Chronic diseases, a compromising factor for coronavirus, also run higher in these communities as do social determinant of health inequities

While the Covid-19 pandemic is ravaging all of New York State, from Montauk on Long Island to Mahopac in the Hudson Valley, many minority communities are feeling the effects more than others. Underlying chronic conditions such as hypertension, chronic obstructive pulmonary disease (COPD), and asthma are some of the chronic conditions that also disproportionately affect minorities.  Public health researchers also note that most of these communities endure inferior housing, higher unemployment, and less access to affordable healthy foods – factors known as the social determinants of health.

In early April, the state began to see a trend where communities of color were contracting COVID-19 at a higher rate than their white counterparts.  In response, the governor opened five new testing sites in downstate minority communities and requested state staff to investigate this disheartening trend.  The Centers for Disease Control and Prevention (CDC) is also tracking this COVID-19 incidence disparity.

But health disparities among minority communities are nothing new. The coronavirus pandemic just brought them to light in a more profound way rather quickly.  It is a perverse silver lining to a persistent problem that has plagued healthcare providers, public health practitioners, and researchers for years.

The Numbers on Long Island

In Nassau County, 17 percent of residents who died from coronavirus were black, while they only make up 11.7 percent of the population. In Suffolk County, blacks made up 11 percent of deaths and only eight percent of the county’s population.  Percentages were derived from the New York State Department of Health COVID-19 data posted on April 14, 2020, and the U.S. Census Bureau 2018 American Community Survey.

The Numbers in the Hudson Valley

Some regions of the Hudson Valley are seeing their unfair share of minority communities being disproportionately infected by the coronavirus.  According to state data as of the end of April, in Westchester County age-adjusted deaths from COVID-19 per 100,000 of the population revealed the rate for Hispanics was 96.7 per 100,000 and for blacks 104.5 per 100,000.  The rate for whites was half.  It is a similar story in Orange County and Rockland County.  In Orange, the rate was 66.2 per 100,000 of the population for Hispanics, 89.1 for blacks, and only 32.1 for whites.  The rates in Rockland County were 133.5, 176.4, and 73.3, respectively.

The state’s analysis of May data for newly diagnosed COVID-19 patients shows these disparities are continuing in both of these suburban regions.

The NYS-Covid-19 Tracker reports that outside of New York City, blacks make up 17 percent of coronavirus-related fatalities, while Hispanics account for 14 percent of deaths. These are revealing statistics as blacks and Hispanics make up only nine percent and 12 percent of the New York State population, excluding New York City, respectively. The report also shows that 88.5 percent of all fatalities suffered from at least one comorbidity.

Long before the days of coronavirus, communities of color were experiencing disparities related to the social determinants of health (SDOH).  These are the conditions in the environment in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. These conditions include economic stability, education, social and community context, healthcare, and neighborhood and built environment.

Black and Hispanic families are more likely to live in areas with higher rates of poverty and are less likely to have access to resources such as quality health coverage, access to new treatments, and paid time off from work. The lack of a federal paid leave policy forces low-income workers to choose between staying home from work when sick and not losing wages.  Those who go to work ill are potentially spreading the coronavirus. Many minority workers are also essential workers who do not have a work-from-home choice. These historical health inequities that affect communities of color are also why they are more likely to suffer from chronic diseases such as asthma, hypertension, and diabetes – the underlying, chronic conditions that make them more vulnerable to the coronavirus.

Solutions

The importance of programs combating chronic diseases, especially in high-need communities, is more necessary than ever.  And equally important, are social determinant of health interventions that work in tandem with medical care.  Hospitals offer a variety of programs and services to help patients manage their chronic diseases, including culturally-sensitive outreach programs that connect with minority communities.  There are onsite hospital-based “farmacies” that equip discharged patients, who have a diagnosis tied to a nutritional need, with bags full of vegetables, fruits, and other healthy foods to set them on their way to healing.  Other hospitals provide medical transportation, either fully-covered or subsidized.

Some health plans also fund social determinant of health interventions.  One plan embeds nutritionists in primary care offices.  Another co-locates social workers so patients’ behavioral needs are addressed during a routine visit.

However, we know more needs to be done to eliminate health disparities.  COVID-19 has made that glaringly apparent. The solutions are not easy and they cost money.  Public and private partnerships have made only a small dent in the need.  But if we are to improve mortality and co-morbidities stemming from chronic diseases we have to intensify our efforts now.

Part of those efforts include chronic disease self-care and management – tools to help individuals easily adapt healthier lifestyle changes, which are scientifically proven to improve health.  The Live Better campaign offered by the Long Island Health Collaborative is designed to do just that – raise awareness about better self-care of chronic diseases.  It provides basic education and links to helpful community and hospital-based programs.

If we chip away at the incidence of chronic diseases now then if and when another contagious epidemic strikes we will be more resilient individually and societally.

Learn more about hospital and health policy and regulations at Suburban Hospital Alliance of New York State.