Health Equity Considerations and Racial and Ethnic Minority Groups
Health equity is when all members of society enjoy a fair and just opportunity to be as healthy as possible. Public health policies and programs centered around the specific needs of communities can promote health equity.
The COVID-19 pandemic has brought social and racial injustice and inequity to the forefront of public health. It has highlighted that health equity is still not a reality as COVID-19 has unequally affected many racial and ethnic minority groups, putting them more at risk of getting sick and dying from COVID-19.,  The term “racial and ethnic minority groups” includes people of color with a wide variety of backgrounds and experiences. Negative experiences are common to many people within these groups, and some social determinants of health have historically prevented them from having fair opportunities for economic, physical, and emotional health. Social determinants of health are the conditions in the places where people live, learn, work, play, and worship that affect a wide range of health risks and outcomes.
To achieve health equity, CDC is committed to understanding and appropriately addressing the needs of all populations, according to specific cultural, linguistic, and environmental factors. By ensuring health equity is integrated across all public health efforts, all communities will be stronger, safer, healthier, and more resilient.
Some of the many inequities in the social determinants of health that put racial and ethnic minority groups at increased risk of getting sick and dying from COVID-19 include:
Unfortunately, discrimination exists in systems meant to protect well-being or health. Examples of such systems include health care, housing, education, criminal justice, and finance. Discrimination, which includes racism, can lead to chronic and toxic stress. This shapes social and economic factors that put some people from racial and ethnic minority groups at increased risk for COVID-19.,
People from some racial and ethnic minority groups face multiple barriers to accessing health care. Issues such as lack of insurance, transportation, child care, or ability to take time off of work can make it hard to go to the doctor. Cultural differences between patients and providers as well as language barriers affect patient-provider interactions and health care quality.  Inequities in treatment  and historical events, like the Tuskegee Study of Untreated Syphilis in the African American Male and sterilization without people’s permission, might also explain why some people from racial and ethnic minority groups do not trust healthcare systems and the government.,,,
People in racial and ethnic minority groups often work in essential worker settings, such as healthcare facilities, farms, factories, grocery stores, and public transportation. Working in these settings can lead to more chances of exposure to COVID-19, which might be contributing to COVID-19 racial and ethnic health disparities. Essential workers are inherently at higher risk of being exposed to the virus that causes COVID-19 due to the nature of their work. Essential workers conduct a range of operations and services in industries that are essential to ensure the continuity of critical functions in the United States from keeping us safe, to ensuring food is available, to taking care of the sick.
Overall, people from some racial and ethnic minority groups have less access to high-quality education. Without a high-quality education, people face greater challenges in getting jobs that offer options for minimizing exposure to COVID-19. People with limited job options likely have less flexibility to leave jobs that might put them at a higher risk of exposure to the virus that causes COVID-19. They often cannot afford to miss work, even if they’re sick, because they may not have paid sick days or enough money saved up for essential items like food and other important living needs.
Living in crowded conditions can make it very difficult to separate when you are or may be sick. A higher percentage of people from racial and ethnic minority groups live in crowded housing as compared to non-Hispanic White people and therefore may be more likely to be exposed to the virus that causes COVID-19.
These factors and others are associated with more COVID-19 cases, hospitalizations, and deaths in areas where racial and ethnic minority groups live, learn, work, play, and worship.,, They have also contributed to higher rates of some medical conditions that increase one’s risk of severe illness from COVID-19. In addition, community strategies to slow the spread of COVID-19 might cause unintentional harm, such as lost wages, reduced access to services, and increased stress, for some racial and ethnic minority groups.
We all have a part in helping to prevent the spread of COVID-19 and promoting fair access to health. To do this, we have to work together to ensure that people have resources to maintain and manage their physical and mental health in ways that fit the communities where people live, learn, work, play, and worship. Below are additional considerations for community leaders supporting individuals who experience discrimination in healthcare systems.
Racism, either structural or interpersonal, negatively affects the mental and physical health of millions of people, preventing them from attaining their highest level of health, and consequently, affecting the health of our nation. A growing body of research shows that centuries of racism in this country has had a profound and negative impact on communities of color. The COVID-19 pandemic and its disproportionate impact on people from some racial and ethnic groups is a stark example of these enduring health disparities. COVID-19 data shows that Black/African American, Hispanic/Latino, American Indian and Alaska Native persons in the United States experience higher rates of COVID-19-related hospitalization and death compared with non-Hispanic White populations. These disparities persist even when accounting for other demographic and socioeconomic factors.
Both historical and current experiences of racism and discrimination contribute to mistrust of the healthcare system among racial and ethnic minority groups. This mistrust may extend to vaccines, vaccination providers, and the institutions that make recommendations for the use of vaccines. To prevent widening health inequities, healthcare providers should engage with communities to tailor strategies aimed at overcoming mistrust and delivering evidence-based information to encourage uptake of COVID-19 vaccination, testing, and treatment. Inequities in COVID-19 impact can worsen mistrust and lead to suboptimal healthcare behaviors.
Strategies to Help Increase COVID-19 Vaccine Confidence
- Focusing on effective messaging delivered by trusted messengers (offering recommendations provided by trusted healthcare professionals).
- Using tactics to address misinformation and hesitancy within the population of focus.
- Tailoring strategies for the specific community.
- Building vaccine confidence to help eliminate stigmas associated with receiving COVID-19 vaccination while also fostering relationships between community members and public health entities.
Address community concerns
Use clear, easy to read, transparent, and consistent information
that addresses specific misinformation or perceived concerns, such as:
- Vaccine side effects or risk (including boosters)
- Newness and effectiveness of vaccine
- Rapidly changing information (e.g., mask use, guidance for gatherings, etc.)
Partner with trusted messengers
Trusted messengers are key to the delivery of critical information for communities to continue advocating for positive change regarding COVID-19 vaccine efforts:
- Ensure that people whose images are included in materials and leading COVID-19 outreach efforts look like, are known to, and can effectively collect input from communities where the outreach initiatives are occurring.
- Engage trusted faith leaders or vaccine workers who share the same race/ethnicity, sexual orientation, and cultural/religious beliefs as the community to share information, promote the benefits of immunization, administer vaccines, and be present at vaccination sites.
Develop culturally relevant materials
- Arts and cultural engagement can generate community demand for COVID-19 vaccines by making vaccination an accessible and socially supported choice.
- Provide messaging and tone that is culturally relevant and in predominant languages spoken in the community.
- CDC COVID Data Tracker. Health Equity Data
- CDC COVID Data Tracker. COVID-NET Laboratory-confirmed COVID-19 hospitalizations
- Data.cdc.gov. COVID-19 Case Surveillance Public Use Data
- Emory University’s COVID-19 Health Equity Interactive Dashboard
- Morehouse School of Medicine Health Equity Tracker
- Access Addressing Gaps in Public Health Reporting of Race and Ethnicity for COVID-19, a report from the Council of State and Territorial Epidemiologists to better understand the challenges in completing race and ethnicity data for COVID-19 and recommendations for improvement.
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