The coronavirus pandemic upended much of life as we knew it in March 2020. Some of the impacts are obvious: changes in how we live, work and play in our daily lives to avoid infection; an economy adversely impacted by business closings, furlough and layoffs; and a healthcare system overwhelmed by the sheer numbers of patients and community members infected with a virus about which researchers are still learning.
Not all of the impacts are immediately visible, though.
- Three months into the pandemic, 40 percent of U.S. adults struggled with mental health or substance abuse, according to a Centers for Disease Control and Prevention study. This included increased anxiety or depression symptoms, substance or alcohol use, trauma and stressor-related disorders and suicide ideation. Meanwhile, access to recovery programs like Alcoholics Anonymous and Narcotics Anonymous was curtailed by social distancing protocols.
- Black, Asian, Latinx, Native American and other minority communities have been far more affected by COVID-19 than white people, according to a study published in EClinicalMedicine, a publication of the medical journal, The Lancet. Black people are twice as likely as white people to be infected with the coronavirus. People from Asian backgrounds are 1.5 times more likely to be infected, and evidence suggests they may be dying at higher rates than white people.
- Members of several minority groups are dying at higher rates than white people, according to The COVID-19 Tracking Project. These groups include Native Hawaiians and Pacific Islanders, black people, Native Americans or Alaskan Natives and Latinx.
ORAU is working with its agency partners to address mental health/substance abuse issues and health disparities in a number of ways.
Diseases of Despair
“The Appalachian Regional Commission calls these types of disorders – substance use, suicide, alcohol use -- diseases of despair,” said Jennifer Reynolds, health communications project manager. “I’ve always loved that characterization because I think that it is absolutely what these are. These are not moral failings or weaknesses of character. These are disorders that are chronic.”
Like all chronic conditions, societal stressors exacerbate these conditions.
“I think we can all agree that there have been many societal stressors and some that are more profound than COVID,” Reynolds said. “I would argue the combination of COVID and socioeconomic and demographic issues have impacted a lot of our populations.”
Reynolds adds that HEALing (Helping to End Addiction Long-term) Communities research indicates the rise in diseases of despair, particularly opioid use, will continue for 12 to 18 months beyond the end of the pandemic. ORAU is working with the University of Kentucky and the National Institutes of Health on the HEALing Communities Study, which hopes to reduce opioid use by 40 percent in target states, including Kentucky, Ohio, Massachusetts and New York.
There are some positives in light of the pandemic, including increased availability of telemedicine and relaxation of policies for connecting people to medications like Suboxone for addiction treatment.
“We’re seeing communities that were totally against distribution of Naloxone (an injectable medication that can save the life of someone experiencing an opioid overdose) that are now more open to it,” she said. “We’re seeing telehealth recovery expanding to people who are not comfortable in a group meeting setting, and more people reaching out for recovery support who may not ever have felt comfortable receiving treatment before.”
Health Disparities and COVID-19
Even with that good news, though, access to telehealth and medication-assisted treatment often depends on sociodemographic factors and race. The COVID-19 pandemic has spotlighted racial and ethnic disparities in access to both medical and behavioral health care. There are many barriers to access to care and treatment, including but not limited to poverty, insurance, language and transportation.
“Transportation is a huge issue whether or not there is a pandemic,” said Kelli Bursey, project specialist in Health Communications. “I sat on a webinar the other day, and they were talking about social determinants of health and how certain components such as transportation and housing and things like that affect people. So, you miss your medical appointment and they put you on a list as non-compliant, right? But your transportation never came, so what do you do? My own grandmother was left at an appointment for hours because her transportation service didn’t pick her up. I’m out of town, so I couldn’t help. I had to send someone else to pick her up. This happens in the Black community all the time.”
It’s not just transportation. Other social determinants of health include income level, educational opportunities, occupational opportunities, access to health and nutritious food, and access to housing and utility services. Not surprisingly, social determinants of health have played a role in the health disparities. According to reports from the Kaiser Family Foundation and Health Affairs, people in minority communities are:
- At increased risk for serious illness if they contract COVID-19 due to higher rates of underlying health conditions, such as diabetes, asthma, hypertension, and obesity compared to white people;
- More likely to be uninsured and to lack a usual source of care which is an impediment to accessing COVID-19 testing and treatment services;
- More likely to work in the service industries such as restaurants, retail, and hospitality that are particularly at risk for loss of income during the pandemic;
- More likely to live in housing situations, such as multigenerational families or low-income and public housing, that make it difficult to social distance or self-isolate; and are
- Often working in jobs that are not amenable to teleworking and use public transportation that puts them at risk for exposure to COVID-19.
ORAU is leaning into its long-standing relationships with 23 Historically Black Colleges and Universities/Minority Education Institutions around the nation in a major effort to address disparities.
Moving forward, these institutions will comprise the Minority Serving Institutions Research Council, which will soon begin developing a research framework designed to highlight the excellence of the research capabilities of each of the council’s member institutions. One of the likely focuses of research will be minority-focused health information, as it relates to the coronavirus pandemic but also to minority health disparities overall.
“We have the opportunity to work together to look at trends and how we can collectively address health issues, from disparities and COVID to co-morbidities and treatments and vaccines, to how we best communicate with minority groups,” said Desmond Stubbs, ORAU director of diversity initiatives.
“Inequities in health and health care have led to disproportionate coronavirus infections and deaths in African American, Latinx, Asian and Native American communities. As the World Health Organization Constitution states ‘Health is not simply the absence of disease – Health is the proactive management of social factors, healthy eating, healthcare access, health practices and genomic factors,’” Stubbs said. “The essence of this statement remains true and forms the basis for the Minority Health Information Exchange. The MHIE is a collaboration between the major HBCU medical colleges, Microsoft and ORAU to establish a minority health data repository comprised of over 100 years of African American health data for use by a national/international research community comprised of federal, academic and commercial researchers to address health disparities in communities of color.”
Where We Go From Here
2020 saw the coronavirus lay bare the inequities that exist in our health care system. That, combined with a summer of racial unrest following the deaths of George Floyd in Minneapolis, Ahmaud Arbery in Brunswick, Ga., and Breonna Taylor in Louisville, has created an atmosphere where gaining or regaining trust is important.
“Mistrust and misinformation are very big issues,” Bursey said. Regaining trust will be part of a project Bursey, Reynolds and other ORAU experts are working with the CDC Office of Minority Health and Health Equity to support communications to populations disproportionately impacted by COVID-19.
“We need to find the best way to reach out to these populations,” Bursey said. “Would they trust taking a vaccine? How do we get them credible information?”
Making in-reach to these communities is something ORAU is expert in, Reynolds said.
“My prediction for where our field is going, because of COVID and all of these other issues, and because the issue of trust is super important, is we will work more with community-based organizations to distribute information, which ORAU, frankly, has been doing for a really long time,” Reynolds said.
Bursey has implemented diabetes education programs in black churches, and Reynolds has provided years of communications and social media expertise and training of local community health departments in how to reach out to and educate vulnerable populations about health issues. All of this work has been on-the-ground, community-based communication.
“The coronavirus crisis and its management is absolutely going to harm the public’s trust in our top agencies. How we as practitioners navigate that is by working through the agencies and organizations that people already trust, like their community center or their library, even their hairdresser,” Reynolds said.
In a world turned upside down by the coronavirus, smart, thoughtful and culturally appropriate communication may begin to set the world right for those in minority communities.