COVID-19: The Health Inequity Magnifier

This week, BMC Nephrology Editorial Adviser, Dr. Deidra Crews discusses how the COVID-19 pandemic in the United States has created a magnified view of longstanding health inequities in this population.

The COVID-19 pandemic and efforts to mitigate its spread have affected people across the entire world—but not equally. Many of the same groups of individuals known to suffer a disproportionate burden of poor health outcomes are faring especially poorly during this pandemic. In many ways, the disparate outcomes being documented in COVID-19 are simply offering a magnified view of longstanding health inequities.

The Robert Wood Johnson Foundation stated that “Health equity means that everyone has a fair and just opportunity to be healthy“. To achieve health equity, obstacles to health must be removed. Socially disadvantaged people, who have been historically marginalized and/or disfavored by social and political institutions, have faced significant obstacles to health equity in the midst of COVID-19.

To achieve health equity, obstacles to health must be removed.

Social distancing, a key recommendation for preventing the spread of COVID-19, has proven to be very difficult for socially disadvantaged persons. Housing insecurity and homelessness are established risk factors for chronic health conditions, including kidney disease. In the setting of COVID-19, these challenges have meant that many individuals cannot feasibly maintain the recommended physical distance from others. Further, for people in service professions that require they interact daily with the public, their ability to socially distance has also been quite challenged. Racial and ethnic minorities and low income persons are overrepresented in such professions, which has increased their risk of COVID-19 exposure.

For people who have sought testing for COVID-19, inequities in health care access and services have been on full display. One report noted that African Americans patients with potential symptoms of COVID-19 (e.g. cough and fever) were less likely to be given a COVID-19 test than were white persons with the same symptoms. This type of biased delivery of health services can lead to socially disadvantaged individuals presenting later (e.g. for hospitalization) with severe symptoms or even death.  As vaccines and treatments for COVID-19 are developed and disseminated, individuals who have directly, or vicariously, experienced bias in the health care setting may be reticent to seek these options, out of fear of inequitable treatment.

COVID-19 mitigation efforts have led to shortages of food in many communities due to store closures as well as bulk purchases by individuals who can afford to do so. Low-income communities have been particularly affected. A consequence of structural inequities including residential segregation, food access is known to vary by community demographics. In this pandemic, diet-sensitive health conditions such as diabetes, hypertension and kidney disease, may be exacerbated, particularly for persons facing food insecurity.

Solutions for addressing the inequities magnified by COVID-19 have been offered and include expanding access to testing and health care, and providing social services to keep vulnerable groups safe. People with kidney diseases are particularly vulnerable to COVID-19 infection, hospitalization and death. Because many are also socially disadvantaged, it will be important to evaluate and expand the services they are provided, including those addressing social needs.

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