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Table of Contents
EDITORIAL
Year : 2021  |  Volume : 10  |  Issue : 2  |  Page : 67-69

Health disparities and the COVID-19 pandemic


Department of Health Information Management, Wilson N Jones Hospital, Sherman, Texas, US

Date of Submission05-Feb-2021
Date of Acceptance10-Feb-2021
Date of Web Publication17-Jul-2021

Correspondence Address:
Shyam Chirravoori
Clinical Documentation Improvement Specialist, Department of Health Information Management, Wilson N Jones Hospital, Sherman, Texas, 75092
US
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcsr.jcsr_13_21

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How to cite this article:
Chirravoori S. Health disparities and the COVID-19 pandemic. J Clin Sci Res 2021;10:67-9

How to cite this URL:
Chirravoori S. Health disparities and the COVID-19 pandemic. J Clin Sci Res [serial online] 2021 [cited 2021 Aug 3];10:67-9. Available from: https://www.jcsr.co.in/text.asp?2021/10/2/67/321695



Once Martin Luther King Jr. said, 'Of all the forms of inequality, injustice in health care is the most shocking and inhumane'.[1] Unfortunately, the inequality continues in the form of health disparity for almost all diseases; however, the current pandemic of COVID-19 has sharply shed light on the innumerable challenges of the health disparities. Despite the progress in science and technology, health experts could not gauge the challenges of the pandemic.[2]

Health disparities are preventable differences in the burden of disease, injury, violence or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.[3] The World Health Organization definition is as follows: Differences in health outcomes that are closely linked with social, economic and environmental disadvantage are often driven by social conditions in which individuals live, learn, work and play.[4]

COVID-19 was initially thought to be an equal-opportunity killer. But, it became evident that it is not be so. Victims of COVID are often the poor and economically vulnerable, living in crowded conditions, including prisons, often without access to healthcare. These are social determinants of health.[5] Social determinants of health are conditions in the places where people live, learn, work, play and worship. These social determinants influence a wide range of health risks and outcomes, such as COVID-19 infection, severe illness and death. Long-standing inequities in social determinants of health that affect these groups, such as poverty and healthcare access, are interrelated and influence a wide range of health and quality-of-life risks and outcomes.

As early as 1995, Link and Phelan put forward the 'Theory of fundamental causes'.[6] This theory explains (i) why the relationship between socioeconomic status and health outcomes is so persistent and is very useful understanding why improving public health is relevant; (ii) how rising living standards, improving nutrition better drinking water and disposal of sewer would improve health status of communities; and (iii) how better medical technology, better education and healthy behaviours impact health.

COVID-19 can attack almost any system of the body with devastating consequences. It is believed that its ferocity is breath taking and humbling.[7] As if that is not enough, new coronavirus variants are identified in the UK, Colorado and California, Florida States of the USA and elsewhere.[8],[9] It is currently believed that new variants are more infectious and spread more rapidly but does not cause more severe illness.

Physically concentrated places such as nursing homes, factories and prisons disproportionately enhance the risk for COVID-19 infection amongst the inhabitants. Certain categories of workers such as health workers and service workers are exposed workers in the sense they are at greater risk as compared to information technology workers or clerical or executive workers. These are the workers who cannot stay at home or work from home. There are people or patients with compromised immunity or old people whose immunity might be low due to old age. Then, there is the specific problem of the paid sick leave. Several groups of workers do not have paid sick leave due to the policies of employers or governments. The current pandemic brought this policy into focus which enhances the disparities.[10]

Data from the Centers for Disease Control and Prevention, Atlanta, USA clearly show that racial and ethnic minority groups are disproportionately represented amongst COVID-19 cases. Distribution of COVID-19 deaths and population distribution by race and ethnicity display that racial and other ethnic groups other than non-Hispanic Whites are disproportionately affected. Hospitalizations due to COVID-19 are also disproportionately more in these racial ethnic groups. It is important to know that data collection and reporting have not been uniform across states and places. It appears that when data collection and reporting become better, the health disparities are likely to be pronounced more sharply.[11],[12],[13]

However, recently, it has been reported that COVID-19 mortality has exhibited a wide range of variability across different nations. The richer nations exhibited a greater mortality rate as compared to poor nations.[14] Disparate impact[15] may also be responsible for the health disparities. As explained elsewhere, poor resources affect living conditions. Lower education and discrimination affect job types. Unequal workplace policies leave some groups of people vulnerable. Poor healthcare or lack of healthcare affects outcomes. All this in combination may impact all disparities.

