As COVID-19 sweeps through communities around our world, racial and ethnic minority groups have been disproportionately affected. However, disparate impacts on the health of communities of color are not new—in fact, the impacts of COVID-19 on racial and ethnic minority groups mirror the social, economic, and physical inequities that quietly and consistently follow these groups.
Citing the disproportionate impact of COVID-19 on racial and ethnic minority groups, the Center for Disease Control and Prevention (CDC) names five social determinants of health that contribute to this imbalance (CDC, 2021): “neighborhood and physical environment, health and healthcare, occupation and job conditions, income and wealth, and education.” The CDC (2021) suggests that each of these factors are influenced by discrimination, including racism and associated chronic stress, and may increase certain communities’ risk of COVID-19 exposure and associated health impacts.
Hispanic communities in the U.S. are one of several racial or ethnic groups of people that already experience health disparities and have now been hard-hit by the pandemic. In defining this ethnic group, the U.S. Office of Minority Health (OMH) includes, “Any person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race” (OMH, 2021). According to data from the 2019 U.S. Census Bureau population estimates, “There are 60.5 million Hispanics living in the United States. This group represents 18.4 percent of the U.S. total population” (OMH, 2021).
To understand how COVID-19 is impacting Hispanic communities in particular, it’s important to acknowledge the factors contributing to the existing gaps in accessing health and healthcare impacting the Hispanic population.
1. LANGUAGE AND CULTURAL BARRIERS: Census data from 2019 shows that approximately seven in 10 Hispanics speak a language other than English at home and some 28.4 percent are not fluent in English (OMH, 2021). Communication is vital to patient care and impacts the quality of care received, and yet many Hispanic adults report difficulty finding a doctor that shares their cultural background and “explains things in a way that is easy to understand” (Artiga et al., 2021).
2. LACK OF HEALTH INSURANCE: The OMH reports, “Hispanics have the highest uninsured rates of any racial or ethnic group within the United States. In 2019, the Census Bureau reported that 50.1 percent of Hispanics had private insurance coverage, as compared to 74.7 percent for non-Hispanic whites” (OMH, 2021). Health coverage for Hispanic people has been a longstanding problem in the U.S., leaving many vulnerable and unable to receive necessary medical care.
3. EMPLOYMENT AND INCOME: An individual’s health insurance is often tied to employment, impacting one’s access to coverage and the ability to pay for medical care. Data collected by the Kaiser Family Foundation (KFF) suggests, “Although Hispanic adults are as likely as White adults to say they are employed, they are more likely to report living in a lower income household” (Artiga et al., 2021).
4. LACK OF ACCESS TO PREVENTIVE CARE: The leading causes of death and illness among Hispanics, as cited by the CDC are, “heart disease, cancer, unintentional injuries (accidents), stroke, and diabetes” (OMH, 2021). Many Hispanic or Latino people are not afforded preventative care to help combat these illnesses, such as heart disease and diabetes, or they experience barriers that increase the challenges of living a health lifestyle. Regarding meeting primary healthcare needs, data from the KFF suggests that Hispanic adults are less likely than non-Hispanic adults to have a usual source of care other than the emergency room. They report, “Nearly one in four (24%) Hispanic adults overall report no usual source of care other than an emergency room, higher than the share of White adults (12%) and similar to the share of Black adults (28%). Among Hispanic adults, roughly three in ten potentially undocumented (32%) and lawful permanent resident (29%) adults say they have no usual source of care other than the emergency room, compared to about one in five (19%) U.S.- born adults” (Artiga et al., 2021).
In an interview with Ana Penman-Aguilar, Chief Science Officer and Associate Director for Science at the CDC’s Office of Minority Health and Health Equity, she explains how environment impacts the health of Hispanic communities, “Latino communities are hard hit by neighborhood conditions that contribute to obesity and type 2 diabetes. Income, education, unemployment, housing conditions, and neighborhood environment profoundly affect whether individuals will consume nutritious food and have options for physical activity” (Commonwealth, 2018).
