Jones & Bartlett Learning Public Health Blog

    Health Equity in the Midst of Covid-19:  Seven Key Issues Impacting Lower Socioeconomic, Black Communities and Potential Solutions

    Posted by Susanne Walker on Apr 1, 2020 9:15:02 AM

    By Dr. Patti R. Rose, Ed.D, author of Health Equity, Diversity, and Inclusion: Context, Controversies, and Solutions



    The existing global pandemic has created new terminology/concepts, new realities and fear across the globe.  Social distancing is a new concept, along with other suggested and required actions, which most people are not accustomed to.  The reality of having to be at least 6 feet away from another human is challenging and posing concerns for many.  As of today, we have learned that social distancing  and staying in your homes will go on until April 30, rather than April 15, which was the initial goal of the U.S. federal government.

    Nevertheless, beyond the above, there are some key issues relevant to lower socioeconomic status that are pertinent to discuss.  Recently, the Congressional Black Caucus stated the following in a press release: “When America catches a cold, Black America catches pneumonia.” This is an indication that any problems that impact mainstream America, health-wise, due to the widening health status gap known as health disparities, bear a greater impact on Black people, especially those who are poor. Below are a list of issues that provide further insight, particularly in the current public health crisis.  Clearly, we are in the midst of  a pandemic so the actual pathogen, does not discriminate.  But, the healthcare “system” in the United States must be proactive regarding how to approach this issue, taking factors associated with health disparities, relevant to racial and ethnic emerging majorities, into consideration, as outlined in Health Equity, Diversity,  and Inclusion: Contexts, Controversies and Solutions.

    1.  The digital divide

    Individuals are being told to go to the Centers for Disease Control and Prevention (CDC) website to get information about COVID-19.  Unfortunately, not everyone has a computer and access to the internet, hence the digital divide.  This is a more severe problem when libraries, schools and universities are shut down due to social distancing. This also impacts the acquisition of information  from the CDC, state and local governments and beyond.  Individuals without cable/internet/broadband, etc. where information is flowing, primarily, are at a loss, in terms of regular updates, completing necessary forms (unemployment applications, etc.) and other information, which may be imperative for their survival.

    Solutions: Every effort must be made to provide individuals with all necessary information through non-digital approaches.  Additionally, efforts must be made, in haste, to close the digital divide by ensuring that everyone in the United States has access to digital equipment, broadband and beyond, if this will be the primary approach utilized to share information.

    2.  Access to Supplies

    CornerMarketOne of the most critical current concerns is that people are hoarding. There are jokes about the over-purchasing of toilet paper, as one specific example.  However, the reality is that people who are poor cannot afford to hoard or to even acquire the basic items that they need to be healthy. Small  convenience stores are generally what is found in low income communities, in terms of acquisition of food, due to lack of large supermarkets. 

    Consequently, while people are running to large Supermarkets, in middle to upper class neighborhoods, to hoard supplies, the small convenience stores are stocked with items such as bleach, toilet paper, canned foods and other non-perishable items because people cannot afford to buy them in significant quantities. Items in these stores are overpriced and often smaller in size.  This is quite problematic.

    paper goods large marketPaper Good Low Income Market

    Solutions:  Build supermarkets in low income, emerging majority communities. Congress should consider passing laws, which provide tax incentives to corporations in the supermarket business to build such stores.  This should have been in the stimulus package, to help those communities in great need of fresh produce, basic hygienic supplies, including toilet paper, etc. (and other items that may be hoarded  at reasonable prices).

    3.  Loss of jobs

    Losing a job is a severe problem for anyone, particularly in a society when many people are  living paycheck to paycheck. As individuals who are making minimum wage or who hold positions that keep them below, at or just above the poverty level, losing a job is a serious problem. Advising people to stay at home, who are making an hourly wage, without sick or any kind of leave available to them, creates untold hardship. As the Covid-19 problem continues, loss of jobs is seriously impactful, and although a one-time stimulus payment may help, it will be a band-aid that is too small to cover the wound, even temporarily.  Many of the individuals  who are losing their jobs were already suffering financially.  Although the recently passed government stimulus package is imperative, to ensure a temporary, short-term safety net for those members of society who are already seriously financially vulnerable, it will not be enough.