Here, it may be relevant that caste and COVID-19 or diseases in India have similar poor health outcomes in certain castes and communities both before and during the pandemic.[16],[17],[18],[19],[20] The current pandemic COVID-19 is enhancing the slur of untouchability of Indian Caste system.[16] Much before the emergence of pandemic, it is observed that the inequalities by geography, Caste, gender, and other disadvantaged factors have been there and the challenges have not been uniform. Development and progress across various states have not been uniform and consistent.[17] As early as 2007, it is found that women from the lower Castes have greater likelihood of anaemia, higher neonatal and infant mortality rates, and their children have a 30% higher likelihood of dying before their fifth birthday and only one in two have access to vaccinations.[18] Another study[19] reported that waiting time when visiting private doctors increased for those from lower social caste. India's instant corona lock down had its own unexpected consequences adding to the iniquities and sufferings of underprivileged and the marginalized communities of the society.[20]

Unintended consequences of COVID-19 mitigation strategies also resulted in health disparities.[20],[21],[22] COVID-19 mitigation activities are the actions that people and communities are expected to take to slow the spread of the virus. These include: hand washing, staying at home during sickness, practicing social distancing, wearing a face mask, restrictions on movements such as travel and group gatherings, academic and business closures and stay at home orders. The goal of these mitigation strategies is to minimize COVID-19 cases and deaths. However, these well-meaning strategies also may have some economic, social and secondary health consequences, resulting in unexpected unwanted health disparities.

Leaders of all walks should work together and public health leaders should pave the way. All measures should be taken to reduce the spread of COVID-19, minimize the severity of illness and lessen the mortality to the possible extent. It is understood there are unintended consequences of COVID-19 mitigation strategies, and there is a dire necessity to allay these consequences. The priority should be given to improve the access to healthcare coverage and healthcare services for testing, prevention and treatment.

There is an urgent need to ponder what needs to be done for the uninsured population. Something like expansion of Medicaid or similar assistance programs should be considered, conceived and executed. Generation of high-quality data on COVID-19 to identify and address various health disparities is paramount. Protection of frontline workers is equally important in combating the pandemic. Finally, addressing the social and economic determinants of health is not only important for COVID-19, but all diseases, both communicable and non-communicable.



 
  References Top

1.
King ML Jr. Presentation at the Second National Convention of the Medical Committee for Human Rights. Chicago;1966.  Back to cited text no. 1
    
2.
Sridhar D. COVID-19: What health experts could and could not predict. Nat Med 2020;26:1812.  Back to cited text no. 2
    
3.
Centers for Disease Control and Prevention. COVID-19 Racial and ethnic health disparities. Available from: https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/. [Last accessed on 2021 Feb 04].  Back to cited text no. 3
    
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Health inequities and their causes. Available from: https://www.who.int/news-room/facts-in-pictures/detail/health-inequities-and-their-causes. [Last accessed on 2021 Feb 04].  Back to cited text no. 4
    
5.
World Health Organization. Social determinants of health. Available from: https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1. [Last accessed on 2021 Feb 04].  Back to cited text no. 5
    
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Phelan JC, Link BG, Tehranifar P. Social conditions as fundamental causes of health inequalities: Theory, evidence, and policy implications. J Health Soc Behav 2010;51 Suppl:S28-40.  Back to cited text no. 6
    
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Wadman M, Couzin-Frankel J, Kaiser J, Matacic C. How does coronavirus kill? Clinicians trace a ferocious rampage through the body, from brain to toes. Available from: https://www.sciencemag.org/news/2020/04/how-does-coronavirus-kill-clinicians-trace-ferocious-rampage-through-body-brain-toes. [Last accessed on 2021 Feb 04].  Back to cited text no. 7
    
