Environments, Behaviors, and Inequalities: Reflecting on the Impacts of the Influenza and Coronavirus Pandemics in the United States

Abstract

In the past century, dramatic shifts in demographics, globalization and urbanization have facilitated the rapid spread and transmission of infectious diseases across continents and countries. In a matter of weeks, the 2019 coronavirus pandemic devastated communities worldwide and reinforced the human perception of frailty and mortality. Even though the end of this pandemic story has yet to unfold, there is one parallel that is undeniable when a comparison is drawn between the 2019 coronavirus and the 1918 influenza pandemics. The public health response to disease outbreaks has remained nearly unchanged in the last 101 years. Furthermore, the role of environments and human behaviors on the effect and response to the coronavirus pandemic has brought to light many of the historic and contemporaneous inequalities and injustices that plague the United States. Through a reflection of these pandemic experiences, the American burden of disparity and disproportionality on morbidity, mortality and overall social determinants of health has been examined. Finally, a reimagination of a post-coronavirus existence has also been presented along with a discussion of possible solutions and considerations for moving forward to a new and better normal.

Clinicians, cooks, and cashiers: Examining health equity and the COVID-19 risks to essential workers

“…Moreover, it has been found that over 30% of EWs would have to borrow money to pay for an unexpected US$500 medical bill (Kearney and Muñana, 2020). Compounding these economic circumstances, many Black Americans and other people of color have experienced challenges securing health-care access and insurance (Roberts and Tehrani, 2020). For instance, COVID-19 testing inequities have been observed throughout the pandemic (Tribune, 2020).…”

“…Overall, people of color have been found to be overrepresented in many frontline industry occupations, such as bus drivers, postal workers, childcare workers, personal care aides, social workers, and nursing assistants, with approximately 41% identifying as Black, Hispanic, Asian American/Pacific Islander, or some classification other than White ( Rho et al, 2020 ). Likewise, many EWs have also been designated as economically vulnerable, as one in three reported living in a household earning less than US$40,000dollars a year, one in seven lacked health insurance, and millions have relied on government assistance programs ( Kearney and Muñana, 2020 ; Roberts and Tehrani, 2020 ). Based on data from the 2014–2018 American Community Survey, a substantial percentage of women, particularly women of color, have worked in low-wage jobs, including housekeeping cleaners (60%), nursing assistants (50%), and personal care aides (46%), which are jobs that can increase COVID-19 exposure because of the contact with coworkers and the public ( Frye, 2020 ; Roberts and Tehrani, 2020 ).…”

“…This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care” ( Braveman et al, 2017 ). These obstacles have generally been defined as “social determinants of health” or the conditions that negatively or positively impact birth, growth, living, learning, working, playing, and aging ( Roberts and Tehrani, 2020 ). As illustrated in the COVID-19 determinants of health model ( Figure 1 ), an adaptation of the Kaiser Family Foundation model, COVID-19 risk can be attributed to both individual and social determinants of health ( Artiga, 2020 ; Hu and Roberts, 2020 ).…”

Green Infrastructure in the Time of Social Distancing: Urban Policy and the Tactical Pandemic Urbanism

“…Existing urban open spaces often acted as open-air hospitals [6]. Exposure to fresh air, sunshine and gentle exercise were official treatment methods in the influenza pandemic [7] reducing the number of infections and deaths reported at open-air hospitals [8]. Medical research showed that regular meals, warmth, and plenty of fresh air and sunlight helped severely ill patients recover better than indoor nursed patients [8].…”

Case-comparison study protocol for gauging effects of neighbourhood trends and sickness: examining the perceptions of transit-Induced gentrification in Prince George’s County

“…The relationship between TIG perception and social determinants of health (SDOH), or rather, factors that contribute to health, including the conditions of birth, growth, living, learning, working, playing and ageing, have been less understood. 71 Research has shown that the availability of affordable housing and increase of walkable streets, as well as a reduction in crime, are SDOH related to gentrification and, more specifically, TIG. 44 46 Although the presence of walkable streets during the construction period of TOD may be limited, the use of LRT after construction has been found to be associated with an increased likelihood of walking.…”