5. IMMIGRATION POLICY AND ENFORCEMENT: In an article written for The Commonwealth Fund, authors Hostetter and Klein suggest that immigration policy and enforcement impact the health of Hispanic immigrants, “Evidence indicates that immigration policy and enforcement have an effect on the health of Hispanic immigrants by increasing stress and discouraging people from seeking care. And newer research suggests that stressors related to immigration can have a spillover effect on the health and wellbeing of U.S.-born Hispanics (i.e., those not subject to deportation) as well as foreign- born Hispanics” (Hostetter & Klein, 2018).
The impact stretches wider than stress and access to healthcare— the KFF reports, “Some Hispanic adults, particularly those who are potentially undocumented, report that they have avoided seeking assistance for food, housing, and/ or health care due to immigration-related fears. One in ten Hispanic adults (11%) say there was there a time in the past 3 years when they or a family member decided not to apply for or stopped participating in a government assistance program because they were afraid it might negatively affect their or a family member’s immigration status” (Artiga et al., 2021).
Some primary health conditions, as listed by the OMH, that impact Hispanic communities include, “asthma, chronic obstructive pulmonary disease, HIV/AIDS, obesity, suicide, and liver disease,” many of which increase a person’s risk of complications from COVID-19.
The CDC explains it clearly—“Long-standing systemic health and social inequities have put many people from racial and ethnic minority groups at increased risk of getting sick and dying from COVID-19…Racial and ethnic minority groups are experiencing higher rates of COVID-19 infection, hospitalization, and death. Inequities in the social determinants of health have historically prevented these groups from having the same opportunities for economic, physical, and emotional health. These inequities are highlighted by the factors that contribute to increased risk of COVID-19 exposure, severe illness from COVID-19, death, and unintended consequences of COVID-19 mitigation strategies” (CDC, 2020).
Although the CDC has launched some community health initiatives and the government is making continual efforts to supply additional support in light of the pandemic, there is still a long way to go to close most of the healthcare gaps for racial and ethnic minority groups. Penman-Aguilar says, “Some of the other things CDC does to address the health of Hispanics and Latinos include providing funding to health departments, community-based organizations, universities, and other health partners that serve Hispanics and Latinos; conducting public health bilingual social marketing campaigns; and conducting research that advances Hispanic and Latino health” (Commonwealth, 2018).
However, one of the biggest needs lies within transforming communities and creating equal access—resolving some of the problems that discrimination inflames. As Penman-Aguilar emphasizes, “Too many communities lack safe places for physical activity or full-service grocery stores. Although the most important approach to solving problems like this is to increase neighborhood options, it is also sometimes possible to help people overcome barriers with tailored approaches…” (Commonwealth, 2018). Without altering those systemic barriers that contribute to the imbalance of health among Hispanic communities and other racial and ethnic minority groups—such as a lack of access to affordable and quality housing, health and healthcare, fair wages and job conditions, and education—little change can be anticipated.
A great place for healthcare organizations to start is through education. It’s important that your leaders, managers, and employees understand your commitment to health equity and how they can contribute. Several topics to begin your educational journey include:
Centers for Disease Control and Prevention (CDC), (2020). Health equity – Promoting fair access to health: COVID-19 racial and ethnic health disparities. Retrieved from: https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/index.html
The Commonwealth Fund, (2018). Q&A with Ana Penman-Aguilar: Diving in to data on Hispanic health. Retrieved from: https://www.commonwealthfund.org/publications/2018/dec/qa-ana-penman-aguilar-diving-data-hispanic-health?redirect_source=/publications/newsletter-article/2018/dec/qa-ana-penman-aguilar
Hostetter, M., Klein, S., (2018). In focus: Identifying and addressing health disparities among Hispanics. The Commonwealth Fund. Retrieved from: https://www.commonwealthfund.org/publications/2018/dec/focus-identifying-and-addressing-health-disparities-among-hispanics
Artiga, S., Hamel, L., Kearney, A., Stokes, M., Safarpour A., (2021). Health and health care experiences of Hispanic adults. Kaiser Family Foundation (KFF). Retrieved from: https://www.kff.org/coronavirus-covid-19/poll-finding/health-and-health-care-experiences-of-hispanicadults/
U.S. Department of Health and Human Services Office of Minority Health (OMH), (2021). Profile: Hispanic/Latino Americans. Retrieved from: https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64Download Article
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