COVID-19 may worsen heath inequities in some communities

Father and son brushing teethThe coronavirus has disproportionately affected Black and Latino people, as well as people in poor neighborhoods. Experts warn the pandemic will worsen the root causes of those disparities, leading to a broader decline in oral health, heart health and overall wellness.

Federal data show Black and Latino people are nearly five times as likely as white people to be hospitalized for COVID-19 —and are more likely to die. An analysis by USA Today found that in the nation’s poorest neighborhoods, where the median household income is less than $35,000, the infection rate was twice as high as in the wealthiest ZIP codes.

“The populations that are disproportionately impacted by COVID-19 are the same populations disproportionately impacted by poor oral health, and a lot of that goes back to how the system is designed,” said Dr. Zachary Brian, director of the North Carolina Oral Health Collaborative. “It’s really about systemic barriers that exist. That correlation is something that people should pay attention to because it’s definitely not a coincidence.”

Pre-existing social conditions — lack of access to quality health care, jobs, education and housing — set the stage for coronavirus-related disparities, the American Heart Association said in a statement earlier this year. Adding financial strain, safety concerns and quarantine-related uncertainty to the formula only adds to the problem, health experts said.

“A pandemic can magnify these issues,” said Dr. Ivor Benjamin, director of the Cardiovascular Center at Medical College of Wisconsin. “The social determinants of health we talk about have to do with where people work, where they go to school, where they navigate their daily activities, and we certainly have had significant curtailment in terms of those opportunities.”

That disruption to everyday life can have a domino effect that leads to poorer overall health, said Benjamin, a past president of the AHA.

“As a result of either getting ill or not being able to work, just having a roof over your head, being able to meet the rent assumes much higher priority than being able to go and get prescriptions filled,” he said. “We know that there are people who will begin to start rationing their medications when a disproportionate amount of fixed income needs to go towards food and housing.”

In March and April, as the pandemic began in the U.S., the American Dental Association recommended that dental practices provide emergency-only care, limiting preventive care. Even months after dental services have resumed to varying degrees, the effect of the disruption remains unknown, Brian said. “The delay in care is particularly worrisome as many of the oral health issues prior to COVID-19, may very well now be further advanced and exacerbated.”

“If you’re already kind of hesitant for various reasons to seek oral health care – maybe the barriers are just too great, maybe it’s transportation issues or financial concerns — now we have a concern about safety, and that care may be delayed further,” he said.

Oral care in particular represents a vital front in the battle for public health because it “really does impact your whole body,” Brian said. “The way I look at it is that the mouth is the window to the body, so what’s going on inside the mouth is really a reflection of what’s going on systemically in the body.”

Some solutions to problems posed by the pandemic — such as the increase in use of telehealth and telemedicine — further expose disparities in access, Benjamin said. A Pew Research Center survey regarding online access in 2018 found nearly 15% of households with students did not have fast internet connections, disproportionately affecting low-income communities and people of color.

“We need to just rewrite what it means to have basic services, and in the 21st century, having access to high-quality internet services that are appropriately priced represents basic rights,” Benjamin said. “A hundred years ago, infectious disease was the dominant thing because there wasn’t adequate sanitation. We had to fix that.”

“The pandemic has revealed that access to high-speed internet is a fundamental technology to achieve education equity and having access to affordable health care,” he said. “This is about social justice and how the AHA wishes to engage with different stakeholders to narrow the gap on health disparities.”


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