    Solutions: There must be laws put in place that require all workers to receive paid time off/leave even when there is not a crisis.  Additionally, unemployment payments must be paid out to individuals, without long-term delays, in the midst of a global crisis, whether they have been terminated or quit their jobs. The recent stimulus package is meeting the latter need but it must happen quickly, getting the funds in the hands of those who need it, with ease.

    4.  Mass incarceration

    Mass incarceration is not a problem that is at the forefront of the discussion of Covid-19, although it should be.  Confinement, in the midst of a pandemic, is creating an unimaginable kind of fear.  Some prisoners are locked up, merely awaiting trial, not actually convicted of a crime, or they have participated in non-violent, low-level crimes.  Some are elders who have spent considerable time in prison or are newly convicted, often for non-violent crimes.  On top of imprisonment, which is a severe form of confinement, social distancing has been determined to be imperative, which is not possible in many prisons due to overcrowding or the sheer design of the facilities.   This must be a particular psychological and physiological concern for the incarcerated, particularly when visitation by loved ones is no longer an option during this pandemic, for many of these prisons.  The majority of individuals who are in prisons are primarily Black men and women, also.   

    Solutions: Mass incarceration of the elderly must end.  Medical and general parole must be a serious consideration for each elder in prison along with compassionate release and community service as priority options as indicated in this piece: The Elderly and Mass Incarceration: A U.S. Atrocity 

    Additionally, the Congressional Black Caucus advocated for the following in the stimulus relief package regarding Covid-19:

    “Criminal Justice Support and Reform: …prioritizing the release of incarcerated individuals in prisons, jails, and detention centers through clemency, commutations and compassionate release; immediate temporary release to home confinement for those determined to be low-risk defenders; and for individuals who will remain incarcerated during this time the allowance of video conferencing and telephone calls free of charge to preserve families and their visitation needs.” 

    5.  Elder abuse

    It's no secret that there has been occurrences of  abuse in nursing homes.  Additionally, nursing homes are very expensive and no longer just a place to house the elderly, but other chronically ill individuals as well.  Due to the fact that nursing homes are very expensive, often times, chronically ill Black individuals, who are poor, do not end up in the highest quality nursing homes, but rather in under-resourced, under-staffed environments. Additionally, during this pandemic, visitors are not allowed to visit their elderly loved ones.  This is an extremely devastating form of vulnerability for the elders that should be shocking to the core. Although the elders in nursing homes are being presumably protected from experiencing Covid-19, who is watching to make sure that they are being cared for with the kind of love and nurturing that they deserve and ensuring that elder abuse will not take place, while their loved ones are not watching? When it was said by a few hospitals in NYC that pregnant mothers would have to birth their babies without a loved one present, there was absolute outrage.  The same kind of commitment and concern must be in place in regard to isolating the elders in our society.

    Solution: If family members are not allowed to visit their elders, reports of their conditions must be provided to families daily, including daily teleconferencing and photos of them to ensure that they are not getting bedsores or being neglected in any way. Facetime, Zoom or other electronic approaches are options to make sure that elders can see and be seen by their loved ones.  

    As stated by Richard J. Mollet, Executive Director of the Long-Term Community Care Coalition in NYC and a prominent Senior Advocate:  

    "We are deeply concerned that residents are cut off from loved ones and vice versa...We know that, in addition to providing company, love and a friendly face, families provide vital monitoring and often essential care."

    As stated by Deborah Schoch of AARP:

    “He [Mollett] urged those people concerned about the Centers for Medicare & Medicaid Services action to write their U.S. senators and representatives.”

    6.  Nutritional Deprivation

    Many children in lower income communities rely on school meals for their breakfast and lunch as in their homes, food may be scarce.  As schools are closed in most states due to the pandemic, efforts must be made to ensure that these children are fed.  Some mayors and educational leaders are ensuring that this happens by making breakfast and lunch available daily for pick-up by parents for their children. This is laudable but why is the fact that children are hungry not being resolved on a macro level.  In a country as wealthy as the United States, why is it that there are children without food to eat in their homes? This is definitely problematic on many levels.

