Blog Post

COVID-19 in context: Why we need to understand the roots of health disparities

Data shows that the new coronavirus is disproportionately striking black and Hispanic residents and killing black residents at a significantly higher rate than others. This is a tragic reflection of a longstanding reality in our state and country – widespread racial and ethnic health disparities.

Even before this pandemic, people of color in Connecticut were more likely to live in poor health than their white counterparts and, for black residents, to die younger. These differences are not accidental, nor are they the result of biological differences between people of different races. Instead, they reflect differences in the opportunities and barriers to being healthy – differences that are rooted in structural racism and bias.

There has been much reporting on the reasons people of color have been especially vulnerable to COVID-19. These include higher rates of underlying conditions, including asthma and diabetes, as well as economic factors, such as being less likely to have jobs that allow for working from home, potentially increasing their exposure to the virus.

As this disease unfolds, it is important to recognize the roots of these disparities. These include differences in access to health care, unequal treatment within the health care system, unequal access to resources such as stable housing and healthy food, and personal experiences of discrimination and racism that have lasting physical and mental health consequences.

Some key facts: 

  • Black and Hispanic residents are more likely than white residents to lack health insurance. In 2018, the uninsured rate for Connecticut residents under 65 was 4% for whites, 7% for blacks, and 14% for Hispanics. That means that Hispanic residents are almost four times more likely to be uninsured than white residents.
  • Having a regular source of care is a key factor in staying healthy; now, it also means having a place to call if you feel sick and wonder if you need to be tested for COVID-19. Yet in 2018, 33% of Hispanic residents and 23% of black residents did not have a personal doctor (by contrast, only 11% of white residents reported not having a personal doctor).
  • Research has also found that black and Hispanic patients are at risk of receiving less aggressive treatment than white patients. For example, studies found that Hispanic patients were half as likely to be given pain medication when they went to the emergency room with a broken bone, and black children and teens with appendicitis were significantly less likely to be given opioids to treat pain. Among patients with heart issues, black patients were significantly less likely than white patients to receive interventions that could promote long-term survival.
  • Research has also linked experiencing racism and discrimination with a wide range of negative physical and mental health consequences including depression, anxiety, hypertension, breast cancer, and giving birth preterm or having a low-birthweight baby. One way discrimination could lead to poorer health is through repeated activation of the body’s stress response system, which can have negative long-term physical and psychological effects.

Recognizing the existence of these underlying factors will be important as we seek to understand the impact of COVID-19 and as we eventually turn to recovery and rebuilding.

More immediately, we can focus on how these factors relate to testing and treatment for COVID-19. We know that black and Hispanic residents are less likely to have regular access to the health care system and that their symptoms have not always been treated as seriously as those of others. Does this hold true in testing for COVID-19 – that is, are black and Hispanic residents less likely to be referred for COVID-19 testing than others?

With testing availability limited, many people have been turned away from testing. However, given the history of people of color not always having their symptoms taken seriously, there is reason to wonder if white and black patients with the same symptoms would be equally likely to be deemed eligible for a test.

Connecticut leaders have made positive first steps by reporting data on the race and ethnicity of patients who test positive for COVID-19 and for those who have died. Officials can provide even more insight by also reporting all testing data – not just positive tests – by race and ethnicity. This would help give a better sense of who is getting tested and could lead to changes if the data shows disparities.

Many observers have noted that much of the reported testing data does not include race and ethnicity, reflecting a longstanding challenge in the collection of race and ethnicity data in health care. This makes it more difficult to identify and target disparities and should be a focus for policymakers and health systems once we are in a recovery phase and building on the lessons from the pandemic.

Beyond testing, there are also questions about what could happen if the demand for treatment resources such as ventilators exceeds the capacity. Some systems for determining which patients would receive priority take into account underlying health conditions – something that could lead to people of color being far less likely to receive lifesaving treatment.

As we think about other lessons to take from this experience once we are in a place of reflection, it will be critical to recognize the roots of health disparities. It is not enough to acknowledge that black and Hispanic residents are more likely to have underlying conditions and socioeconomic challenges. We must also understand and address the reasons for these differences; only then will we be on the path to making sure everyone has the ability to be as healthy as possible.