Health Equity Considerations and Racial and Ethnic Minority Groups

Unfortunately, there is discrimination in systems that are designed to protect well-being or health. Examples of such systems are health care, housing, education, criminal justice, and finance. Discrimination, which includes racism, can lead to chronic and toxic stress. This shapes social and economic factors that put some people from ethnic and ethnic minorities at increased risk for COVID-19. (4), (5)

People from some racial and ethnic minorities face several barriers to accessing health care. Problems such as a lack of insurance (6), transport, childcare or the ability to take time off from work can make it difficult to see a doctor. Cultural differences between patients and service providers, as well as language barriers, influence the interaction between patients and service providers and the quality of health care. (7) Treatment inequalities (8) and historical events such as the Tuskegee Study of Untreated Syphilis in African American and Unsanitary Sterilization could also explain why some ethnic and ethnic minority people affected health systems and government ), (10), (11), (12)

Overall, people from some racial and ethnic minorities have less access to quality education. Without quality education, people face greater challenges in finding jobs that offer opportunities to minimize exposure to COVID-19. (14) People with limited job options are likely to have less flexibility to leave jobs, putting them at higher risk of exposure could expose to the virus that causes COVID-19. Often times, they cannot afford to miss their job even if they are sick because they may have unpaid sick leave or may not have saved enough money for essentials like groceries and other vital necessities.

Living in tight quarters can make it very difficult to break up when you are or might be sick. A higher percentage of people from ethnic and ethnic minority groups live in overcrowded homes compared to non-Hispanic whites and therefore may be more at risk of the virus that causes COVID-19.

These and other factors have been linked to more COVID-19 cases, hospital admissions, and deaths in areas where racial and ethnic minorities live, learn, work, play, and worship. (6), (15), (16) They have, too contributed to higher rates of some illnesses that increase the risk of developing serious illness from COVID-19. In addition, collaborative strategies to slow the spread of COVID-19 among some racial and ethnic minorities can cause unintended harm, such as reduced wages, reduced access to services, and increased stress. (17)

We all work to prevent the spread of COVID-19 and promote fair access to health. To do this, we must work together to ensure people have the resources to maintain their physical and mental health maintain and manage that fit the communities in which people live, learn, work, play and worship. Below are additional considerations for community leaders serving as individuals who face discrimination in health systems.

Effects of Racial Inequalities on Our Nation's Health

Racism, be it structural or interpersonal, negatively affects the mental and physical health of millions of people, prevents them from reaching their highest levels of health, and consequently affects the health of our nation. A growing body of research shows that centuries of racism in this country have had a profound and negative impact on color communities. The COVID-19 pandemic and its disproportionate impact on people of some races and ethnic groups are a clear example of these persistent health disparities. COVID-19 data shows that Black / African American, Hispanic / Latino, American Indian and Native American people in the United States have higher rates of COVID-19-related hospitalizations and deaths compared to non-Hispanic white populations. (18) These differences persist even after taking into account other demographic and socio-economic factors.

Both historical and current experiences of racism and discrimination contribute to the distrust of ethnic and ethnic minorities towards the health system. This suspicion can extend to vaccines, vaccination providers, and the institutions that make recommendations for vaccine use. To prevent health inequalities from growing, health care providers should work with communities to develop strategies to overcome distrust and provide evidence-based information to promote uptake of COVID-19 vaccinations, tests and treatments. (19) Injustices The effects of COVID-19 can exacerbate suspicions and lead to suboptimal health care behaviors. (19)

Strategies to Increase Confidence in the COVID-19 Vaccine

Various strategies can help communities build confidence in COVID-19 vaccines and improve equity in the vaccine, but some can be especially helpful when it comes to suspicion of people.

Focus on effective messaging through trusted messengers (with recommendations from trusted healthcare professionals).
Use tactics to address misinformation and reluctance within the population in focus.
Tailor-made strategies for the respective community.
Boost confidence in the vaccine to remove stigmatization related to COVID-19 vaccination while promoting relationships between community members and public health institutions.

Address community concerns

Use clear, easy-to-read, transparent, and consistent information
addressing specific misinformation or perceived concerns (20), such as:

Side effects or risks of the vaccine (including boosters)
Novelty and effectiveness of the vaccine
Rapidly changing information (e.g. mask usage, guidance for meetings, etc.)

Work with trusted messengers

Trustworthy messengers are key to providing critical information for communities to continue advocating for positive change in the COVID-19 vaccine effort:

Ensure that people whose images are included in materials who lead public outreach on COVID-19 look, are known, and can effectively collect input from communities where the outreach is taking place. (20)
Hire trusted faith leaders or vaccination workers who share the same race / ethnicity, sexual orientation, and cultural / religious beliefs as the community to share information, promote the benefits of vaccination, administer vaccines, and attend vaccination sites. (20)

Develop culturally relevant materials

Arts and cultural engagement can increase community demand for COVID-19 vaccines by making vaccination an accessible and socially supported choice. (21)
Provide culturally relevant messages and tonalities in the predominant languages spoken in the community. (20)