    Solution: Every child needs to be fed now and in perpetuity.  Food is a form of healthcare.

    7.  Homelessness

    How is it possible for a person to wash his/her hands if all of the stores, restaurants, malls, coffee shops, etc., are closed?  How is  one to shelter in place if she or he is homeless?  Where are homeless people to eat?  As there are jokes going around about the hoarding of toilet paper, how is a homeless person to go about accessing this product, now seen as a commodity, like no other to some? How will homeless people get their stimulus checks, without an address per the new stimulus package provided by the federal government?  There are so many questions to ask about the plight of the homeless, that it is unclear how to sort out where to begin and where to end.  The fact that handwashing stations have been set up at some places in the U.S. is a step, but clearly not enough.  How many people feel  comfortable having the opportunity to wash their hands, but not thoroughly wash the rest of their body at any time, especially in the midst of a pandemic? What about laundry? Given the shortage of hand-sanitizer, even those homeless individuals who would normally use these products, may no longer have access to them.  In a study conducted in Boston, MA, Leibler, J., et al. (2017) point out that of the 194 respondents (most were African American  who participated in their study):

    Most participants (72%) reported taking a daily shower. More than 60% reported hand washing with soap five or more times each day, and use of hand sanitizer was widespread (89% reported using sanitizer in the last week). A majority (86%) used a laundromat or laundry machine to wash clothing, while 14% reported washing clothing in the sink.

    During this pandemic, how are individuals, who are homeless, to handle their hygienic needs? According to the National Alliance to Homeless People:

    By far the most striking disproportionality African Americans, who make up 40 percent of the homeless population despite only representing 13 percent of the general population. This imbalance is not improving over time. From slavery to segregation, African Americans have been systematically denied equal rights and opportunities. The effects of long-standing discrimination linger and perpetuate disparities in poverty, housing, criminal justice, and health care, among other areas. These disparities, in turn, can contribute to more African Americans experiencing homelessness.

    Solution:  Every person who is homeless needs to be housed now, not sheltered.   Housing is a form of healthcare. Business  facilities in the country that have been closed for business otherwise, that have  showers, bathrooms, etc. needs to allow their facilities to be used for hygienic purposes for the homeless during this crisis. In addition to bread and food lines, there needs to be hygiene lines, until every person living on the street is provided with a place to live.

     As the situation from this pandemic continues to unfold, there must be a focus on the needs of those individuals disproportionately impacted by the inequities in the health care system.  Those individuals who were impacted greatly before this pandemic/crisis will have a more severe experience now. Social justice and health equity must be a priority, especially during this global pandemic.


    Congressional Black Caucus (CBC) Press Release.  March 27, 2020 

    Rose, P. (2020). The Elderly and Mass Incarceration:  A U.S. Atrocity.

    Schoch, D. (2020). Families Worry About Loved Ones in Nursing Homes, Assisted Living. 

    About the Author

    Patti RosePatti R. Rose, MPH, Ed.D. - President and Founder, Rose Consulting, Miami, Florida

    Dr. Patti Rose acquired her Master's Degree (MPH) in Health Services Administration from the Yale University School of Public Health followed by her Doctorate (Ed.D.) in Health Education from Columbia University, Teachers College. She is the President and Founder of Rose Consulting through which she offers speaking engagements, workshops and consultation in the United States and abroad. She is author of Health Equity, Diversity, and Inclusion: Context, Controversies, and Solutions, Second Edition and Cultural Competency for Health Administration and Public Health

    Note: The views and opinions in this blog are those of the author and do not necessarily reflect the position of Jones & Bartlett Learning, LLC, the WHO, CDC or any other organizations. Statements in this webinar do not comprise medical or legal advice and are subject to change, particularly with respect to evolving public health issues, medical information and related guidance relative to COVID-19. We advise all readers to carefully monitor developments and advice of the CDC, WHO, and other public health experts and officials. 

    Topics: Patti R. Rose, elder care, health disparities, mass incarceration, nutrition, Patti Rose, elderly, health equity, COVID-19, digital divide, homelessness, unemployment, nursing homes