Addressing disparities in healthcare during COVID-19

Healthcare disparities for racial and ethnic minority groups

Unfortunately, existing healthcare disparities can be exacerbated by PHEs such as the COVID-19 crisis. The Centers for Disease Control and Prevention (CDC) includes racial and ethnic minorities in its list of individuals who need to take extra precautions amid the pandemic.

From March through June 13, 2020, some racial and ethnic minority populations experienced higher rates of hospitalization from COVID-19 than non-Hispanic white individuals, according to data from the CDC. For example, non-Hispanic American Indian or Alaska Native individuals were hospitalized at a rate about five times greater than non-Hispanic white individuals.

The CDC lists several factors that can put racial and ethnic minority groups at greater risk during COVID-19. These include:

• Living in densely populated areas: Congested cities or overcrowded living conditions impose challenges to social distancing. Large households that include extended families may find increased difficulty keeping sick individuals separate from elderly family members.
• Working in essential industries: Essential workers often have roles that require them to interact closely with the public or other individuals even during a healthcare crisis.
• Lack of health insurance or sick leave: Hispanic individuals are almost three times more likely to lack health insurance than white individuals, according to the CDC. Another factor that can increase COVID-19 risk is not having paid sick leave, which could discourage employees from taking time off when ill.
• Not receiving care: This could result in part from lack of trust in the healthcare system. Black Americans have more distrust of the medical community than white or Hispanic individuals, a recent Pew Research Center study found. While 75% of white adults have a positive view of doctors, only 61% of black adults do so. Additionally, 54% of black adults said they would get a COVID-19 vaccine if available, in comparison to 74% of white adults.
• Increased likelihood of chronic conditions: The CDC points to underlying medical conditions such as obesity and high blood pressure that are more likely to affect some minority populations. An article published in the Journal of the American Medical Association (JAMA) notes that the higher rates of chronic conditions in minority groups is a common explanation for these populations’ increased risk from COVID-19.

In response to the pandemic’s disproportionate impact on minority populations, the U.S. Department of Health and Human Services (HHS) Office of Minority Health announced a $40 million initiative in partnership with the Morehouse School of Medicine. The National Infrastructure for Mitigating the Impact of COVID-19 within Racial and Ethnic Minority Communities is focused on providing education and resources, sharing COVID-19 response best practices, and connecting communities to testing.

To explore all HHS and CDC initiatives for minority communities, view this fact sheet. For more resources, visit the CDC’s Office of Minority Health and Health Equity.

Healthcare disparities in rural populations

Rural communities are another population at risk amid the COVID-19 crisis. As many practices switched to telehealth visits to reduce exposure, patients with poor Internet connections or limited access to technology faced obstacles to receiving care.

For instance, Hugh Chatham Memorial Hospital found telemedicine challenging when delivering care to its largely rural population in North Carolina and Virginia.

“It’s definitely been a challenge in a rural area, where patients struggle with technology and having access,” said LeAnn Hooker, Clinical Administrator, Physician Services.

In addition to barriers to telehealth, rural communities encounter healthcare disparities relating to less access to care, specialists, emergency or critical care facilities, and healthy foods. This population also has the highest prevalence of chronic obstructive pulmonary disease (COPD), which the CDC lists as one of the underlying medical conditions that increases risk of severe illness from COVID-19.

For more information on health issues affecting this population, visit the CDC’s rural health page.

How can providers overcome health disparities?

Federally Qualified Health Centers (FQHCs), community health centers (CHCs), and rural health clinics (RHCs) are uniquely positioned to deliver care to underserved communities.

The Centers for Medicare & Medicaid Services (CMS) and the Health Resources & Service Administration (HRSA) provide resources to help practices better serve at-risk populations. Here are a few:

• CMS flexibilities for RHCs and FQHCs during COVID-19
• HRSA coronavirus-related funding FAQs
• HRSA funding search
• HRSA health center COVID-19 survey results

HRSA designates Medically Underserved Areas/Populations (MUA/Ps) based on the following criteria:

• Too few primary care providers
• High infant mortality
• High poverty
• High elderly population

To determine if your practice provides care to an underserved region, use HRSA’s search tool.

Additionally, providers and healthcare practices can improve care by understanding social determinants of health (SDOH) — factors such as living conditions, education level, or income that impact an individual’s health and access to care. Visit the CDC website for SDOH tools to promote health equity.

Other ways to combat healthcare disparities include providing helpful resources, building trust with patients, and finding solutions to language or cultural barriers preventing care. By recognizing healthcare inequities, providers can take a meaningful step toward improving outcomes during the COVID-19 crisis and into the future.