The other pandemic: social determinants of health
By Glenn Ellis
There is an old saying, “When America catches a cold, Black people get pneumonia.” An article from The Brooking Institution goes into detail in describing the data that demonstrates that in 2020, Blacks in just about every state (with racial data available) have higher infection rates and higher death rates of COVID-19. At this point in the pandemic here in the United States, the COVID-19 infection rate is three times higher in predominantly Black counties than in predominantly White counties, and the mortality rate is six times higher. Even though there is only racial data available for just 35 percent of those who have fallen victim to the virus, the pattern of discrimination is undeniable.
This is nothing new, for centuries pandemics disproportionately affect the poor and disadvantaged. Sadly, it’s no secret that structural and institutional racism, in our society today, is real. This column aims to contribute what we must know, and do, in order to navigate this system and enjoy the highest quality of life achievable.
The institutionalization of racial inequality was sowed into this nation from its beginning. All of the inequities in community resources and within the entire healthcare system are nothing but the fruits of this harvest. And, when crises like the COVID-19 pandemic occur, inequalities are on steroids rather than reduced.
The media coverage, and some our own personal experiences have made it crystal clear that COVID-19 is highly contagious and potentially deadly. But you would be hard pressed to find the news cycles highlighting the fact that the same social determinants (including poverty and most definitely race and ethnicity) that impact the risk of being infected with COVID-19 also influence our disproportionate rates of chronic diseases. We are more likely to work (for those who are employed) in those “so-called essential jobs”; like as nursing homes or home health care, grocery stores, fast food, retail, restaurants, and mass transit. Jobs where we are more likely to come into close contact with people who are sick. No wonder we have such high rates of chronic conditions, like diabetes, high blood pressure, and heart disease, all known to be risk factors for infection and death from COVID-19!
The term, social determinants of health, was most widely publicized after the World Health Organization, whose Commission on Social Determinants of Health in 2008 published the report, “Closing the gap in a generation: Health equity through action on the social determinants of health.”
Why is no one advocating for the school closures/disruptions that have increased food insecurity for children living in poverty who traditionally have benefited from school breakfast and lunch programs. Malnutrition causes substantial risk to both the physical and mental health of these children, including lowering immune response, which has the potential to increase the risk of infectious disease transmission.
And what about the homeless, who are at higher risk of infection and transmission? People experiencing homelessness are vulnerable to COVID-19 due to the risk of transmission and the high rates of chronic diseases, like many of the rest of us.
How much attention and resources are our leaders devoting to making sure that access and availability of primary care, and medications are sufficient to address this disproportionate rate of chronic conditions in disadvantaged and marginalized communities? Kaiser Health News published research that shows the impact of COVID-19 on community primary health centers. Drops in patient visits, and worker shortages has the ripple effect of centers with multiple sites closing or reducing hours. Not only does this negatively affect those in these communities whose chronic conditions require regular primary care, but also how they get their medications.
The New York Times reported that state regulatory agencies around the country are seeing more and pharmacists at companies like CVS, Rite Aid and Walgreens described understaffed and chaotic workplaces where they said it had become difficult to perform their jobs safely, putting the public at risk of medication errors
This is leading a lot of doctors to complain that pharmacies bombard them with requests for refills that patients have not asked for and should not receive. Refills are closely tracked by pharmacy chains and can factor into employee bonuses. It’s all a hot mess!
Please, remain vigilant!
The “second wave” of Fall and wintertime outbreaks of COVID-19, coupled with flu season, means that as a member of a marginalized community in this country, it is imperative that you try to understand as much as you can about infectious diseases; all of them – COVID, Flu, and pneumonia. Learn how they are transmitted, and how to best protect yourself and your families. Read up on the best type of face masks, and the correct way to wear them; as well as how often you need to replace them. Spend the extra time with the young and the elderly; help them understand the seriousness of the times.
Pay close attention to how “they” are deciding what’s safe and effective for any of the many vaccines being researched in this “Warp Speed” race. We have had over six months to witness, firsthand, that all of the experts, agencies, and officials, we thought we could look to for credible guidance have failed us.
Remember, I’m not a doctor, I just sound like one. Take good care of yourself and live the best life possible!
The information included in this column is for educational purposes only. I do not dispense medical advice or prescribe the use of any technique as a replacement form of treatment for physical, mental or medical problems by your doctor either directly or indirectly. Glenn Ellis, MPH is a Visiting Scholar at The National Bioethics Center at Tuskegee University and a Harvard Medical School Fellow in Research Bioethics and Writing. He is author of Which Doctor? and Information is the Best Medicine. Ellis is an active media contributor on Health Equity and Medical Ethics. For more good health information visit: www.glennellis.com