COVID-19 is hitting minorities harder than other communities. According to the Centers for Disease Control, as of June 12, 2020, the age-adjusted hospitalization rates were reported highest among non-Hispanic American Indian or Alaska Native and non-Hispanic black persons, followed by Hispanic or Latino persons. The CDC clearly states that such racial and ethnic minority groups are an increased risk of the getting COVID-19 regardless of age due to long-standing systemic health and social inequities. It has been found that non-Hispanic American Indian, Alaska Native, and non-Hispanic black persons are hospitalized for COVID-19 at a rate 5 times that of non-Hispanic white persons. Hispanic or Latino person have a rate approximating 4 times that of non-Hispanic white persons.

Why are minorities at increased risk during the COVID-19 pandemic?

For decades, health differences among racial and ethic groups have arisen due to living, working, health, and social conditions. During this pandemic, such conditions have not disappeared but work against minorities by isolating them from the resources they need to cope with such outbreaks.

Living conditions contribute to an increased risk of COVID-19 for minority groups. Many minorities live in highly populated communities due to institutional racism. Such institutional racism occurs through residential housing segregation. An example of this can be seen in the overcrowding in tribal reservations and Alaska Native villages. As a result of such densely populated areas, it acts as a barrier to social distancing. Racial housing segregation is all linked to several health conditions such as asthma which increases the risk of becoming severely ill or death from the virus. Also, certain communities with higher minority populations also have increased exposure to pollution and environmental hazards. The reservation homes of non-Hispanic Native Americans also have been found insufficient in plumbing when compared to the rest of the U.S. As a result, it proves a challenge for handwashing to occur regularly. Some members of minority groups also rely heavily on public transportation, making it difficult to follow through with social distancing. Minority groups also more commonly have multigenerational and multi-family households, which makes it harder to protect older adult family member or isolate sick household members in such limited space available. Minority groups are also over-represented in congregate environments such as jails, prisons, homeless shelters, and detention centers, which again presents a challenge for social distancing as they engage in activities of daily living in group settings.

Certain work conditions and policies also put workers at an increased risk of being infected with COVID-19. Certain minorities are more likely to work under such conditions. Being an essential worker in essential industries like health care, meat-packing, grocery stores, and factories put minorities at risk. This is because they are required to still work despite outbreaks occurring in their communities and some may need to work such jobs due to economic circumstances. They also may not have sick leave so such workers are more likely to work despite being sick. Income, education levels, and unemployment are other factors that must be considered. When considering the average earning of minorities compared to non-Hispanic whites, minorities earn less, possess less accumulated wealth, have lower levels of education, and higher rates of unemployment. All such factors contribute to the social and physical conditions of minorities which also affect health outcomes.

Lastly, the health circumstances of minorities play a major role in their being at increased risk of COVID-19. The issue of being uninsured is one of the highest concerns. Hispanics are about 3 times more likely to be uninsured than non-Hispanic whites. Whereas, non-Hispanic blacks are about twice as likely to be uninsured when compared to non-Hispanic whites. Minorities report cost as a barrier to seeing a doctor as well as distrust of the health care system, language differences, and losing wages due to missing work. Minorities also suffer from certain health conditions at higher rates than non-Hispanic whites. Black have higher rates of chronic conditions and at earlier ages with higher death rates than non-Hispanic whites. Non-Hispanic American Indian and Alaska Native adults are reportedly experiencing higher rates of obesity hypertension, and smoking then non-Hispanic white adults. Such health conditions put minorities at increased risk of severe illness. Racism, stigma, and systemic inequalities also contribute to health circumstances that increase the risk of COVID-19 in minorities. Such factors undercut prevention and increase the levels of stress in such communities, therefore, continuing health and healthcare disparities.

What can we do as health care providers and organizations?

As health care providers we must first understand this novel virus and how to best prevent, intervene, and treat it. However, in order to combat the health disparities in minorities, health care systems should offer providers training on how to identify their implicit biases. Providers must understand how implicit bias affects the way they communicate with their patients and how their patients will react to such communication. They also should be trained on how bias can affect their decision-making. Medical interpreters should be available in health care systems. Health care systems should work on community outreach projects in an effort to reduce the cultural barriers to care. As providers, we need to connect our patients with community resources that can help them manage underlying conditions. We should encourage our patients of all backgrounds to ask questions and promote a trusting relationship. All of these strategies could combat the distrust minorities may experience of health care in general. The starting point for all these forms of action is to learn more about the socioeconomic conditions that put certain patients at risk for getting sick with COVID-19. It is my hope that this essay is only the starting point for all health care providers and administrators who read it to aggressively protect the lives of racial and ethnic minority groups during this grueling pandemic.

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