Framing a Needed Discourse on Health Disparities and Social Inequities: Drawing Lessons from a Pandemic.
TL;DR: Grounded in the social determinants of health conceptual framework, the application of the disproportionate impact of COVID‐19 on vulnerable populations and communities of color for a discussion on strategies for minimizing health disparities is explored.
Abstract: COVID-19 provides numerous opportunities for policymakers to consider matters of social equity in relation to the field of public health. Specifically, by reflecting on health disparities in relation to the disproportionate impact of COVID-19 on minority and historically underserved populations, we can leverage a needed discourse on health outcomes for many communities. Grounded in the social determinants of health conceptual framework, this article explores the application of the disproportionate impact of COVID-19 on vulnerable populations and communities of color for a discussion on strategies for minimizing health disparities. This article is protected by copyright. All rights reserved.
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TL;DR: In this article, the authors leverage unique worldwide data that record the daily evolution of policy mandate adoptions and COVID-19 infection and mortality rates to understand the extent to which a policy instrument's early adoption is crucial in crisis management, and they show that the mask mandate is consistently associated with lower infection rates in the short term, and its early adoption boosts the longterm efficacy.
Abstract: To understand the extent to which a policy instrument's early adoption is crucial in crisis management, we leverage unique worldwide data that record the daily evolution of policy mandate adoptions and COVID-19 infection and mortality rates. The analysis shows that the mask mandate is consistently associated with lower infection rates in the short term, and its early adoption boosts the long-term efficacy. By contrast, the other five policy instruments?domestic lockdowns, international travel bans, mass gathering bans, and restaurant and school closures?show weaker efficacy. Governments prepared for a public health crisis with stronger resilience or capacity and those with stronger collectivist cultures were quicker to adopt nationwide mask mandates. From a policy design perspective, policymakers must avoid overreacting with less effective instruments and underreacting with more effective ones during uncertain times, especially when interventions differ in efficacy and cost. This article is protected by copyright. All rights reserved.
23 citations
Cites background from "Framing a Needed Discourse on Healt..."
...…mandates hurt the economy and other aspects of social and personal wellbeing (Gourinchas et al. 2020; McKibbin and Fernando 2020; Spelta et al. 2020; see also Gaynor and Wilson 2020; Martin-Howard and Farmbry 2020; Menifield and Clark 2021; Yancy 2020 about social and racial equity concerns)....
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21 citations
TL;DR: Evidence-based, focused, long-term interventions which are adequately funded and bolder changes to central policies and social structure are needed for sustained change will allow some mitigation of the affects of COVID-19 but also reduce negative outcomes in future comparable situations.
19 citations
TL;DR: In this paper, the authors report on a survey of over 700 families to explore how Australia's National Disability Insurance Scheme (NDIS) supported children and young people and their families to learn remotely during COVID-19.
Abstract: Individualized funding schemes are designed to offer people with disability greater choice and control over the services they receive. In this research, we report on a survey of over 700 families to explore how Australia's National Disability Insurance Scheme (NDIS) supported children and young people and their families to learn remotely during COVID-19. NDIS funding to support education during the first COVID-19 lockdown period forms an important case study of the flexibility of individualized funding schemes. Our results suggest that participant experiences varied widely, with some people able to make the changes they required and others left with a significant service gap. This shows that individual funding schemes are not necessarily more flexible than traditional systems in an emergency situation-useful flexibility depends on many factors, such as clarity of information giving, all actors having a shared message, proactive support of flexibility initiatives, and participants' ability to quickly navigate a complicated system. This research also highlights problems with the interface between the NDIS and mainstream services such as education.
18 citations
TL;DR: In this article, the authors show that some states experienced a higher rate of COVID-19 deaths than other states and that African American communities were hit harder by the virus than other racial groups.
Abstract: In the early months of 2020, news spread that a coronavirus (COVID-19) had been detected in Wuhan, China The virus quickly spread across the country and to other continents As deaths mounted in the United States, evidence indicated that some states experienced a higher rate of COVID-19 deaths than other states and that African American communities were hit harder by the virus than other racial groups Hence, we pose two questions in this research: Are COVID-19 deaths spread equally across different states and regions of the United States? Secondly, are African Americans more likely to die from COVID-19 than other racial groups? Using data from the Centers for Disease Control and Prevention (CDC) and APM Research Lab, we show that some states witnessed significant loss of life due to the virus and that African Americans were more likely to die from the virus when compared with White residents © 2020 by The American Society for Public Administration
11 citations
References
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Centers for Disease Control and Prevention1, United States Department of Health and Human Services2, Colorado Department of Public Health and Environment3, Yale University4, Veterans Health Administration5, Emory University6, Alabama Department of Public Health7, Maryland Department of Health8, New Mexico Department of Health9, New York State Department of Health10, University of Rochester11, Ohio Department of Health12, Vanderbilt University13, Lake County14
TL;DR: It is suggested that older adults have elevated rates of COVID-19-associated hospitalization and the majority of persons hospitalized with CO VID-19 have underlying medical conditions, which underscore the importance of preventive measures to protect older adults and persons with underlyingmedical conditions, as well as the general public.
