What is health inequity and how does it affect minorities during a pandemic?

The COVID-19 pandemic has wreaked havoc across the globe, devastating economies, slashing millions of jobs and creating a health crisis like many have never seen before.

But to say that the coronavirus is an indiscriminate predator would be misleading, as minorities face a much higher fatality rate at the hands of the respiratory illness than do their counterparts.

How can this happen? How can certain ethnicities face a higher probability of death, even in the United States where healthcare is considered top-of-the-line?

According to researchers, health disparities affect millions of Americans, pandemic or not, but with the introduction of a novel disease, the effects of the disparities have become brazen.

According to the Centers for Disease Control and Prevention, “Current data suggest a disproportionate burden of illness and death among racial and ethnic minority groups."

Experts with the CDC found in a study that included race and ethnicity data from 580 patients hospitalized with lab-confirmed COVID-19, 33% of hospitalized patients were black, compared to 18% in the community, and 8% were Hispanic, compared to 14% in the community.

A study by the APM Research Lab found that as of May 19, COVID-19 had claimed the lives of nearly 99,000 Americans, and of those deaths, 89% were of known race and ethnicity. Based on that data set, APMRL found that the “COVID-19 mortality rate for black Americans is 2.4 times as high as the rate for whites and 2.2 times as high as the rate for Asians and Latinos.”

Based on COVID-19 statistics collected from 40 states that track ethnicities of those who died due to the disease as of mid-May, APMRL found 1 in 1,850 Black Americans has died due to coronavirus.

For perspective, 12.9% of the total U.S. population is reported as black or African American, according to the Census Bureau. A large part of that population lives in New York City and Chicago, two of the cities hit hardest by COVID-19.

Researchers with the Harvard School of Public Health cited similar findings saying that “preliminary data has shown that African Americans are dying from COVID-19 at higher rates than whites, even though they make up a smaller percentage of the population.”

Where do these inequities begin and how can they permeate an entire nation?

According to the Johns Hopkins University & Medicine Coronavirus Resource Center, disparities occur on two primary levels: with preexisting conditions predominant in certain ethnicities and with “inequities in socio-economic status, living conditions, and access to care.”

Dr. Lisa A. Cooper, Bloomberg Distinguished Professor at the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins School of Medicine and director of the Johns Hopkins Center for Health Equity, said in an interview with the Resource Center that there are multiple reasons for health disparities, but a key few ring true for many Americans.

“Existing racial disparities in the rates of chronic medical conditions increase the risk among ethnic minorities for serious complications of the novel coronavirus and resulting higher death rates,” Cooper said. “Because many racial and ethnic minority persons live in poverty, they are experiencing this pandemic in a different way. For example, they may rely on public transit if they cannot afford a car, need to shop more frequently for basic necessities since they cannot afford to stockpile goods, and do not have health insurance or access to regular medical care. Social distancing may not be a convenient or realistic option for many, because they may live in small, multi-family apartments or homes.”

The CDC also reported that work circumstances play a large role in health disparities for minority communities.

Health officials with the CDC said that critical workers, or those who worked in professions considered essential under emergency orders, had a higher risk of becoming ill during a pandemic.

The CDC found:

• “Nearly a quarter of employed Hispanic and black or African American workers are employed in service industry jobs compared to 16% of non-Hispanic whites.”
• “Hispanic workers account for 17% of total employment but constitute 53% of agricultural workers; black or African Americans make up 12% of all employed workers but account for 30% of licensed practical and licensed vocational nurses.”
• “Workers without paid sick leave might be more likely to continue to work even when they are sick for any reason. This can increase workers’ exposure to other workers who may have COVID-19, or, in turn, expose others to them if they themselves have COVID-19. Hispanic workers have lower rates of access to paid leave than white non-Hispanic workers.”

How can disparities be reduced during a pandemic?

Reducing racial and ethnic health disparities in health care is “politically sensitive and challenging in part because their causes are intertwined with a contentious history of race relations in America,” cites the Kaiser Family Foundation, a nonprofit agency that focuses on national health issues by developing its own policy analysis.

According to KFF, disparities in quality of care are not getting smaller. Over time, the gap between whites and African Americans, Hispanics and Asians has either remained the same or worsened.

To battle disparities, the KFF analyzed the four broad policy areas the National Center on Minority Health and Health Disparities federal agency was tasked with exploring. The agency fell under the National Institutes of Health and was required to release a National Healthcare Disparities Report.

The brief tackled four topics: raising public and provider awareness of racial and ethnic disparities in health care, expanding health insurance coverage, improving capacity and number of providers in underserved communities and increasing knowledge base on causes and interventions.

KFF’s analysis cites that perceptions of a problem often influence the actions taken to change policy and practices. A 2006 study revealed 6 in 10 people surveyed believed African Americans received the same quality of care as whites. Data shows otherwise.

One of the reasons being minority communities are least likely to have health insurance, thus are least likely to go to a doctor. When they do decide to get medical treatment, it's often when it is difficult to go without it.

KFF says minority communities often go without health insurance because of cost and availability, pointing to Medicaid as an example of a needed resource.

Analysts added that insurance companies and public health officials should make stringent efforts to decrease geographic, language and cultural barriers to provide more holistic care.

“Approaches to strengthening communication and relationships between patients and providers include greater use of medical interpretation services, expanding the racial/ethnic diversity of the health professions workforce, and developing provider training programs and tools in cross-cultural education. Since minority health professionals are more likely than Whites to practice in minority and medically underserved areas, a more diverse health workforce could help to improve access and adherence to treatment,” the brief reads.

Ultimately, more access to health insurance and affordable healthcare can help reduce disparities, along with providing education that’s understandable and tailored to specific communities.