This pandemic has shaken the world to its core and will change life as we know it. In the United States, COVID19 has unveiled our dirty little secret—that longstanding historical, racial, and social inequities continue to persist despite extensive public health and clinical efforts. Although COVID-19 is the culprit killing thousands of Americans, the real culprits are individuals, ideologies, and systems that create and support unfavorable Social Determinants of Health (SDOH; e.g., inadequate access to health care, racial inequities, inadequate access to healthy food options, and poor education systems) that continue to plague minorities, who tend to have less privilege and limited access to opportunities. These poor SDOH disproportionately affect African Americans and low-income populations, leading them to carry much of the burden of chronic conditions (diabetes, hypertension, etc.) that put them at a higher risk for severe COVID-19 outcomes, including hospitalizations and death.
We must embrace profound decisions that address these SDOH while addressing the health and wellbeing of Americans during the COVID-19 pandemic and moving forward. Essential workers, especially those in vulnerable situations need more opportunities to recover; they do not have the privilege of working from home. Individuals need protected time (annual and sick leave) to care for children, elderly parents, and themselves or take time to get tested. Individuals and families need health insurance to afford COVID-19 tests and hospitalization costs. Policies, cultural values, socioeconomic status, psychosocial factors impact an individual’s health, well-being, and quality of life. By acknowledging these factors and better understanding them, we can pinpoint policy areas to improve (e.g., demanding health insurance and protected sick time for all Americans) and promote health equity.
‘‘Stay at Home’’ orders promote equity because many employers may have been legally required to shut down, providing employees the privilege or opportunity to stay home, thus avoiding COVID-19 transmission. Stimulus checks promoted equity because Americans were given financial assistance to pay bills, buy groceries, cover COVID-19 screening costs, or purchase protective equipment (masks and gloves). However, because of longstanding inequities, even these policies are not enough to help essential workers, especially those who are racial/ethnic minorities, considered low-income groups, or underprivileged.
African Americans are disproportionately employed in essential positions that place them at a heightened risk of acquiring COVID-19. African Americans make up 37% of certified nursing assistants and home health aides, 34% correctional officers and jailers, and 27% of bus drivers. These employees are considered essential workers with high contact with the public, placing them at a higher risk for COVID-19 and preventable hospitalizations and deaths. Racial disparities in education and job opportunities are just one result of the historical and current policies of exclusion and racism that have caused African Americans to bear a disproportionate burden of poor SDOH and now COVID-19 transmission.
Moving forward, every American should demand (1) adequate health and dental insurance coverage, (2) equal access to high-quality K-12 education and free college education, and (3) an acceptable amount of annual paid sick leave for every American, regardless of race/ethnicity or job title. These are the type of systemic changes we need to begin to close the gap in health care and address deep-rooted racial disparities in this country. Acknowledging our privilege or lack thereof during this pandemic is essential as our new world beyond COVID-19 continues to unfold. Society has the opportunity to change the way service and care is delivered to make sure the most vulnerable are protected— acknowledge the role of SDOH and how they impact African Americans and low-income groups and advocate for those groups.