many people of color went untreated. For example, 69% of Black adults with mental illness and 42% with serious mental illness received no treatment in 2018. A startling 88% of Blacks reported receiving no treatment for substance use disorders in 2018. Substance use is growing during the pandemic, with an increase in drug-related deaths among Native Americans, Blacks, Latinxs, and older adults.

The change to remote care only during the pandemic presents a significant barrier to supporting and monitoring the most vulnerable individuals and increasing the risk for relapse. Due to limited resources, many clinics are closed to new referrals. Further obstacles involve a lack of insurance and access to a primary care doctor and living in underserved areas. Many individuals delay seeking care, including urgent care fearing exposure to the virus in hospitals and clinics.

Among children and adolescents with mental illness or developmental disabilities, the school closure creates barriers to accessing clinical services and limited opportunities to receive academic and social support. Children and adolescents of color are at a significant disadvantage when receiving services to address mental health conditions. Furthermore, vulnerable youths may experience an increase in neglect and domestic violence due to parental unemployment and financial loss.

The disproportionate effects of the pandemic on children of color

Losses in income, employment, housing, and food insecurity impact children of color catastrophically. Family instability can negatively affect children’s social-emotional, cognitive, and educational outcomes. Housing insecurity adversely affects children who need safe and stable housing. Housing insecurity leads to low academic and social consequences, including reduced vocabulary skills, grade retention, increased high school dropout rates, and unstable employment.

Children of color are disproportionately impacted academically by the pandemic. As schools’ transition to remote learning, many families of color experience critical obstacles in creating a learning environment equal to in-person schooling. Many families are under-connected, with mobile-only access and inconsistent internet connectivity. Latinx immigrants encounter even more significant challenges than low- and moderate-income families. As a result, students of color will disproportionately suffer learning loss, with a growing risk of being left further behind.

Practical strategies to close the gap

Racial injustice has produced significant health disparities for minority populations. Practical actions to reduce coronavirus exposure include:

  • Expanding free minority-neighborhood-based COVID-19 testing
  • Reducing the time for reporting test results
  • Increasing the tracking and tracing of contacts to slow the spread
  • Providing free temporary housing to isolate non-critically ill and asymptomatic individuals with COVID-19 living in crowded conditions to mitigate exposure to the virus
  • Paid sick leave for essential workers

As hopes for a SARS-CoV-2 vaccine is on the horizon, a recent study reported that 68% of whites trust the safety of the vaccine; only 40% of Blacks express confidence in its safety. Historic discrimination and exploitive behavior from the medical establishment toward people of color has resulted in distrust among minority communities. Recruiting people of color is imperative for vaccine trials to ensure its effectiveness in diverse populations and build trust among minority communities.

Further actions to alleviate the burden among people of color during the pandemic include:

  • Community-based organizations as multi-service providers that integrate health, behavioral health, and social services
  • Flexibility in treatment policies and payments for opioid treatment programs to dispense take-home methadone and allowing use of buprenorphine to protect Blacks and Latinxs needing interventions for opioid-use disorders
  • Expanding and increasing flexible coverage for telehealth visits via telephone and video using Smartphones
  • Provision of language translation with culturally suitable messages regarding COVID-19 and public health measures
  • Faith-based leaders and technology via radio broadcasts, Zoom sermons, Facebook Live, and podcasts to provide spiritual support
  • Community-accepted first responders such as neighbors, friends, extended family members, pastors, and other community leaders responsible for disseminating crucial COVID-19 information

COVID-19 disproportionately impacts people of color, leading to increased exposure, infection, hospitalization, and death. Historic racism and discrimination exacerbate the higher rates of illness and death from COVID-19. Additionally, the social determinants of health are critical factors in contributing to the pandemic’s adverse consequences among people of color.

References

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Editor’s note: this post was originally published on January 26, 2021 and updated on January 27, 2021.

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