Abstract: Since SARS-CoV-2, the novel coronavirus that causes coronavirus disease 2019 (COVID-19), was first detected in December 2019 (1), approximately 1.3 million cases have been reported worldwide (2), including approximately 330,000 in the United States (3). To conduct population-based surveillance for laboratory-confirmed COVID-19-associated hospitalizations in the United States, the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) was created using the existing infrastructure of the Influenza Hospitalization Surveillance Network (FluSurv-NET) (4) and the Respiratory Syncytial Virus Hospitalization Surveillance Network (RSV-NET). This report presents age-stratified COVID-19-associated hospitalization rates for patients admitted during March 1-28, 2020, and clinical data on patients admitted during March 1-30, 2020, the first month of U.S. surveillance. Among 1,482 patients hospitalized with COVID-19, 74.5% were aged ≥50 years, and 54.4% were male. The hospitalization rate among patients identified through COVID-NET during this 4-week period was 4.6 per 100,000 population. Rates were highest (13.8) among adults aged ≥65 years. Among 178 (12%) adult patients with data on underlying conditions as of March 30, 2020, 89.3% had one or more underlying conditions; the most common were hypertension (49.7%), obesity (48.3%), chronic lung disease (34.6%), diabetes mellitus (28.3%), and cardiovascular disease (27.8%). These findings suggest that older adults have elevated rates of COVID-19-associated hospitalization and the majority of persons hospitalized with COVID-19 have underlying medical conditions. These findings underscore the importance of preventive measures (e.g., social distancing, respiratory hygiene, and wearing face coverings in public settings where social distancing measures are difficult to maintain)† to protect older adults and persons with underlying medical conditions, as well as the general public. In addition, older adults and persons with serious underlying medical conditions should avoid contact with persons who are ill and immediately contact their health care provider(s) if they have symptoms consistent with COVID-19 (https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html) (5). Ongoing monitoring of hospitalization rates, clinical characteristics, and outcomes of hospitalized patients will be important to better understand the evolving epidemiology of COVID-19 in the United States and the clinical spectrum of disease, and to help guide planning and prioritization of health care system resources.
2,016 citations
"Framing a Needed Discourse on Healt..." refers background in this paper
...A report from the Centers for Disease Control released around the same time indicated similar disproportionalities in a COVID-19 sample, noting that in a catchment of 580 hospitalized COVID-19 patients with race/ethnicity data, approximately 45% were white, 33% were African-American, and 8% were Hispanic, suggesting a disproportionate impact of COVID-19 in minority communities (Garg et al. 2020)....
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...…in a COVID-19 sample, noting that in a catchment of 580 hospitalized COVID-19 patients with race/ethnicity data, approximately 45% were white, 33% were African-American, and 8% were Hispanic, suggesting a disproportionate impact of COVID-19 in minority communities (Garg et al. 2020)....
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DOI•
01 Apr 2007
TL;DR: A shared understanding of where and how to intervene to reduce health inequities is sought that can orient the work of the Commission on Social Determinants of Health.
Abstract: When he announced his intention to create the Commission on Social Determinants of Health (CSDH), WHO Director-General Lee Jong-wook identified the Commission as part of a comprehensive effort to promote greater equity in global health, in a spirit of social justice1. The Commission’s goal, then, is to advance health equity, driving action to reduce health differences among social groups, within and between countries. Getting to grips with this mission requires finding answers to three fundamental problems: 1. Where do health differences among social groups originate, if we trace them back to their deepest roots? 2. What pathways lead from root causes to the stark differences in health status observed at the population level? 3. In light of the answers to the first two questions, where and how should we intervene to reduce health inequities? This paper seeks to make explicit a shared understanding of these issues that can orient the work of the CSDH.
1,880 citations
TL;DR: This paper argues that the central question becomes: who and what is responsible for population patterns of health, disease, and well-being, as manifested in present, past and changing social inequalities in health?
Abstract: In social epidemiology, to speak of theory is simultaneously to speak of society and biology. It is, I will argue, to speak of embodiment. At issue is how we literally incorporate, biologically, the world around us, a world in which we simultaneously are but one biological species among many—and one whose labour and ideas literally have transformed the face of this earth. To conceptualize and elucidate the myriad social and biological processes resulting in embodiment and its manifestation in populations' epidemiological profiles, we need theory. This is because theory helps us structure our ideas, so as to explain causal connections between specified phenomena within and across specified domains by using interrelated sets of ideas whose plausibility can be tested by human action and thought.1–3 Grappling with notions of causation, in turn, raises not only complex philosophical issues but also, in the case of social epidemiology, issues of accountability and agency: simply invoking abstract notions of ‘society’ and disembodied ‘genes’ will not suffice. Instead, the central question becomes: who and what is responsible for population patterns of health, disease, and well-being, as manifested in present, past and changing social inequalities in health?
1,719 citations
"Framing a Needed Discourse on Healt..." refers background in this paper
...…to an integrated, multi-level, social determinants approach complements a focus on individual biology of disease with attention to social and economic factors, physical and social environment, and social and health policies (Durch, Bailey, and Stoto 1997; Berkman and Kawachi 2000; Krieger 2001)....
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TL;DR: In the 117th Shattuck Lecture, Dr. Steven Schroeder asks why the American system fails to deliver a standard of health similar to that observed in many other countries.
Abstract: In the 117th Shattuck Lecture, Dr. Steven Schroeder asks why the American system fails to deliver a standard of health similar to that observed in many other countries. In his arguments, he focuses on the public health risks of smoking and obesity and how they have been managed.
892 citations