COVID-19 double jeopardy: the overwhelming impact of the social determinants of health

Abstract

Background The COVID-19 pandemic has strained healthcare systems by creating a tragic imbalance between needs and resources. Governments and healthcare organizations have adapted to this pronounced scarcity by applying allocation guidelines to facilitate life-or-death decision-making, reduce bias, and save as many lives as possible. However, we argue that in societies beset by longstanding inequities, these approaches fall short as mortality patterns for historically discriminated against communities have been disturbingly higher than in the general population. Methods We review attack and fatality rates; survey allocation protocols designed to deal with the extreme scarcity characteristic of the earliest phases of the pandemic; and highlight the larger ethical perspectives (Utilitarianism, non-Utilitarian Rawlsian justice) that might justify such allocation practices. Results The COVID-19 pandemic has dramatically amplified the dire effects of disparities with respect to the social determinants of health. Patients in historically marginalized groups not only have significantly poorer health prospects but also lower prospects of accessing high quality medical care and benefitting from it even when available. Thus, mortality among minority groups has ranged from 1.9 to 2.4 times greater than the rest of the population. Standard allocation schemas, that prioritize those most likely to benefit, perpetuate and may even exacerbate preexisting systemic injustices. Conclusions To be better prepared for the inevitable next pandemic, we must urgently begin the monumental project of addressing and reforming the structural inequities in US society that account for the strikingly disparate mortality rates we have witnessed over the course of the current pandemic.

Primary Care’s Challenges and Responses in the Face of the COVID-19 Pandemic: Insights From AHRQ’s Learning Community

“…The COVID-19 pandemic raised awareness of sizable health inequities among racial/ethnic groups and other socioeconomically disadvantaged populations who faced higher rates of infection and death from COVID-19, were disproportionately affected by the economic crisis, and encountered challenges in accessing COVID-19 vaccinations. 13,14 Essential workers in low-wage jobs were at risk for exposure, worsening disparities. The pandemic exacerbated multiple factors contributing to health inequities, including limited access to health care, lack of insurance coverage, limited transportation to testing or vaccine appointments, income gaps, and discrimination.…”

“…The pandemic exacerbated multiple factors contributing to health inequities, including limited access to health care, lack of insurance coverage, limited transportation to testing or vaccine appointments, income gaps, and discrimination. 13,14…”

Attitudes, perceptions, and preferences towards SARS CoV-2 testing and vaccination among African American and Hispanic public housing residents, New York City: 2020–2021

“…The COVID-19 pandemic has had disparate effects on African American and Hispanic populations compared to non-Hispanic Whites. The reasons are multifactorial, involving social and structural determinants of health including differential access to health insurance, high quality medical care, economic opportunities and quality housing [1][2][3]. During the early stages and height of the pandemic, low-income, predominantly minority populations had less access to SARS CoV-2 testing compared to more affluent, predominantly White populations [4][5][6].…”

Community health workers: A sustainable health system innovation or just an emergency response?

“…Whilst having detrimental effects for many populations living in socially vulnerable conditions ( 14 ), the COVID-19 pandemic also stimulated health system innovations ( 1 ). Inspired by CHW programmes in low-and-middle income countries (LMICs), researchers advocated for improved and expanded implementation of CHW programmes in high-income countries (HICs) ( 9 , 15 , 16 ).…”