The Relationship Between Social Determinants of Health and COVID-19

As the nation continues to contend with the coronavirus pandemic, existing health and healthcare disparities among Americans has been exacerbated. While anyone could be infected and develop COVID-19, what is becoming increasingly apparent is that traditionally marginalized populations—including people of color—are much more likely to contract and die from this disease.

The reason behind these discrepancies lies in understanding the social determinants of health (SDOH). SDOH are the conditions in which people are born, live, and age that affect a wide range of health outcomes and risks. There are many things that could be considered SDOH, but Healthy People 2020 categorizes these conditions into five groups:

1. Economic Stability—this includes issues like poverty, employment (including being unemployed or underemployed), and food or housing insecurity.
2. Education—this includes variables like high school graduation rates, literacy levels, and access to early childhood education.
3. Health and Healthcare—this category includes access to healthcare, access to primary care, health literacy levels.
4. Neighborhood and Built Environment—this includes access to healthy foods, the quality of one’s housing, and neighborhood crime and violence rates.
5. Social and Community Context—this category includes issues such as discrimination, civic participation, and incarceration.

Impact of Social Characteristics on Healthcare Access

Of course, biological/genetic factors as well as health behaviors also have a hand in an individual’s or population’s health outcomes. However, these factors only account for about 25% of health outcomes. In contrast, social characteristics, access to healthcare, and physical environment account for the other 75% of health outcomes—in other words, social determinants of health drive the vast majority of our wellness and health outcomes.

Despite this, the onus of responsibility is often placed on individuals’ health behaviors. Recently, a state senator from North Carolina suggested that the state’s Latino population was harder hit by the coronavirus because they do not practice social distancing or wear masks as frequently as other groups. An Ohio lawmaker recently made similar remarks about Black Americans, stating that this population experienced a higher rate of coronavirus cases because they do not wash their hands as well as other groups. It is critical to point out here that many individuals—including policymakers—will often attribute individual behavior, rather than systemic causes, when trying to explain health disparities.

When viewed from the lens of social determinants, there are many reasons outside of individual behavior that better explain why Black and Latino Americans are dying of COVID-19 at substantially higher rates than white Americans:

• Economic Stability: 25% of Black and Latino workers are employed in the service industry and considered essential workers, leaving them at a higher risk of contracting the coronavirus. Additionally, these essential worker positions are much less likely to have benefits such as paid sick leave, leaving individuals in the difficult predicament of going to work even if they have symptoms, when staying home could mean losing days’ or weeks’ worth of wages.
• Neighborhood & Build Environment: Black and Latino Americans are much more likely than white Americans to live in multigenerational households. This can make it much more difficult to appropriately socially distance if a family member falls ill.
• Social & Community Context: Black and Latino individuals are largely overrepresented in jail, prison, and detention center populations. These settings carry a large risk for infection due to congregate living, the inability to socially distance, and poor access to adequate healthcare.

Social Determinants and COVID-19

These are just a few examples of the social determinants that are impacting Black and Latino individuals’ health outcomes during the pandemic—there are many more aspects of SDOH that could also come into play. But what these clearly demonstrate is that, overwhelmingly, social determinants have a heavier hand in the poor outcomes among these populations during COVID-19. They also give a better explanation as to why Black and Latino individuals are dying at a higher rate than white Americans outside of simple individual health behaviors.

When employers, agencies, and healthcare organizations begin to understand the nuance of social determinants and the effect they have on COVID-19 infection and death rates, they can better understand how to help individuals prevent this disease. It can also help providers identify different at-risk groups in their community and drive them to provide targeted and individualized outreach to high-risk populations. As the pandemic continues, understanding the connection between SDOH and COVID-19 is one of the best ways providers can address the needs of high-risk populations and begin to initiate activities that will prevent infections and deaths.