COVID-19 Shines A Spotlight on Health Inequalities

SASKIA V. POPESCU, MPH, MA, CIC
SASKIA V. POPESCU, MPH, MA, CIC

Saskia v. Popescu, PhD, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist. During her work as an infection preventionist, she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She holds a doctorate in Biodefense from George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in Infection Control and has worked in both pediatric and adult acute care facilities.

COVID-19 not only amplifies, but also triggers further health disparities and inequalities.

In recent weeks, COVID-19 news has continued to be front and center. And one thing is for certain—COVID-19 is deeply impacting.

More and more, this pandemic had shed light upon the long-standing health inequalities that exist. These socio-economic, ethnic, and geographical inequalities are not unique to the United States, and yet we have seen an overwhelming amount.

A new study from British researchers evaluated COVID-19 and health inequalities, underscoring the long history of inequalities, from those seen during the 1918 pandemic, to even the 2001 H1N1 influenza pandemic in which Mexico faced higher mortality rates when compared globally to higher-income countries.

In this current pandemic, ethnic inequalities have been shown across the globe, such as those higher rates of critical illness in Black, Asian, and minority ethnic (BAME) peoples in Wales and the UK, despite accounting for only 14% of the population. The researchers noted that minority ethnic groups and those in marginalized groups, such as homeless people and street-based sex workers, are more likely to experience co-existing non-communicable disease at an earlier age and in a more severe form.

The authors noted that “The social determinants of health also work to make people from marginalized communities more vulnerable to infection from COVID-19—even when they have no underlying health conditions. Decades of research into the psychosocial determinants of health have found that the chronic stress of material and psychological deprivation is associated with immunosuppression.”

The authors also discuss how the economic crisis and lockdown challenges during the pandemic have highlighted these existing inequalities, but is also likely to result in increases in mental ill health, suicide and death, but also morbidity.

Those impacted by unemployment or inability to work remotely are then at risk for further morbidities or exacerbation of existing health inequalities. “Both then and now, these inequalities have emerged through the syndemic nature of COVID-19—as it interacts with and exacerbates existing social inequalities in chronic disease and the social determinants of health. COVID-19 has laid bare our longstanding social, economic and political inequalities - even before the COVID-19 pandemic, life expectancy amongst the poorest groups was already declining in the UK and the USA and health inequalities in some European countries have been increasing over the last decade.”

Ultimately, as the authors emphasize and what so many of us have seen, is that events like COVID-19 not only amplify, but also trigger further health disparities and inequalities.

Focused and additional efforts must be undertaken to care for marginalized populations and seek to address health inequalities both in times of struggle, like a pandemic, but also outside of events that can widen these inequalities.