The vast majority of health care leaders' attention is rightly focused on the new coronavirus and preparing for unprecedented demand on the health care system. However, provider organizations risk long-term damage to community health if leaders don't also attempt to mitigate the epidemic's impact on the social determinants of health, which are amplified in vulnerable patient populations.
Major cities including New York, San Francisco, Los Angeles, and Washington, D.C. shut down operations of all "non-essential" businesses, including bars, dine-in restaurants, gyms, and libraries. Public health experts acknowledge that while these steps are required to slow the virus' spread and avoid disaster scenarios, lockdowns will also have untold economic implications for individuals and communities.
Already, one-fifth of U.S. households have seen reduced hours or lost jobs entirely. The impact is more pronounced for lower-income workers, especially in the service, hospitality, and entertainment industries—one-fourth of households that make less than $50,000 annually have already reported lost work. Congress is taking action to pass stimulus packages to get money into Americans' hands, but as the majority of Americans don't have an emergency savings account, fear continues to mount about how individuals and families will weather the coming months.
As a result, coronavirus is poised to exacerbate the social determinants of health in four ways:
Housing instability: With up to 78% of Americans living paycheck to paycheck, a sudden loss of wages will interfere with mortgage and rental payments due at the end of the month. Further, residents of crowded, low-income housing and shelters are less able to adequately practice social distancing, potentially hastening the spread of the virus.
The Trump administration announced on Wednesday, March 18th that the Department of Housing and Urban Development and the Federal Housing Finance Agency will halt foreclosures and evictions on government-backed properties. While it is a step in the right direction, this directive doesn't protect all home owners and renters, nor does it aid people experiencing homelessness.
Food insecurity: Although grocery stores have been allowed to continue operations during lockdowns, panicked shoppers report widespread shortages and empty aisles. Stores are pushing on their supply chains to meet increased demand, but many essentials—including toilet paper, infant formula, and disease-specific nutrition—remain limited or missing altogether. Farm labor organizers fear increased disruption to the American food supply given new restrictions on guest worker visas.
While higher income shoppers may feel comforted with a hearty stockpile, lower-income shoppers are less able to purchase food they need immediately, and face even fewer options as WIC-approved products are picked through. People who live in food deserts and typically rely on extensive public transportation to access affordable food face reduced schedules and options for transit. Proposed emergency cash assistance, such as calls to send between $600-1,200 checks to every American, could mitigate financial barriers to food access.
Social isolation: Widespread requirements to practice social distancing are essential to mitigate the new coronavirus' spread. However, long-term distancing will exacerbate the nationwide loneliness epidemic, which can be as lethal as smoking a pack of cigarettes a day. Simple in-person interactions, even with acquaintances in businesses or public spaces, will no longer help to mitigate the impacts of social isolation. Virtual interactions can help, but not all have access to the Internet and necessary technology.
Prejudice and discrimination: Historical experience from the SARS epidemic and recent reports suggest some Asian Americans are already experiencing verbal harassment and physical assaults. Continued, wrongful depiction of the virus as the "Chinese virus" could place Asian Americans at increased risk for mental health challenges and physical injury. Some Asian Americans may be reluctant to seek care, potentially exacerbating the virus’ spread. Asian American business owners may also face more dramatic revenue losses as customers wrongfully view the risk of virus spread as higher at those establishments. Health system leaders must unequivocally denounce anti-Asian racism, dispel myths, and detail repercussions for any discriminatory treatment of patients or staff.
Ultimately, already-marginalized populations, including people of color and low-income communities, will witness disproportionate disruption to their lives because of the new coronavirus. They're also less likely to access testing and more likely to contract and die from the virus. We'll be watching upcoming negotiations on the Hill to see if low-income patients can expect some relief. Senate Republicans unveiled their plan on Thursday March 19th, which includes $1.32 billion in emergency funds for community health centers.
Regardless of federal action, hospital leaders should coordinate with population or community health departments to review existing channels of social support, collaborate with community-based organizations to prepare for increased demand, and proactively reach out to high-risk patients to assess their preparedness. To learn more about how provider organizations can make long-term change by addressing the root causes of social determinants of health, download our new Field Guide to Defining Providers’ Role in Addressing the Social Determinants of Health.
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