Covid-19 Overview

Social Determinants of Health

Social determinants of health (SDH) are defined by The World Health Organization as “conditions in which people are born, grow, live, work & age. These circumstances are shaped by the distribution of money, power & resources at global, national, & local levels. Social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries”


Some of the specific SDH that affect an individual's quality of life include:


Healthcare Access & Quality including access to primary and preventative care, health insurance, and transportation costs & barriers in accessing healthcare sites. It can include trust (or lack of trust) in one's healthcare provider as well as the healthcare system and the belief (or lack of belief) that your healthcare provider will understand your specific needs.


Education Access & Quality including educational attainment, language barriers, access to early childhood education, childcare, internet access, and technology necessary for remote learning.


  • Factors such as low socioeconomic status, disability, and social discrimination have been shown to lead to lower high school graduation rates and lower levels of higher education. This often leads to less stable and lower-paying jobs which have been linked to poor health outcomes such as heart disease, diabetes, and depression.


Economic Stability which includes poverty, employment, food security, and housing stability

  • Difficulty finding & sustaining a job – added challenges for those with disabilities, injuries, or chronic health conditions.

  • Issue related to affording stable child care.

  • Stressors associated with poverty have been linked to changes in children's brain development which are subsequently linked to poor health outcomes.


Neighborhood & Environment including quality of housing, access to transportation, access to healthy foods, air & water quality, neighborhood crime & violence

  • Work exposure that puts individual's at risk (i.e., secondhand smoke, unsafe working conditions)

COVID-19 & Discrimination

  • Research has shown that throughout the Covid-19 pandemic, hospitalization and mortality due to Covid-19 was higher among black Americans than white Americans


  • One study found that despite 20% of U.S. counties being black, they accounted for 52% of COVID-19 diagnoses and 58% of COVID-19 deaths nationally


  • Research found that during the pandemic, geographic areas that reported both less testing and low proportion positive tests were found to have a higher average income, education, & a predominantly white population. Conversely, geographic areas that reported high testing rates and a high proportion of positive tests were found to be disproportionately black and of low socioeconomic status

1 in 10 people in the United States currently do not have health insurance (Berchick et al., 2018)

COVID-19 & Healthcare Access & Utilization


  • Lack of transportation, child care, flexibility to take time off work, language and cultural barriers, as well as discrimination embedded in healthcare systems, are some of the reasons people of color site when thinking about negative health care experiences.

COVID-19 & Occupation


  • Due to their status as essential workers, these individuals faced an increased risk of contracting COVID due to increased and unavoidable contact with others due to the nature of their work and an inability to work from home.

In 2018, the poverty rate for people living with a disability was 25.7%

COVID-19 & Housing




  • Due to the COVID-19 pandemic and the subsequent evictions and homelessness individuals have faced, racial and ethnic minority groups have reported disproportionate unemployment rates compared to their white counterparts.


  • Community mitigation strategies (i.e., social distancing & limiting large gathers) that have been put into place in an attempt to slow the spread of COVID-19 have caused harm in the form of lost wages, reduced access to services, and increased stress, for many racial and ethnic minority groups.

In the United States, Black people have died at 1.4 times the rate of white people due to COVID-19

COVID-19 & Health Disparities



  • Racial & ethnic minority groups have faced an increased risk of exposure to COVID-19 due to housing, occupation, education, income & wealth gaps


COVID-19 Vaccine Rollout















  • Data has shown that Black and Latinx populations have been vaccinated at a lower rate than their non-Hispanic white counterparts.



  • National data from the CDC has found that, as of March 25, 2021, Black and Latinx individuals represent only about 7.2% of total COVID-19 vaccinations.

References

Berchick, E.R., Hood, E., & Barnett, J.C. (2018). Health Insurance Coverage in the United States: 2017. Retrieved from https://www.census.gov/content/dam/Census/library/publications/2018/demo/p60-264.pdf


Bureau, U. S. C. (2019, November 8). Health Insurance Coverage in the United States: 2018. The United States Census Bureau. https://www.census.gov/library/publications/2019/demo/p60-267.html.


Cordes, J., & Castro, M. C. (2020). Spatial analysis of COVID-19 clusters and contextual factors in New York City. Spatial and Spatio-Temporal Epidemiology, 34, 100355.


Economic Stability. Economic Stability - Healthy People 2030. (n.d.). https://health.gov/healthypeople/objectives-and-data/browse-objectives/economic-stability.


Education Access and Quality. Education Access and Quality - Healthy People 2030. (n.d.). https://health.gov/healthypeople/objectives-and-data/browse-objectives/education-access-and-quality.


Health Care Access and Quality. Health Care Access and Quality - Healthy People 2030. (n.d.). https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality.


Institute of Medicine; Board on Health Sciences Policy; Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care; Brian D. Smedley. (2002, March 20). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Confronting Racial and Ethnic Disparities in Health Care | The National Academies Press.


Institute of Medicine (US) Committee on the Consequences of Uninsurance. (2002). Care Without Coverage: Too Little, Too Late. National Academies Press (US).


Kim, S. J., & Bostwick, W. (2020). Social Vulnerability and Racial Inequality in COVID-19 Deaths in Chicago. Health Education & Behavior, 47(4), 509–513.


Lewis, N. M., Friedrichs, M., Wagstaff, S., Sage, K., LaCross, N., Bui, D., … Dunn, A. (2020). Disparities in COVID-19 Incidence, Hospitalizations, and Testing, by Area-Level Deprivation — Utah, March 3–July 9, 2020. MMWR. Morbidity and Mortality Weekly Report, 69(38), 1369–1373.


Millett, G. A., Jones, A. T., Benkeser, D., Baral, S., Mercer, L., Beyrer, C., … Sullivan, P. S. (2020). Assessing differential impacts of COVID-19 on black communities. Annals of Epidemiology, 47, 37–44.


Neighborhood and Built Environment. Neighborhood and Built Environment - Healthy People 2030. (n.d.). https://health.gov/healthypeople/objectives-and-data/browse-objectives/neighborhood-and-built-environment.


Paradies, Y. (2006). A systematic review of empirical research on self-reported racism and health. International Journal of Epidemiology, 35(4), 888–901.


Price-Haywood, E. G., Burton, J., Fort, D., & Seoane, L. (2020). Hospitalization and Mortality among Black Patients and White Patients with Covid-19. New England Journal of Medicine, 382(26), 2534–2543.


Social and Community Context. Social and Community Context - Healthy People 2030. (n.d.). https://health.gov/healthypeople/objectives-and-data/browse-objectives/social-and-community-context.


The Annie E. Casey Foundation. Unequal Opportunities in Education [online]. 2006 [cited 2020 Jun 24]. Available from: https://www.aecf.org/m/resourcedoc/aecf-racemattersEDUCATION-2006.pdf


Wadhera, R. K., Wadhera, P., Gaba, P., Figueroa, J. F., Joynt Maddox, K. E., Yeh, R. W., & Shen, C. (2020). Variation in COVID-19 Hospitalizations and Deaths Across New York City Boroughs. JAMA, 323(21), 2192.


Webb Hooper, M., Nápoles, A. M., & Pérez-Stable, E. J. (2020). COVID-19 and Racial/Ethnic Disparities. JAMA, 323(24), 2466.


World Health Organization. (n.d.). Social determinants of health. World Health Organization. https://www.who.int/teams/social-determinants-of-health.