Data from Illinois, Michigan, and New York shows COVID-19 is disproportionally affecting socioeconomically disadvantaged and racial-ethnic minority Americans. These groups are likely to be among the hardest hit populations nationwide as well.
Andrea N. Polonijo, a Chancellor’s Postdoctoral Fellow in the Department of Social Medicine, Population, & Public Health at the UC Riverside School of Medicine, studies how social factors such as income, education, and race-ethnicity shape health behaviors and outcomes. She received her doctoral degree in 2018 from the University of British Columbia in Canada and worked with Richard M. Carpiano, a professor of public policy and sociology at UCR. She currently works with Brandon Brown, an associate professor in the Center for Healthy Communities.
Polonijo answers a few questions about the social implications of COVID-19:
How could COVID-19 exacerbate socioeconomic and racial-ethnic disparities in health?
The best means of COVID-19 prevention is self-quarantine, but this is more difficult for many lower socioeconomic status and racial-ethnic minority Americans, as they are more likely to live in multigenerational households, rely on public transportation, and hold jobs that require them to attend work in person rather than remotely. Lower socioeconomic status households — a disproportionate percentage of which are also racial-ethnic minority — also lack the financial savings necessary to stock up on essential items to avoid repeated exposure in grocery stores and pharmacies. Rates of underlying health conditions such as chronic respiratory disease, cardiovascular disease, diabetes, and cancer are also higher among low socioeconomic status and racial-ethnic minority groups, making them particularly vulnerable to experiencing serious cases of COVID-19. These groups also experience high rates of noninsurance and barriers to accessing health care services, leaving them at risk to forego or be denied critical COVID-19 care when they need it.
How might these disparities be addressed?
Collecting routine data on the socioeconomic and racial-ethnic backgrounds of COVID-19 patients would help to prioritize the allocation of scarce public health resources to communities that could benefit from them most. Ideally, communities should also be consulted to identify and address their most critical needs. Some possible solutions for mitigating the impact of disparities could involve distributing multilingual up-to-date prevention information, providing low- or no-cost housing to members of households that are working on the frontlines or who have conditions that put them at high-risk of COVID-19 complications, offering affordable alternatives to public transportation, implementing policies that restrict sellers from inflating the cost of food and other basic household items, and ensuring COVID-19 testing and care is affordable and equitably distributed.
What role do social and economic concerns play in how people of color perceive the threat from the novel coronavirus?
Polls have shown that black and Hispanic Americans perceive coronavirus as a greater threat than white Americans. This threat is likely even more salient for people of color who are of low socioeconomic status, as they are less likely to have the types of jobs that allow them to work from home, the savings necessary to meet their basic needs during this unprecedented time, or connections to higher socioeconomic-status people who have resources that they can draw upon. On the one hand, those who are of low socioeconomic status may face layoffs and a loss of income and employer-paid health benefits that have lasting negative consequences for their overall health and well-being. On the other hand, low socioeconomic status workers whose jobs are deemed essential, such as grocery workers or janitorial staff, are put at constant risk of disease exposure on the job and most likely lack the means to pay for alternative accommodations to allow them to self-isolate from their families or housemates.
How might COVID-19 disproportionately affect the poor?
COVID-19 has led to the widespread closure of programs that help support America’s poor. For example, with school closures we’ve seen the cancellation of most school-subsidized meal programs, placing greater financial strain on poor families. With no school supervision, poor parents who are deemed essential workers may now face the choice of leaving their children unsupervised or left under the care of vulnerable grandparents. America’s homeless population, who are among the poorest of the poor, will be particularly impacted. This population lacks access to up-to-date COVID-19 prevention information as well as the basic facilities required to engage in recommended hygiene practices, such as handwashing. Many meal programs have shut down, while homeless shelters may be closed or risky to sleep in due to overcrowding. Moreover, alternative places for food, shelter, and hygiene, such as fast food restaurants, public libraries, and gyms, are also closed leaving few alternatives.
What other negative impacts will we see now that the pandemic has widened social and economic divisions?
We can expect that the widened social and economic divisions due to COVID-19 will have long-term negative impacts on disparities in other health outcomes. For example, growing socioeconomic inequality can be extremely stressful, which may increase rates of suicide and the incidence of a wide array of diseases. Growing socioeconomic inequality may also lead to an increase in health-damaging coping behaviors, such as alcoholism, drug use, and violence. Shocks to income accompanied by the rising cost of essential goods may necessitate that those at the lower end of the socioeconomic spectrum consume more cheap, unhealthy foods, which may exacerbate existing disparities in, for example, heart disease, diabetes, and obesity. Income loss may also force lower income families out of their current homes and into more affordable, yet less safe, accommodations. Finally, many Americans have lost their employer-sponsored healthcare due to job loss and there has been much anticipation of higher healthcare premiums for the next year, which will likely lead to an increase in delayed and foregone care for other health conditions, especially for those most socioeconomically disadvantaged.
What impact has COVID-19 had on education at all levels? What are some ways it could reshape education?
COVID-19 has led educators to seek innovative ways to engage with students outside of the traditional classroom. In most instances this is done virtually, which could have a lasting impact on how technology is integrated in classrooms. However, equitable access to technology is a challenge, and the shift toward virtual learning may exacerbate inequalities in education for some students. Many students may lack computer or internet access and a safe and quiet place to study at home. Most no- or low-cost options for computer and internet, such as libraries and cafes, have closed. While some internet providers are now offering low-cost internet connections, students living in rural and remote communities that lack broadband access have been left behind. The scramble to accommodate the masses online also raises concerns about accessibility: how can we accommodate, for example, students facing mental or physical challenges? Children requiring special education are at increased risk of falling behind if these questions are not addressed at the outset.
How is COVID-19 changing social norms? Are there any that should be dropped or replaced?
Some obvious ways in which social norms are changing is the increased vigilance around public health practices, such as hand-washing, and the blurring of personal and professional lives as a growing number of higher socioeconomic status employees shift to working from home. We’re also seeing the decline of individual agency and rise of prosocial behavior and social accountability, for example, staying home due to government recommendations to help protect vulnerable others and shaming individuals who do not follow social distancing orders. At the same time, Americans may be gaining a new appreciation for lower-paid essential service workers and an awareness of the injustices they face, such as a lack of paid sick time. My hope would be that this leads to their improved working conditions and benefits in the long term. Tragically, COVID-19 has also led to an increase in racism, xenophobia, and violence toward people of Asian descent, which could have long-term negative impacts on their health, safety, and ability to secure employment.