Tracking Social Determinants of Health During the COVID-19 Pandemic

The public health and economic impact of the pandemic continues to affect the well-being of many Americans. The American rescue plan included resources not only to deal with the public health crisis of the pandemic, but also to provide economic support to many low-income people who were struggling to make ends meet. Millions have lost their jobs or incomes since the pandemic began, making it difficult to pay for expenses including basic necessities like food and housing. These challenges will ultimately affect people's health and wellbeing as they affect the social determinants of health. This letter provides an overview of the social determinants of health and a look at how adults fared with a range of measures in September 2021, when part of the population remained unvaccinated and hospital admissions and deaths due to the Delta variant in some areas increase by leaps and bounds even if they decrease in others.

What are social determinants of health?

Social determinants of health are the conditions under which people are born, grow up, live, work and age. These include factors such as socio-economic status, education, neighborhood and physical environment, employment and social support networks, and access to health care (Figure 1).

Figure 1: Social determinants of health

Although health care is essential to health, research shows that health outcomes are influenced by a number of factors, including underlying genetics, health behaviors, social and environmental factors, and financial hardship and all of its implications. While there is currently no research consensus on the size of the relative contribution of each of these factors to health, studies suggest that health behaviors, as well as social and economic factors, are the most important drivers of health outcomes and that social and economic factors can affect individuals & # 39; Health behavior. There is extensive research that concludes that addressing social determinants of health is important to improving health outcomes and reducing health inequalities. Prior to the pandemic, there were a variety of initiatives to address social determinants of health in both the health and non-health sectors. The COVID-19 pandemic has exacerbated the health inequalities that already exist for a wide range of population groups, but especially for people of color.

How are adults doing regarding a number of social determinants of health during the pandemic?

With a wide variety of metrics, large segments of people experience hardship. The Census Bureau's Household Pulse Survey is designed to quickly and efficiently collect and compile data on how people's lives have been affected by the coronavirus pandemic. For this analysis, we looked at a number of measures taken over the course of the pandemic. Unfortunately, the Household Pulse Survey does not provide any pre-pandemic comparative measures. Although we have followed the data over time and have fluctuated at various points since March 2020, the patterns of hardship remain largely consistent and changes in measures do not necessarily follow economic indicators or pandemic trends. The data for the most recent period from September 1 to September 13 shows the following (Figure 2):

More than one in six adults (17.4%) reported that they or someone in their household had suffered a loss of income in the past four weeks;
More than half (50.9%) of adults said they had difficulty paying normal household expenses in the past 7 days and 30.5% had used credit cards or loans to meet household needs;
5% of adults had no confidence in their ability to pay the apartment for the next month (via tenants and owners) and 8.8% said that their household was insufficiently supplied with food;
Almost one in three (32.1%) adults reported symptoms of depression or anxiety.

Black and Hispanic adults perform worse than white adults on almost all metrics, with big differences in some metrics. In September 2021, nearly seven in ten black and Hispanic adults (66.4% and 69.2%, respectively) reported having difficulty paying household expenses compared with 43.6% of white adults; 12.9% of black adults and 10.6% of Hispanic adults said they have no confidence in their ability to make the apartment payment for the next month, compared with 4.1% of white adults; and 14.9% of black adults and 14.2% of Hispanic adults reported lack of food in the household compared with 6.3% of white adults. In addition, about a quarter of black and Hispanic adults said they lived in a household that had lost income in the past four weeks (24.9% and 27.2%, respectively) compared with 13.1% of whites Adult.

While the differences between age and sex were not as great, younger adults (aged 18 to 44 years) fared worse than older adults on many measures. For example, a higher proportion of younger adults reported symptoms of anxiety and depression and difficulty paying normal household expenses. In addition, more women reported symptoms of depression or anxiety and difficulty paying normal household expenses than men in the past seven days.

For most of the metrics, adults with children in the household performed worse than adults as a whole. For example, 22.0% of adults with children in the household have lost an income from work in the household in the past four weeks, compared with 17.4% of adults in total, and six in ten (59.7%) adults with children in the household admitted reported having difficulty paying household expenses in the past week compared to the total population of 50.9%. Adults in households with children were also more likely than the general population to report food shortages, symptoms of depression or anxiety, and lack of confidence in their ability to make home payments for the next month.

Hardship patterns over time indicate both the impact of the pandemic and related measures, as well as long-standing disparities in social determinants of health. The data show that the proportion of people in need peaked in December 2020, but has otherwise remained largely stable (Figure 2). Trends in all measures have improved since December 2020, reaching lows during the pandemic in March and April 2021, likely due to the introduction of the COVID-19 vaccines and the new federal funding available during that period. However, the differences in hardship cases between certain population groups have remained largely stable throughout the pandemic and to some extent reflect long-term disparities that existed before the pandemic. Understanding these differences in the context of increased needs over the past year, however, highlights these differences and shows who could benefit most from government aid.

What needs to be considered in the future

The US rescue plan provides $ 1.9 trillion in funding to help combat the ongoing health and economic effects of the pandemic. Provisions that provide vital economic assistance to individuals include direct incentive payments to individuals, an increase in federal unemployment insurance payments, a child tax credit of up to $ 300 per child per month from July through the end of the year, additional funding for food insecurity, emergency aid for rental housing and tackle emergency shelter vouchers. This federal support may have contributed to some improvements in metrics, but severity will also be impacted by the progress of the pandemic (including an increase in cases and deaths from the Delta variant and any changes in vaccination rates). Looking ahead, the impact of some temporary federal support and the pandemic will likely continue to be factors in future data releases; However, additional and expanded federal support that is being discussed in Congress that could seek to address fundamental economic issues beyond the pandemic has the potential to change longstanding hardship patterns in various demographic groups.