Lack of access to services, fresh foods, vaccination sites increased vulnerability, experts say
By Julianne Hill, Justin Fernandez, Gabriella Fuster, and Melissa Noda
Urban Health Media Project
Florida’s response to the COVID-19 pandemic unmasked disparities in healthcare based on socioeconomic factors, disproportionately hurting communities of color in the state while exposing weaknesses in leadership, according to a Florida health expert.
“We know from our country’s history that responding to a disaster is a time when we’ll see systemic racism play out,” said Alison Yager, executive director of the nonpartisan Florida Health Justice Project. In Florida, she said, “People have not had the same types of access to services from the onset… We know that at every point that you might be measuring, people are disparately able to access the services that they need and disparately exposed to harm.”
Inequitable access to services and increased exposure to unhealthy and dangerous living and working conditions hurt all populations, but especially damage under-resourced communities. In Florida, Hispanics make up 27 percent of the state’s population, but accounted for 41% of COVID cases, according to the Kaiser Family Foundation. Nationwide, Hispanic and Latino people have had nearly double the rate of COVID cases, and almost triple the rate of hospitalizations compared to whites, according to the Centers for Disease Control and Prevention.
“Our leadership has been in denial about COVID, has been wanting to minimize the impact of the pandemic across our state and that’s had all kinds of different consequences,” said Yager, including not investing enough in essential services and not putting in place regulations such as mask-wearing for frontline, essential workers. “There was pushback on that from the beginning.”
COVID spotlights systemic problems
Around the country, people of color have been hit harder by the virus itself and its many ripple effects.
As of September 30, Florida reported 3.57 million COVID-19 cases and 55, 299 deaths from the virus. Of those, 513,886 cases and 9,219 deaths were among Black people and 1,083,805 cases and 11,944 deaths were among Hispanic people, according to the Florida Department of Health.
But, said emergency physician and George Washington University public health professor Leana Wen, “it’s not the virus that’s doing the discriminating; it’s our systems.”
These systems--including schools, transportation, healthcare, the courts and employment--create disparities based on income, geography and race, leading to unequal access to quality healthcare, education, jobs that pay a living wage, healthy foods, and even clean air and water, said Wen.
COVID-19 hit Black people particularly hard, for example, because they were over-represented in frontline positions, such as clerks and childcare workers, where the risk of exposure to the virus was higher, and because they were more likely to be employed in sectors that had layoffs, such as restaurants and hotels, she added.
COVID-related layoffs have led to even higher rates of food insecurity-- the lack of access to adequate, nutritious food-- across the country. Two years ago, the national food insecurity rate was 10.3% and it’s expected to increase to 13.6% this year, according to Feeding America. One in eight -- or 42 million people--may experience food insecurity in 2021, an increase from 35 million before the pandemic.
COVID and food insecurity create a vicious cycle of illness, according to health experts. Not having access to adequate, nutritious food makes it more likely for people to have many of the health conditions that in turn make them more susceptible to falling ill from the coronavirus.
“In my city, in Baltimore, one in three African-Americans live in a food desert without access to healthy fruits and vegetables compared to one in 12 whites,” said Wen. “So is it any surprise that we also have a disproportionate degree of heart disease, diabetes, and obesity--conditions that predispose to severe outcomes for COVID-19?”
Vaccination rates in low-income communities reflect access issues
Limited access and a lack of information play a role in keeping vaccination rates low in the Black and Latino communities in the U.S. and Florida, Yager said.
While 77.6 percent of all American adults received at least one dose of the vaccine by October 3, only 36.4 percent of Black people and 43.2 percent of Latinos received at least one dose of the vaccine, according to the CDC. In Florida, as of June 3, more than 2 million people received at least one dose, of which nearly 496,664 were Latino and about 174,861 were Black, according to the state’s Department of Health.
Communities of color have received fewer screenings and vaccinations, partly due to access. Not everyone is close to one of the chain drug stores that distributes vaccines, Yager said.
“If we put vaccination and the power to vaccinate our communities into the hands of retail institutions, then we have to make sure that those retail institutions are in every community,” she said. “Or if not, we have to make sure that the communities that need to get to those places have a way to get to them, and that there’s public transportation provided.”
The government has taken steps to increase vaccinations, such as partnering with faith-based organizations to deliver walk-up vaccines in underserved communities. Also, Florida counties offer free or reduced-cost programs for COVID-19 treatments in hospitals for the underprivileged and uninsured.
However, promotion of these programs is not robust, and many uninsured people continue to avoid treatment in fear of a financial burden, Yager said.
“The reality is people don’t necessarily know that those programs exist,” she added.
Improving access, addressing inequities key to improving outcomes
Expanding Medicaid--the federal and state program that provides healthcare to low- income people, children and pregnant women, among others-- to include coverage for more people, is one way to solve some of these income-related access issues, said Yager.
Florida is one of 12 states that have not expanded Medicaid access under the Affordable Care Act (ACA), leaving a coverage gap above the state’s Medicaid eligibility threshold but under the Federal Poverty Line. Households in this coverage gap do not receive healthcare benefits.
“If Florida were to expand Medicaid, the current estimate is that over a million Floridians would benefit from the health coverage provided,” she said. “There are undoubtedly lots of uninsured folks who’ve had COVID, with long-haul symptoms, and the state needs a systemic reform to provide insurance to those folks.”
But, as both experts pointed out, the reasons for COVID’s disparate impact on poor people and people of color run far deeper and wider than whether or not they have health insurance, and any solutions will have to address the systemic inequities in all aspects of American life.
While these inequities existed long before the pandemic, COVID-19 has made them nearly impossible to ignore and have “shown us that unless we're really intentional to eliminate disparities that they're going to get worse,” said Wen.
Yager echoed that sentiment.
“It’s really important when we are thinking about a health crisis to think not just about how do we get people tested and treated and vaccinated, but also how do we keep people housed and how do we keep people fed and all of what we call the social determinants of health,” she said.
UHMP Intern Aileen Delgado contributed to this story.