The COVID-19 pandemic, caused by the spread of the novel coronavirus, has created an unexpected and unprecedented lifestyle shift for many people across the globe. Several months into the pandemic, the public has been exposed to a number of issues they might not have previously considered or thought possible, from hospitals rapidly reaching capacity and the lack of personal protective equipment (PPE) to the mental and social challenges of physical distancing and being quarantined.
Another problem brought to light during the pandemic is the deep-rooted and unsurprising inequalities inherent in the healthcare system. What COVID-19 has confirmed to the world is that human rights do not only constitute a political or social issue. This is also a public health issue—and one for which public health officials and public health systems were disappointingly unprepared.
The Impact of COVID-19 on Minorities
According to multiple sources of data generated during the pandemic, black, Latinx, indigenous and immigrant communities across the nation are disproportionately impacted by COVID-19. This is largely due to structural racism, including the policies and practices that systemically devalue and harm people of color (POC) while benefitting white people. As research shows, oppressive systems, such as racism and classism, determine who is able to access the resources critical to their health—known as social determinants.
According to a study by Leighton Ku and Erin Brantley, the age-adjusted COVID-19 mortality rates are exceedingly higher for black and Latinx patients than white patients. Additionally, economic and social disparities have widened in relation to racial/ethnic, educational, and immigration status.
The U.S. Departments of Disease Control and Prevention (CDC) further report that long-standing systemic health and social inequities have put some members of racial and ethnic minority groups at increased risk of getting COVID-19 and/or experiencing severe illness, even death, as a result of contracting the disease. As of June 2020, the highest rates of hospitalization from COVID-19 were experienced by non-Hispanic American Indians/Alaska Natives and non-Hispanic black people, followed by Hispanic or Latinx persons. For example, American Indian, Alaska Native, and black individuals were five times more likely to experience severe illness and hospitalization than non-Hispanic white people. The hospitalization rate among Hispanic and Latinx persons was approximately four times that of white individuals.
This is not only a COVID-19 problem, though. Historically, the CDC reports, the severe illness and death rates during public health emergencies tend to be higher for racial and ethnic minority populations than affluent white populations.
What Social Practices Contribute to Gaps in Health?
The past and current social, political and economic practices that have contributed to creating healthcare gaps for marginalized demographics are numerous and diverse. A few examples include:
- Redlining, or the practice of denying home mortgages to otherwise qualified buyers based solely on their race, which impedes not only home ownership but also upward economic mobility in general. Although this practice is now prohibited, the adverse effects of its past use still create challenges for minorities.
- Gentrification, which is the process of renovating an urban neighborhood or district so it conforms to the taste of the white middle class while displacing POC who have lived in the area for years or even decades.
Other common factors that disproportionately impact minority communities and deter their ability to access equitable healthcare include job insecurity, living in densely populated areas, racial housing segregation, exposure to environmental hazards, and not being given the same work-related benefits as whites, including health insurance and sick leave.
How Public Health Officials Can Address Disparities
Although communities are responsible for addressing the systemic racism prevalent within their jurisdiction, the onus falls primarily on public health officials to develop and implement strategies to change and improve the health sector.
The first step is simply acknowledging the vital intersection between social justice, healthcare, and public health. Other solutions include:
Better Training for Physicians
Physicians and nurses are the link between the public and community members’ collective and individual health. These healthcare professionals are the people with whom patients primarily have contact, so it is vital they are provided robust training and knowledge of how societal factors, in addition to biological factors, influence health. For example, reliable access to food, transportation, education, safe housing, insurance and jobs all impact a person’s health, as does equal protection under the law. These are social factors disproportionately endured by racial and social minorities and marginalized communities, which undermines their ability to prioritize and protect their health.
A good place to start is by making courses on social justice and inequity at medical schools required rather than optional and ensuring they are given the same weight as other areas of study.
Analyzing and Addressing Social Determinants of Health
Physicians, nurses and other employees who work in a clinical setting are not the only ones who need exposure to better training that is grounded in critical race theory, along with an understanding of the various social determinants of health. Individuals who are involved in the theoretical and policy side of health, including public health professionals, need to analyze all factors that affect a person’s overall public health. From there, these issues must be taken into consideration when discussing, developing and implementing public health policies and practices and making decisions about how and where to direct resources.
Expanding Healthcare Options in Marginalized Communities
With the appropriate critical race lens, public health officials can then work toward enhancing access to healthcare—including testing, treatments, and preventatives measures—for racial and ethnic minorities. As the CDC has demonstrated, this is accomplished most effectively by fostering partnerships between researchers, community groups, tribal medicine leaders, professional groups, and other community members to ensure important information about preventing COVID-19 and other public health emergencies is disseminated throughout racial and ethnic minority communities.
Working Among Other Sectors
Since public health intersects with human rights and social justice issues, it’s important for public health professionals to build connections and collaborate with professionals in other sectors, including education, business, transportation, and housing, as well as community and faith-based organizations. Together, these agencies and individuals can share information and develop the best strategies and measures for reducing social and economic barriers to healthcare.
Confronting Pandemics with a Social Justice Approach
Whether it be COVID-19 or a different public health crisis in the future, a social justice approach is necessary for successfully dealing with the problem in a way that prioritizes and protects individuals of all races, ethnicities, and classes. For individuals who are interested in learning how structural racism engenders health inequity and making a different in the public health sector, becoming a part of the solution can begin with a Master of Public Health Degree.
- “Doctors can’t treat COVID-19 effectively without recognizing the social justice aspects of health.” The Conversation. Accessed online at https://theconversation.com/amp/doctors-cant-treat-covid-19-effectively-without-recognizing-the-social-justice-aspects-of-health-138787?utm_source=twitter&utm_medium=bylinetwitterbutton&__twitter_impression=true
- “Widening Social and Health Inequalities During the COVID-19 Pandemic.” Leighton Ku, PhD, and Erin Brantley, PhD. Accessed online at https://jamanetwork.com/channels/health-forum/fullarticle/2767253
- “COVID-19 in Racial and Ethnic Minority Groups.” U.S. Centers for Disease Control and Prevention. Accessed online at https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html