Addressing Racial and Ethnic Disparities During the COVID-19 Pandemic

The COVID-19 pandemic has exposed healthcare disparities in the United States and highlighted the need for medical communities to work toward ending those inequalities. The Health Equality and Diversity Committee (HEDC) of the American Thoracic Society (ATS) recently hosted a virtual town hall meeting to address racial and ethnic disparities in healthcare. The HEDC subsequently published the article titled “The Structural and Social Determinants of the Racial/Ethnic Disparities in the U.S. COVID-19 Pandemic. What’s Our Role?” that identified some of the health disparities that have been revealed during the pandemic, and steps that ATS members can take to work toward achieving greater health equality.1

In this article, Neeta Thakur, MD, Assistant Professor in Residence, Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco, and colleagues discussed the prevalence and mortality associated with COVID-19 among racial and ethnic groups. According to the Centers for Disease Control and Prevention, the prevalence of COVID-19 in Latino Americans has been disproportionately high.2 Similarly, the mortality rates from COVID-19 in black Americans far exceeds the proportion of the US population they represent.3

Racial and Ethnic Groups Face Numerous Challenges

Dr Thakur and colleagues highlighted several unique challenges faced by low-income communities, non–US-born communities, and communities of color, particularly in relation to the COVID-19 pandemic, including increased exposure to the virus and limited access to information and care. They also identified structural and social determinants of health that have contributed to these challenges and disparities.

Increased Exposure

The authors asserted that members of minority communities are at higher risk for infection. This is a result of increased exposure because of occupational or living circumstances. They reported that 70% of employees providing essential services in New York City are people of color, and that national statistics are similar.1 Essential workers often depend on hourly wages and may continue to work despite inadequate personal protective equipment (PPE). In addition, childcare and eldercare may present a challenge for these individuals, further increasing exposure within their communities as their social networks expand to provide care for dependents. High-density housing and crowded living conditions, which make social distancing and self-isolation much more challenging in many communities, also increase risk for infection.

“These considerations have long-term implications, as the ability to self-isolate and rapidly readopt shelter-in-place orders will be crucial over the next 12-18 months, as we move from the active phase of the pandemic to the second phase of disease containment,” the authors noted.

Limited Access to Information and Care

The authors identified several factors that may contribute to limited access to information, which may lead to greater challenges. Minority communities with low socioeconomic status or limited English proficiency receive less public communication during crises. These vulnerable populations may also lack Internet access, further limiting the availability of information. Education regarding viral transmission and preventive measures to slow transmission is vital but may not reach many of these communities.

Limited access to healthcare services, including testing for COVID-19 and care for those with the infection, have been identified in minority communities and communities with low socioeconomic status. In addition, the economic pressure brought on by the pandemic has left some communities with a lack of funding for community and federally qualified health centers.

“This has left many communities without access to timely testing and potentially without a lifeline for accessing care when feeling unwell,” the authors noted.

In addition, health systems primarily serving the urban poor often lack the capital available in more resourced medical centers. Without adequate funding, these centers face challenges in pivoting to new systems such as telehealth, and in obtaining adequate supplies, including PPE.

Strategies for Improving Access to Information and Care

Members of the HEDC and other participants in the town hall meeting identified several strategies that can be used to reduce disparities. Because increasing access to information and care remains a top priority, the ATS and American College of Chest Physicians have jointly developed online educational materials on COVID-19, which are available in English and Spanish (https://formylunghealth.com).4 Additional areas of focus for the ATS and its members include improving information delivery (including cooperation with other medical societies to support efforts and legislation for universal access to broadband Internet) and prioritizing the effective communication of accessible health information.

Healthcare providers need to be aware of the root causes of health inequity as it relates to COVID-19. These include work environment, transportation, and housing, which may contribute to higher rates of exposure for certain patients. They must also work to identify barriers to care, such as insurance, copayments, childcare, food insecurity, and lack of housing. Providers should be encouraged to discuss these factors with patients in an effort to reduce the potential negative effects on care plans. They should also be prepared to provide patients with referrals to social workers, local programs, and community resources when the need arises.

ATS’s Position and Guidelines on Overcoming Disparities

As an organization of pulmonary and critical care specialists, the ATS is positioned to set standards and practice guidelines related to COVID-19. This may include advocating for appropriate safety and PPE for individuals in all types of employment as well as hazard pay for those employed in high-risk jobs. The ATS continues to develop resources and guidelines for the care of patients with COVID-19. To ensure that these standards are met across all population groups, this should include guidance on the provision of high-quality care in low-resource settings and during surge-capacity situations.

Healthcare is a right and universal access to affordable health insurance is a necessary step toward ending healthcare inequality in the United States. The ATS is encouraging its members to take a position locally in support of causes that will work toward closing the gap on health disparities.

References

  1. Thakur N, Lovinsky-Desir S, Bime C, et al; for the Health Equality and Diversity Committee of the American Thoracic Society. The structural and social determinants of the racial/ethnic disparities in the U.S. COVID-19 pandemic. What’s our role? Am J Respir Crit Care Med. 2020;202:943-949.
  2. Centers for Disease Control and Prevention. CDC COVID data tracker: demographic trends of COVID-19 cases and deaths in the US reported to the CDC. Updated November 5, 2020. https://covid.cdc.gov/covid-data-tracker/#demographics. Accessed November 5, 2020.
  3. United States Census Bureau. Quick facts: United States. www.census.gov/quickfacts/fact/table/US/PST045219. Accessed November 4, 2020.
  4. American Thoracic Society, American College of Chest Physicians. For my lung health. https://formylunghealth.com/. Accessed November 4, 2020.

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