COVID-19 and the US response: accelerating health inequities.

• Type of Material: Article
• Authors: Nneoma Okonkwo, Johns Hopkins University; Ugochi Aguwa, Johns Hopkins University; Minyoung Jang, Johns Hopkins University; Iman A. Barré, Meharry Medical College; Kathleen R. Page, Johns Hopkins University; Patrick Sullivan, Emory University; Chris Beyrer, Johns Hopkins University; Stefan Baral, Johns Hopkins University
• Language: English
• Date: 2020-06-03
• Publisher: BMJ Publishing Group
• Publication Version: Final Published Version
• Copyright Statement: © Author(s) (or their employer(s)) 2020.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/bmjebm-2020-111426
• Title of Journal or Parent Work: BMJ Evidence Based Medicine
• Grant/Funding Information: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
• Keywords: socioeconomic factors; delivery of healthcare; infectious disease medicine; public health; healthcare quality, access, and evaluation
• Research Categories: Health Sciences, Immunology; Health Sciences, Public Health

Abstract

Health inequities have long defined health and the healthcare system in the USA. The clinical and research capacity across the USA is unparalleled, yet compared to other high and even some middle-income countries, the average health indicators of the population remain suboptimal in 2020, a finding at least in part explained by inequity in healthcare access. In this context, COVID-19 has rapidly emerged as a major threat to the public's health. While it was initially thought that severe acute respiratory syndrome coronavirus 2 would be the great equaliser as it would not discriminate, it is clear that COVID-19 incidence and mortality have rapidly reinforced health disparities drawn by historical and contemporary inequities. Here, we synthesise the data highlighting specific risks among particular marginalised and under-resourced communities including those in jails, prisons and detention centers, immigrants and the undocumented, people with disabilities and people experiencing homelessness across the USA. The drivers of these disparities are pervasive structural risks including limited access to preventive services, inability to comply with physical distancing recommendations, underlying health disparities and intersecting stigmas particularly affecting racial and ethnic minorities across the country, including African Americans, Latinx Americans and Native Americans. Advancing the COVID-19 response, saving lives and restarting the economy necessitate rapidly addressing these inequities rather than ignoring and even reinforcing them.