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Health Disparities During a Pandemic and the Reasons Behind Them

The COVID-19 outbreak has brought to light some of the most shocking disparities in the US. As shown by data recently released by the Massachusetts Department of Public Health, people living in lower income communities are being infected and hospitalized at higher rates, and are more likely to end up in the ICU than wealthier patients. I had the opportunity to speak to local pediatrician, public health expert, and Temple Sinai board chair Charles Homer, about these health disparities and the reasons behind them.

Dr. Charles Homer, MD, MPH

Even before COVID-19, the statistics around economic status and life expectancy were staggering. A recent study demonstrated that there is as much as a 14 year difference in the average life expectancy between the lowest and highest income people in the United States. Although these numbers are already astonishing, the spread of COVID-19 has even further highlighted the health disparities in the US. Hospital data released by the Centers for Disease Control and Prevention showed that 33% of hospitalized patients were African American, while they make up only 13% of the US population. In New York City, COVID-19 is killing African American and Latinx residents at twice the rate that it is killing white residents. These are only a few examples of the disparities in the pandemic’s victims.

What is the reason for these large-scale inequities? It’s a complicated answer. Factors like access to healthcare, pre-existing medical conditions, and socioeconomic conditions all come into play. In the end, it boils down to the systemic inequities faced by minorities and people of low-income backgrounds.

Image from CBSLocal News

“There’s a concept in public health [called] social determinants of health. …Basically it says that the real drivers of health are the social conditions in which you live,” Dr. Homer explains. Socioeconomic conditions, health behaviors, pre-existing conditions, and disparities in healthcare are all functions of the conditions in which people go about their lives. Higher rates of infection can occur for people who work in jobs that can’t be done remotely, and who depend on public transit to get around. Still needing to attend work and inability to practice social distancing leads to higher risk of exposure and ultimately higher rates of infection. To provide for themselves and their families, individuals often must continue to work jobs that endanger their health.

“There’s been a lot of work over the past several decades looking at what drives health,” Dr. Homer explains. Yes, there are higher rates of conditions like diabetes and hypertension in communities with people of color, but just using that as an explanation isn’t enough. The environment and economic factors of where someone is living greatly affect the rates of these conditions. Pre-existing conditions can be caused by air pollution from airports and power plants near the homes of lower-income communities. Environmental racism leads to higher rates of asthma and lung conditions in communities with more black and brown residents. “Sure, maybe COVID-19 is indiscriminate.” Dr. Homer says. “But when you get COVID-19, because you’ve been living in a place with air pollution, [you’re more likely to end up in the ICU]. You might say, oh it’s just air pollution, air pollution is not discriminating. Well, air pollution is discriminating because it depends on where you live.”

Healthcare disparities also play a role in the reasons for increased mortality rates in lower-income communities. Racial and socioeconomic differences in access to healthcare can affect the way people receive medical attention. Especially when it comes to health insurance, immigrant and undocumented immigrant communities tend to be left behind. The uninsured receive less care and have a harder time getting access to treatments. Dr. Homer says that while public hospitals are very helpful, there can be discrimination and mistakes when it comes to the allocating of resources and treatments. “There’s certainly ample evidence of discrimination and structural racism [in healthcare and medicine], but I wouldn’t jump to that as the primary reason,” Dr. Homer clarifies.

Dr. Homer also pointed out that the COVID-19 health disparities are prevalent in the community around us. The state of Massachusetts recently released a report of the confirmed Coronavirus cases, with Chelsea as an outlier in terms of number of cases per 100,000 people. Chelsea had 1890.37 cases per 100,000 people. To put that in perspective, Boston had 663.20 and Brookline had 223.66.

As people living in Massachusetts, it’s important to remember our privilege and the clear inequalities across the greater Boston area. The disparities in rate of infection between towns like Brookline and Chelsea are undeniable.

I also talked with Dr. Homer about the effects of COVID-19 on children in lower-income communities. Children with COVID-19 exhibit far less symptoms, and have much lower mortality rates than adults. However, as Dr. Homer explains, children, especially ones living in low-income communities, are being significantly hurt by the outbreak as well. “There is a very significant effect on children. First of all, the stress you experience, the trauma you experience by observing your parents, observing the scarcity that people have… that has a lifelong impact on kids’ mental health, and actually a lifelong impact on physical health. That’s critically important,” Dr. Homer emphasizes. When parents contract COVID-19, the issue of finding a caregiver for children is harder for people in low-income communities. Children in foster care whose caretakers can no longer look after them have to relocate. Kids with special needs, kids who rely on home-nurses, and kids with pre-existing lung conditions are put at a higher risk.

But all of these disparities in the COVID-19 outbreak are not new concepts. Health inequities, both racial and economic, have been prevalent in the United States for a long time. All of these issues existed before the virus, Dr. Homer tells me. “It’s just that COVID-19 is making it more obvious and more immediate.” The racial and economic disparities in health are something that we need to address as a state and as a country. These are pressing issues that are in the spotlight due to COVID-19, but it’s important to not forget about them when the outbreak dies down.

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