Data on COVID-19, as well as race and ethnicity

CDC resources

Other resources

References

(1) Stokes EK, Zambrano LD, Anderson KN et al. Coronavirus Disease Case Surveillance 2019 – US, Jan 22-30 May 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 759-765. DOI: http://dx.doi.org/10.15585/mmwr.mm6924e2external symbol
(2) Killerby ME, Link-Gelles R, Haight SC, et al. Hospital-Related Characteristics in Patients with COVID-19 – Metropolitan Atlanta, Georgia, March – April 2020. MMWR Morb Mortal Wkly Rep. EPub: June 17, 2020. DOI: http://dx.doi.org/10.15585/mmwr .mm6925e1external symbol
(3) U.S. Department of Health. Social determinants of health (online). 2020 (cited June 20, 2020). available at https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-healthexternal symbol
(4) Paradies Y. A systematic review of empirical research on self-reported racism and health. Int J Epidemiol. 2006; 35 (4): 888-901. DOI: https://doi.org/10.1093/ije/dyl056external symbol
(5) Simons RL, Lei MK, Beach SRH, et al. Discrimination, Segregation, and Chronic Inflammation: Testing the Explanation of Weathering for Black Americans' Bad Health. Developer Psychol. 2018; 54 (10): 1993-2006. DOI: https://doi.org/10.1037/dev0000511external symbol
(6) Berchick, Edward R., Jessica C. Barnett, and Rachel D. Upton Current Population Reports, P60-267 (RV), Health Insurance Coverage in the United States: 2018, US Government Printing Office, Washington, DC, 2019.
(7) Institute of Medicine (US) Committee on the Consequences of Non-Insurance. Care without cover: too little, too late. Washington (DC): National Academies Press (USA); 2002. DOI: https://doi.org/10.17226/10367external symbol
(8) Institute of Medicine. 2003. Inequality: Confronting Racial and Ethnic Differences in Healthcare. Washington, DC: The National Academies Press. DOI: https://doi.org/10.17226/10260external symbol
(9) United States National Library of Medicine. Native Voices: Timeline: Government Admits Forced Sterilization of Indian Women (online). 2011 (cited June 24, 2020). Available from URL: https://www.nlm.nih.gov/nativevoices/timeline/543.htmlexternal symbol
(10) Novak NL, Lira N., O'Connor KE, Harlow SD, Kardia SLR, Stern AM. Disproportionate Sterilization of Latinos as Part of the California Eugenic Sterilization Program, 1920-1945. Am J Public Health. 2018; 108 (5): 611-613. DOI: https://dx.doi.org/10.2105%2FAJPH.2018.304369external symbol
(11) Stern AM. Sterilized in the Name of Public Health: Race, Immigration, and Reproductive Control in Modern California. Am J Public Health. 2005 Jul; 95 (7): 1128-38. DOI: https://dx.doi.org/10.2105%2FAJPH.2004.041608external symbol
(12) Prather C, Fuller TR, Jeffries WL 4. et al. Racism, African American Women, and Their Sexual and Reproductive Health: A Review of Historical and Contemporary Evidence and Impact on Health Equity. Equal health opportunities. 2018; 2 (1): 249-259. DOI: https://dx.doi.org/10.1089%2Fheq.2017.0045external symbol
(13) US Bureau of Labor Statistics. Labor force characteristics by race and ethnicity, 2018 (online). 2019 (cited June 24, 2020). Available at URL: https://www.bls.gov/opub/reports/race-and-ethnicity/2018/home.htmexternal symbol
(14) The Annie E. Casey Foundation. Unequal opportunities in education (online). 2006 (cited June 24, 2020). Available at: https://www.aecf.org/m/resourcedoc/aecf-racemattersEDUCATION-2006.pdfPDF symbol
(15) Wadhera RK, Wadhera P, Gaba P, Figueroa JF, Joynt Maddox KE, Yeh RW, and Shen C. Variation in COVID-19 hospitalizations and deaths in New York boroughs. JAMA. 2020; 323 (21), 2192-2195. https://doi.org/10.1001/jama.2020.7197external symbol
(16) Kim SJ, Bostwick W. Social Vulnerability and Racial Inequality in COVID-19 Deaths in Chicago. Health education behavior. 2020; 47 (4): 509-513. DOI: https://doi.org/10.1177/1090198120929677external symbol
(17) Webb Hooper M, Nápoles AM, Pérez-Stable EJ. COVID-19 and Racial / Ethnic Inequalities. JAMA. 2020; 323 (24): 2466-2467. DOI: https://doi.org/10.1001/jama.2020.8598external symbol
(18) Centers for Disease Control and Prevention. Effects of Racism on Our Nation's Health (online). 2021 (cited on November 12, 2021). available at https://www.cdc.gov/healthequity/racism-disparities/impact-of-racism.html
(19) LM Bogart, BO Ojikutu, K. Tyagi et al. COVID-19 Medical Suspicion, Health Impact, and Potential Vaccination Reluctance Among Black Americans Living With HIV. J Acquir Immune Defic Syndr. 2021; 86 (2): 200-207. https://journals.lww.com/jaids/Abstract/2021/02010/COVID_19_Related_Medical_Mistrust,_Health_Impacts,.11.aspxexternal symbol
(20) Centers for Disease Control and Prevention. A Guide for Community Partners – Increasing the Spread of COVID-19 Vaccines in Racial and Ethnic Minority Communities (online). 2021 (cited on November 12, 2021). Available from: https://www.cdc.gov/vaccines/covid-19/downloads/guide-community-partners.pdfPDF symbol
(21) Centers for Disease Control and Prevention. How to Use the Arts to Build Confidence in the COVID-19 Vaccine (online). 2021 (cited on November 12, 2021). available at https://www.cdc.gov/vaccines/covid-19/vaccinate-with-confidence/art.html