Disclaimer: The views presented here are of the authors and do not necessarily reflect the views of United Hospital Fund, its staff, or its board of directors
The existence of racial and socioeconomic health disparities in the U.S. is, unfortunately, nothing new. Decades of data point to troubling discrepancies in everything from maternal mortality rates to diabetes. More recently, we have developed a better understanding of the social determinants of health that are contributing to these gaps.
Now, the coronavirus pandemic is exacerbating these existing health disparities across the country and here in New York City, where new data reveal the disproportionate rates of COVID-19 illness and death among already vulnerable communities. One thing is abundantly clear: COVID-19 is not the great equalizer. Instead, the virus is taking a greater toll on disadvantaged New Yorkers who were already at enormous risk to any interruption of work, income, and health.
Disparities by Wealth and Race
With more than 168,000 confirmed cases of COVID-19, New York City has the most cases and deaths of anywhere in the country—but these rates are not divided equally across socioeconomic and racial lines. According to data from the NYC Department of Health and Mental Hygiene, the highest number of cases are concentrated in lower-income neighborhoods in parts of Brooklyn, Queens, and the Bronx. In contrast, mostly white and upper-class neighborhoods in Manhattan have relatively fewer cases. The New York City zip codes in the bottom 25% of average incomes represent 36% of all cases of the disease, while the wealthiest 25% account for less than 10%.
The data on racial disparities is even more eye-opening: COVID-19 is killing Black and Latino New Yorkers at twice the rate of white New Yorkers. While the New York City data is changing daily, the age-adjusted death rate for Hispanic people is reported at 98 people per 100,000 and the rate for Black people is 105 per 100,000. Compare this with the death rates for white and Asian people: 54 and 45 per 100,000, respectively.
COVID-19 Disparity Drivers
Many factors drive these disparities. One major component is the higher rates of pre-existing conditions, such as heart disease and asthma, in under-resourced communities. These conditions increase people’s risk of infection as well as the severity of the illness, if they do get it.
Lack of access to quality health care among vulnerable populations is also at play. Approximately 22.6% of New York State’s uninsured population are poor. Racial minorities make up 58.6% of the uninsured, but only about 39.6% of the population.
Workforce factors play a role too. In New York City, 75% of all frontline workers are people of color; these are the same individuals who are disproportionately affected by COVID-19. White-collar workers, who have the privilege to work remotely, have a significantly lower risk of exposure and infection.
Compounding Concerns
Adding insult to injury, the communities facing disproportionate rates of COVID-19 illness and death are the same vulnerable communities who were already struggling financially and will be hardest hit during the impending recession.
More than 30 million people across the country have filed for unemployment over the last six weeks, including 1.6 million New Yorkers. Many have limited savings and will soon need help getting food and accessing health care, if they don’t already. Even after New York gets COVID-19 under control, the economic consequences of the crisis will live on for months, perhaps even years.
The Role of the Social Safety Net
We need to be ready to meet people’s needs for the long term; enrolling them in programs like the Supplemental Nutrition Assistance Program (SNAP, which provides food stamps) and Medicaid can help New Yorkers get there.
Food safety-net programs are more than an emergency measure. They not only help individuals and families afford nutritious food to get them through challenging times like the current crisis—they help them get back on their feet for the long term. These safety-net programs will also reduce health care spending and help stimulate the economy. SNAP is one of the fastest, most effective forms of economic stimulus during a downturn, generating approximately $1.50 in economic activity for every dollar of federal spending.
Now more than ever, health care coverage must be expanded to reach as many New Yorkers as possible. This is critical because anyone can get sick from COVID-19, and many of those more likely to get sick are uninsured. New York State and local governments must expand awareness of, and invest in, the long-term, social safety-net programs that help New Yorkers keep afloat for the duration of this crisis and beyond.
We have a critical opportunity to learn from this pandemic and to address long-standing disparities. By doing so, we can finally get on track toward health equity once and for all.
Lisa David is the president and CEO of Public Health Solutions.
United Hospital Fund has a long history of bringing together diverse perspectives to address critical challenges in health care in New York. In the current crisis, it’s more important than ever to hear from all parts of the health care system. Today’s commentary from Lisa David looks at how COVID-19 is exacerbating existing health disparities and what can be done to help those who are most vulnerable. – UHF President Tony Shih