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Wise J. Covid-19: New coronavirus variant is identified in UK. BMJ 2020;371:m4857.  Back to cited text no. 8
    
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The coronavirus crisis. U.S. COVID-19 Death Toll Tops 350,000. Available at URL: https://www.npr.org/sections/coronavirus-live-updates/2021/01/02/952842631/new-covid-19-variant-spreads-to-dozens-of-countries. [Last accessed on 2021 Feb 01].  Back to cited text no. 9
    
10.
Ranji U, Long M, Saganicoff A. Coronavirus puts a spotlight on paid leave policies. Available from: https://www.kff.org/coronavirus-covid-19/issue-brief/coronavirus-puts-a-spotlight-on-paid-leave-policies/. [Last accessed on 2021 Feb 02].  Back to cited text no. 10
    
11.
Centers for Disease Control and Prevention. COVID-19 racial and ethnic health disparities. Disparities in COVID-19 illness. Available from: https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/increased-risk-illness.html. [Last accessed on 2021 Feb 05].  Back to cited text no. 11
    
12.
Centers for Disease Control and Prevention. COVID-19 racial and ethnic health disparities. Disparities in deaths from COVID-19. Available from: https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/disparities-deaths.html. [Last accessed on 2021 Feb 01].  Back to cited text no. 12
    
13.
Centers for Disease Control and Prevention. COVID-19 racial and ethnic health disparities. Disparities in COVID-19-associated hospitalizations. Available from: https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/disparities-hospitalization.html. [Last accessed on 2021 Feb 01].  Back to cited text no. 13
    
14.
Chatterjee B, Karandikar RL, Mande SC. Mortality due to COVID-19 in different countries is associated with their demographic character andprevalenceof autoimmunity. Curr Sci 2021;120:501-8.  Back to cited text no. 14
    
15.
Sholas MG. The actual and potential impact of the novel 2019 coronavirus on pediatric rehabilitation: A commentary and review of its effects and potential disparate influence on Black, Latinx and Native American marginalized populations in the United States. J Pediatr Rehabil Med 2020;13:339-44.  Back to cited text no. 15
    
16.
Sur P. Under India's caste system, dalits are considered untouchable. The Coronavirus is intensifying that slur. CNN. Available from: https://edition.cnn.com/2020/04/15/asia/india-coronavirus-lower-castes-hnk-intl/index.html. [Last accessed on 2020 Apr 16].  Back to cited text no. 16
    
17.
Cowling K, Dandona R, Dandona L. Social determinants of health in India: Progress and inequities across states. Int J Equity Health 2014;13:88.  Back to cited text no. 17
    
18.
Nayar KR. Social exclusion, caste and health: A review based on the social determinants framework. Indian J Med Res 2007;126:355-63.  Back to cited text no. 18
[PUBMED]  [Full text]  
19.
Shaikh M, Miraldo M, Renner AT. Waiting time at health facilities and social class: Evidence from the Indian caste system. PLoS One 2018;13:e0205641.  Back to cited text no. 19
    
20.
Agoramoorthy G, Hsu MJ. How the coronavirus lockdown impacts the impoverished in India. J Racial Ethn Health Disparities 2020:1-6. [doi: 10.1007/s40615-020-00905-5].  Back to cited text no. 20
    
21.
Centers for Disease Control and Prevention. COVID-19 racial and ethnic health disparities. Unintended consequences of COVID-19 mitigation strategies. Available from: https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/disparities-impact.html. [Last accessed on 2021 Feb 02].  Back to cited text no. 21
    
22.
COVID-19 Policy Brief: Disparities Among Rural Communities in the United States. Version: December 22, 2020. Available from: https://www.idsociety.org/globalassets/idsa/public-health/covid-19/covid19-health-disparities-in-rural-communities.pdf.[Last accessed on 2021 Feb 02].  Back to cited text no. 22
    




 

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