Blog Post

Why our nation’s outbreak preparedness is a health equity issue

The spread of the new coronavirus has given rise to reminders about the importance of proper handwashing and other illness-prevention habits.

Unfortunately, it is also likely to provide a real-life reminder of how unequal our society is when it comes to health, the things that keep us well, and the consequences of getting sick.

Take the advice federal authorities are providing on how to prepare for a coronavirus outbreak: Don’t go to work if you’re sick. Stay home unless you need medical care. If you get medical care, don’t take public transportation or a ridesharing service to get there.

This is important information – but for many people, following these recommendations will be difficult. As the authors of a recent New York Times article point out, many service-industry workers can’t work from home and, with few or no sick days, can’t forgo weeks of pay. Not everyone has access to a car if they need to go to the doctor. Not everyone has insurance that will cover a visit to the doctor or emergency room.

“The disparity could make the new coronavirus…harder to contain in the United States than in other rich countries that have universal benefits like health care and sick leave, experts say,” wrote the authors, Claire Cain Miller, Sarah Kliff, and Margot Sanger-Katz. “A large segment of workers are not able to stay home, and many of them work in jobs that include high contact with other people. It could also mean that low-income workers are hit harder by the virus.”

How do these inequities play out in Connecticut? Here are a few examples:

Think you might need to go to the doctor? It’s more affordable if you have insurance.

In Connecticut, 14% of Hispanic residents under 65 were uninsured, compared to 11% of black residents, 6% of Asian and Pacific Islander residents, and 4% of white residents, in 2018. In other words, Hispanic residents are more than three times as likely as white residents to be uninsured, while black residents are nearly twice as likely to lack coverage.

Compounding a lack of health coverage is the fact that people with chronic respiratory conditions appear to be more susceptible to falling ill from the coronavirus. In Connecticut, asthma disproportionately affects black and Hispanic residents. Compared to white adults, black and Hispanic adults are more than five times as likely to be hospitalized for asthma.

Perhaps you’re not sure if you need care and want to call your doctor for advice. But what if you don’t have a usual source of care?

In Connecticut, one in three Hispanic residents (33%) did not have a personal doctor in 2018. Similarly, more than one in five black residents (23%) and Asian and Pacific Islander residents (20%) reported not having a personal doctor. By contrast, 11% of white residents said they didn’t have a personal doctor.

If you need to go get medical care and are supposed to avoid public transportation, do you have access to a vehicle?

Black and Hispanic residents are far less likely to have access to a car when they need it. According to a 2018 Connecticut survey, 87% of white respondents said they very often had access to a car when they needed it, compared to just 65% of black and Hispanic respondents.

Let’s say you need to take a couple weeks off work because you’re sick or you have a sick child. Can you handle the lost income?

National data shows a tremendous amount of financial vulnerability in American households: In a 2017 survey, 41% of respondents said they would not be able to pay an unexpected $400 expense without having to borrow, sell something, or just not pay it at all.

Even without that unexpected expense, many Americans are not able to pay their current monthly bills – and the rates are higher among people of color.

  • Among those with a high school degree or less, 25% of white survey respondents said they couldn’t fully pay their current month’s bills – compared with 41% of black and 35% of Hispanic respondents.
  • For those with a bachelor’s degree or more, 10% of white survey respondents said they couldn’t fully pay their monthly bills, compared to 21% of black and 17% of Hispanic respondents.

Adding an unexpected expense – say, a big medical bill or lost income from time home sick from work – significantly increased the proportion of households unable to make ends meet.

Connecticut does have at least one advantage: a state law that mandates that workers (in some companies) receive paid sick time. While the law only covers certain workers (it only applies to employers with at least 50 workers, for example), research has linked it and similar paid sick time laws in other states to reduced spread of flu.

Most policy conversations aren’t primarily focused on how they will position our society to handle an outbreak. Yet outbreaks put our health care and social service systems to the test – and they make clear just how much inequity exists when it comes to health.