Deeply embedded systemic issues such as racism and classism have historically served as barriers to achieving health equity. These issues often result in several health dwindling factors such as increased density of households, unemployment and a lack of access to basic healthcare services. And, during COVID-19, these existing health disparities have become even more prevalent in minority populations, as Black and Hispanic communities across the U.S. experience greater financial impacts, higher rates of infection and higher rates of death.
As more COVID-19 testing data becomes available, it has become increasingly apparent that the pandemic has been especially devastating for minority communities in the U.S. However, beyond just demonstrating the impact of COVID-19, this testing data has also provided us with the opportunity to identify impacted communities that reflect the underlying racial and ethnic health inequalities in treatment and care that have been exacerbated by the pandemic but have long plagued our country’s most vulnerable populations.
Black and Hispanic populations already face higher rates of chronic conditions like diabetes, stoke and asthma that result in significant complications from COVID-19. However, due to lack of access to quality healthcare options and potentially compounded by distrust in the medical system, it’s common for members of minority populations to not even be aware they have an underlying health condition, leaving these health issues untreated.
Additionally, because of the nation’s history of segregation and health equity gaps, many minorities live in low-income communities, with crowded neighborhoods and housing, making social distancing challenging or impossible. They are also often employed in lower-income or essential roles that may not provide insurance and they may fear taking sick leave at the risk of being laid off.
By increasing access to COVID-19 community-based testing, we can help to address these health disparities among minority and underserved communities—not only by identifying and aspiring to quell the spread of the virus among our most at-risk populations, but also by providing valuable demographic data that can be used as a tool to help improve health equity in the long term at the local and national level.
The systematic collection of racial and ethnic data gleaned from COVID-19 testing in underserved communities can be used to better understand this pandemic and inform measures within our control to prevent the spread of disease in the future. This data can also enable us to better understand and address the country’s longstanding and pervasive healthcare disparities, by providing evidence and support for a more equitable allocation of resources and funds based on the specific needs of certain demographics.
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Cooperation between healthcare organizations and local groups is critical to effectively increasing access to COVID-19 testing in the underserved and uninsured populations that are being hit the hardest by the lack of health equity. Rapid-response community testing sites that are co-located at local organizations’ facilities including free clinics, community colleges and faith-based institutions can be key in helping to reach individuals in highly vulnerable and disadvantaged populations who may not otherwise have access to testing due to their socio-economic status, living conditions, language or educational barriers.
Recognizing that patients from diverse populations are more trusting of doctors from their own neighborhood, expanding community-based testing in underserved areas can also help to encourage those who may be distrustful of the healthcare system and more at risk to delay care. By co-locating testing sites at trusted community facilities, organizations can tap into local networks to target and expand data collection efforts in the areas that have the greatest need.
COVID-19 diagnostic testing in minority neighborhoods that is tailored to the needs and culture of the community makes it easier for people to access testing in the places that carry the heaviest burden of the disease, particularly for those located in high-risk neighborhoods that need the most support, as measured by the Centers for Disease Control and Prevention's Social Vulnerability Index. The index tracks a variety of census variables that impact health equity including poverty, lack of access to transportation and crowded housing that may weaken a community's ability to prepare for and recover from hazardous events like natural disasters and disease outbreaks. For example, expanding walk-up testing sites in low-income areas with a lack of transportation enables us to meet people where they are, making them more likely to get tested and provide us with valuable data that can be broken down by race and ethnicity to help identify COVID-19’s impact in specific communities, educate on future pandemics, and deploy resources to those in need strategically with social determinants and health disparities in mind.
Historical health inequities in underserved areas have been highlighted by COVID-19 but won’t end once the outbreak does. Increasing access to testing in minority communities not only has the potential to limit the detrimental impacts of COVID-19 on our most at-risk population but can also play a vital role in bridging historical and current health inequities and improving population health.
The collection and analysis of demographic data gleaned from community-based testing is key to helping us better identify and address the gaps that have been created by systemic inequity in the healthcare system. This pandemic has illustrated the power of community health and demonstrated that the overall health of a nation largely depends on the health of its communities, specifically its most vulnerable. Now and when planning for future health crises, it is critical that we remember that our local infrastructure is the backbone in the creation of a stronger, healthier national healthcare system.
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