Racial Disparities and COVID-19

The COVID-19 pandemic has been catastrophic. It has crippled the US economy and exposed weaknesses in our healthcare system. Currently, the number of cases in the United States is approaching 7 million, with an excess of 200,000 deaths. Those numbers are rapidly increasing. The World Health Organization declared COVID-19 a pandemic on March 11, 2020, and by mid-April politicians, health professionals, advocates, and media outlets called for the release of the racial breakdowns of COVID-19 cases since racial disparities exist for other health conditions. Unfortunately, those data were incomplete. After months of data collection and transparency, America learned that the infection rates and deaths caused by COVID-19 were significantly higher in Black and Latinx communities compared to white communities.

Social Determinants of Health

The reasons for the disproportionate impact of the disease are complex. “We need to understand that it's less a phenomenon of race,” says Clyde Yancy, Professor of Medicine and Medical Social Sciences, from Northwestern University, Feinberg School of Medicine. “There's nothing about biology that sets up this vulnerability, but rather it is the place where people live and the circumstances under which they live.” Poor access to healthy food, education, health care, economic opportunities, and housing set up Black and Latinx communities to be at higher risk for COVID-19 infection and worse outcomes once they are infected.

Increased risk of infection for Black and Latinx communities can, in part, be attributed to the occupations they hold. Black and Latinx communities hold a disproportionate percentage of essential professions such as health care support, personal health care, correctional officers, agriculture factory work, and food service. These workers are exposed to a greater number of people and may work in high population density environments. They often face a considerably higher risk of exposure compared to those who hold jobs in finance, management, and law, in which work can be conducted remotely. In addition to the higher risk of COVID-19 infection, rates of cardiometabolic diseases including hypertension, cardiovascular disease, obesity, and diabetes are all higher amongst Blacks and Latinx, and all of these diseases have shown to increase COVID-19 morbidity and mortality.

It’s important to note that the increased burden of cardiometabolic diseases is not explained by genetics but rather through social factors. “Social determinants of health include socioeconomic position, housing, education, economic opportunity, and the built environment,” explains Yancy. In the United States, a lack of economic opportunity results in limited health care access, and a dearth of healthy foods can lead to obesity and diabetes. Additional challenges such as access to technology and transportation impose limits on utilizing Telehealth, picking-up prescriptions, and gaining access to COVID-19 testing. “Access to testing is even more difficult, if not impossible, for minority and underserved communities,” states Shelley Cole, Associate Professor at Texas Biomedical Research Institute and the Southwest National Primate Research Center. Without robust testing across all demographics it is possible that the impact of COVID-19 in Black and Latinx populations is even greater than currently believed.

Next Steps

“We're seeing in real time what it means to be part of an underserved community that disproportionately shares the health burden already,” notes Professor Cole. As COVID-19 has exposed the extent and depth of racial and health disparities, The National Institute for Minority Health and Health Disparities has recently created a new Approved Research Concept entitled, “Health Services Research on Minority Health and Health Disparities.” This initiative will promote research to generate new knowledge to improve health care access, delivery, utilization, quality, and health outcomes of populations affected by health disparities.

To fulfill this initiative, the first step is to gain a true picture of the racial disparities in COVID-19 through epidemiological studies. Luckily, studies on this topic have been published or are in the publishing pipeline. Preliminary research and experts in the field have proposed solutions ranging from increasing relief funding for COVID-19 to disproportionately Black counties, improving the data collection and release on COVID-19 and race, reducing overcrowded housing to allow for proper quarantining, and providing food service workers with appropriate personal protective equipment like masks.

Long-term Solutions and Prevention

To eliminate racial disparities in health and prevent the synergistic damage to underserved communities during the next pandemic, experts in the field have called for an acknowledgment and productive fixes to the structural systems and structural racism that place Black and Latinx populations at higher health risks. These systems lead to poor housing, food insecurity, high rates of unemployment and low wages, and deficient health care quality. These are the factors that lead to the social determinants of health that are the core of racial disparities in health. The elimination of these racial disparities, especially with COVID-19, is critical as it improves the health of all communities.

To learn more about efforts to ensure greater diversity, equity, and inclusion of vulnerable groups in COVID-19 clinical trials currently underway to evaluate investigational vaccines or therapies, check out the Academy eBriefing Advances in COVID-19 Vaccines and Therapies.