The pandemic has had a disproportionate impact on racial/ethnic groups, low-income earners, and women, according to a new review from Public Health Nursing (PHN).
The findings from the systematic review, published this week by Wiley Online Library, emphasize the direct relationship between social determinants of health (SDoH) and the health and well-being outcomes of adults amid the COVID-19 pandemic.
As the pandemic exacerbated SDoH and subsequent health inequities, vulnerable populations have faced concerning health outcomes far beyond the virus. To better understand the impacts of SDoH and health outcomes amid COVID-19, PHN researchers evaluated 15 papers published in the first six months of the pandemic that reported on SDoH or health outcomes and wellbeing.
Three key conclusions were drawn from PHN’s research:
1. Racial minority and low-income populations are more susceptible to and have been disproportionately affected by COVID-19 in multiple ways.
Racial minority and low-income populations have been disproportionately affected with high numbers of COVID-19 cases and substantially higher mortality rates due to COVID-19 than any other group. Because the vulnerable populations are already prone to other SDoH and are at a higher risk of chronic diseases, they are predisposed to worse health outcomes if they were to contract COVID-19.
Racial and ethnic disparities deriving from structural health inequalities such as racism, poverty, economic vulnerability, and a lack of social services play a significant role as well. Communities of color and low-income earners have been unable to work from home, increasing their exposure to COVID-19 and limiting their ability to practice physical distancing. Unable to afford to stock up on food items and household supplies, many struggled with food insecurity due to others stockpiling goods. Disadvantaged community members also struggled to secure housing amid the pandemic. Shelters reached record-high numbers of capacity and overcrowding, furthering risk of virus transmission.
2. COVID-19 has exacerbated gender inequalities and family violence and caused diminished wellbeing among women.
The closing of schools and childcare due to COVID-19 has added pressure to families, particularly women who carry more of the responsibility for childcare in the home. The burden of balancing paid work and around-the-clock childcare all from home has negatively affected women’s wellbeing, explained PHN, noting research has indicated women will face an unequal loss of income throughout the pandemic compared to men.
The pandemic has also exacerbated tensions and stressors in family relationships, causing an increased concern of domestic and family violence. With limited options to leave the home or their abuser, combined with loss of income and resources, women are especially vulnerable.
3. COVID-19 has exacerbated SDoH including unemployment/income, lack of access to health care, housing instability, homelessness, and challenges in physical distancing.
The pandemic has intensified longstanding SDoH experienced by disadvantaged communities, especially in geographical locations with limited access to health care. Population groups in these areas not only face barriers to COVID-19 testing and hospitalization but limited care for other existing health conditions.
Access to health care has been further limited by some states’ refusal to accept the Affordable Care Act, causing regional hospital closures as well as an increase in health coverage disruptions among racial/ethnic populations. With limited access to care and a lack of coverage, health conditions are expected to worsen and lead to poorer outcomes, explained PHN.
Public health actions in collaboration with governments and public health professionals are critical to support vulnerable populations throughout the pandemic and prevent worsened conditions in the future, according to PHN researchers, who called for SDoH consideration in vaccine rollout, policy decisions made in result of COVID-19, and community partnerships.