Pandemic highlights racial disparities in U.S. healthcare
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Abubakarr Jalloh,Β Hollins University
Pandemic highlights racial disparities in U.S. healthcare
How the pandemicβs unequal toll on people of color underlines US health inequities β and why solving them is soΒ critical
From the earliest days of the pandemic, COVID-19 has wrought aΒ far higher toll in communities of colorΒ than in the general population β thrusting the long-standing issue of health disparities in the U.S. into the attention of public health officials and the general public.
Even though non-Hispanic white people make up 60% of the population, racial and ethnic minorities in the United States have borne significantly higher risks of COVID-19 infections than white people, as well asΒ hospitalizationsΒ andΒ deathsΒ from COVID-19.
So aΒ conversation is ragingΒ among doctors, health researchers, public health officials, policymakers, and activists about how to address theΒ social determinants of healthΒ that are driving this unequal toll onΒ communities of color.
I am aΒ global public health professorΒ with expertise in multicultural health and health disparities. My teaching and research focus on theΒ social determinants of health: the layers of policies, economic factors, and social structures that affect health and quality of life, and the complicated ways they interact. I also study social justice in the context of public health, including the sociocultural context of infectious diseases.
Throughout the pandemic, American Indians and Alaska Natives as well as Hispanics and Latinos have borneΒ more than twice the risk of white peopleΒ of death from COVID-19, and Black people have been at nearly twice the risk.
βThe pandemicβs unequal burden on Black communities has placed a spotlight on the longstanding and ongoing impact of systemic racism on the health of Black Americansβ
Rachel Werner
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Research has shown that the pandemicβs unequal toll on communities of color has been driven by long-standing health inequities: injustice or unfairness in the distribution of good health and well-being in society. Public health experts and professionals call the resulting health gaps βhealth disparitiesβ: the inequitable differences that exist between various groups of people in terms of disease, injury, death, and other health issues.
Disparities in U.S. healthcareΒ takes many forms
The World Health Organization describesΒ health inequitiesΒ as differences in health status or the distribution of health resources between certain populations of people. The differences are generally caused by the varied social conditions in which people are born, grow, live and work.
In the U.S., the main drivers of health inequities areΒ structural inequalities. They include poverty, unemployment, lack of health insurance, and inability to afford health care, as well as access to healthy food, good education, and transportation.
Covid-19 pandemic highlights racial disparities in U.S. healthcareCLICK TO TWEET
These problems can cut across race and ethnicity. Overall, however, people of color are atΒ higher risk of poor healthΒ than non-Hispanic white Americans, whom the U.S. Census Bureau defines as being of European, Middle Eastern, or North African ancestry.
For example, Black Americans are twice as likely as their white counterparts to suffer fromΒ hypertension and heart failure. Black Americans also have a diabetes rate of 13% and an obesity rate of 38.3%, compared with 8% and 30% for non-Hispanic white people in the U.S., respectively, according to data from the Centers for Disease Control and Prevention.
In a 2021 study, researchers investigated the influence of social determinants of health on COVID-19 outcomes at the county level. They found that counties with higher overall death rates had a greater proportion of Black residents. They also had higher rates of health and social inequities, including low birth weight, uninsured adults, or households lacking internet.
In 2020,Β life expectancy declinedΒ across most ethnic or racial groups, according to the CDC. However, while the drop for the majority population of white Americans was 1.5 years, Black Americansβ life expectancy dropped by 2.9 years. For people of Hispanic and Latino descent, life expectancy dropped by three years.
Not surprisingly, health inequities also affectΒ immigrants of color. My previous work over the past four years with Hispanics, Black Africans, Burmese, and other minority refugees and immigrants participating in theΒ Iowa Migrant Education ProgramΒ revealed that the health inequities they experience are largely caused by poverty, unemployment, and lack of access to health care.

In 2020, life expectancy declined across most ethnic or racial groups, according to the CDC. However, while the drop for the majority population of white Americans was 1.5 years, Black Americansβ life expectancy dropped by 2.9 years.
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Health equity could help all Americans
TheΒ U.S. populationΒ has become more racially and ethnically diverse over the past decade. Many demographers predict that by 2045, the majority of people in the U.S.Β will be people of color.Β Children of colorΒ already make up the majority of people under age 18 in many states.
But these trends donβt mean that health inequities will improve on their own. Solutions will require dealing withΒ the root causes of inequitiesΒ in all sectors of society, includingΒ education, employment, income,Β housing, transportation, food, and health care.
Research suggests that effectively addressing social determinants of health involves anΒ equity-focused approach. This will require providing not just equal resources and opportunities, but enough resources to reach equal health outcomes for disadvantaged populations.Β In action, this might look like providing disadvantaged neighborhoods with grocery stores that offer healthy food options, or improving parks and playgrounds so residents have better opportunities to exercise, play and enjoy the outdoors.
Read more:Β Racism and depression β the insidious link
Policymakers may be starting to take this approach. For example, the city of Roanoke, Virginia, recently established anΒ equity and empowerment advisory board. The boardβs tasks include reviewing all existing city policies, ordinances, and regulations in order to advise its City Council on those needing change or elimination because they promote inequities.
A massiveΒ body of evidenceΒ shows that eliminating the barriers for certain groups of people will not only enable them to live to their fullest potential but thatΒ health equity is necessaryΒ for aΒ healthy society. Right now theΒ U.S. infant mortality rateΒ averages 5.8 per 1,000 live births β two points higher than in most rich countries. Among the most developed countries in the world, theΒ U.S. ranks 33rd in life expectancy.
Research has shownΒ that those numbers stem largely fromΒ unaddressed health disparities. It remains to be seen whether the pandemic will be the health crisis that finally spurs deep enough changes to bring about health equity and justice.
Abubakarr Jalloh, Assistant Professor of Public Health,Β Hollins University

The Conversation
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Caption:
Throughout the pandemic, American Indians and Alaska Natives as well as Hispanics and Latinos have borne more than twice the risk of white people of death from COVID-19, and Black people have been at nearly twice the risk.