Inequities in health care, education, economic stability and housing have persisted for years in Connecticut, fueling disparate health outcomes, life expectancies, employment opportunities and personal wealth.
The COVID-19 pandemic has brought these disparities into sharp focus, amplifying problems that have long festered, researchers with New Haven-based DataHaven concluded in a new report about social inequity and the impact of coronavirus.
“These disparities are concerning even outside of a pandemic. But as COVID-19 takes an especially sobering toll on already-disadvantaged communities, it becomes evident that systemic oppression based on race, language, poverty, and other socioeconomic factors has left some people more vulnerable than others,” the report’s authors, Kelly Davila, Mark Abraham, and Camille Seaberry, wrote.
In its wide-ranging study, DataHaven examined how discrimination and other social factors led to the disparate outcomes. As COVID-19 spread across Connecticut, the group also looked at how those inequities have been magnified during the pandemic.
Black residents here are 2 ½ times more likely to die from a coronavirus infection than whites. The death rate for Hispanics is 67% higher than for white residents when adjusted for age differences.
People of color here are also more likely to work in high-risk, “essential” jobs, such as those in nursing homes, grocery stores and retail, to live in densely populated communities, and to have higher rates of pre-existing conditions like diabetes and asthma that are caused or worsened by systemic racism.
During the pandemic, residents in low income, predominantly minority neighborhoods have faced larger barriers to testing and other services.
“The racial and ethnic health disparities that are so clear during this pandemic reflect longstanding disparities in health outcomes and access to resources,” said Patricia Baker, president and CEO of the Connecticut Health Foundation, who reviewed the report. “It is critical that as we work to eliminate disparities, we recognize and address the many ways that racism shapes health outcomes and influences the systems and institutions we all rely on.”
Here are some of the areas the researchers explored:
Education and economic stability
DataHaven looked at achievement gaps, educational attainment, unemployment and income disparity, among other issues.
Even before the coronavirus crisis, four-year public high school graduation rates for Black and Latino students were lower than the rate for white students (80% and 78% for Black and Latino students, respectively, compared to 93% for white students). Two-thirds of adults who speak Spanish at home have a high school diploma or less, disadvantaging them within the state’s workforce.
In 2018, 12% of Black workers and 10% of Latino workers in Connecticut were unemployed. These populations were also twice as likely as white adults to be underemployed, the researchers noted. Many jobs in urban areas are high-wage but are in fields that require higher levels of education, placing them out of reach for some urban residents who are less likely to have reliable access to a vehicle and have lower rates of post-secondary education.
Twenty percent of Black and Latino residents lived in poverty in 2018, a rate twice as high as the statewide figure.
The COVID-19 crisis has worsened these disparities.
“The pandemic has necessitated remote learning, but not all Connecticut residents have equal access to computers and broadband internet,” the researchers wrote. “Additionally, school-based support systems are especially important for higher-needs students, who may now be further disadvantaged.”
During the early months of the pandemic, retail, food service, personal care and other businesses that heavily employ immigrants and people of color closed, leaving many out of work. And disparities that lead to concentrated poverty, chronic health conditions and habits like smoking have been linked to an increased likelihood of contracting COVID-19.
Uninsured rates, the affordability of health care and access to medical services were also examined in the report.
Among the findings: One-in-10 Connecticut adults have reported experiencing discrimination while accessing health care. Black, Latino, and Asian adults were far more likely to report instances of discrimination due to their race – about 7% of Black, 5% of Latino, and 3% of Asian adults reported discrimination, compared to less than 1 percent of white adults.
Language is a barrier for households speaking Spanish or Asian/Pacific Island languages. For the latter, households are especially isolated in rural areas, where they may not have neighbors or health care workers that speak their language.
Insurance rates are lower in cities and areas with higher poverty and unemployment. Seventy-four percent of Connecticut adults reported going to a dentist during the past year, but only 57 percent of low-income adults did. And 15% percent of low-income adults said they were unable to afford prescriptions.
As massive layoffs occurred during the COVID-19 crisis, many people lost their health coverage. “This leaves people who are especially vulnerable to contracting the infections unable to afford the costs of care and recovery,” the report’s authors wrote.
Black, Latino, immigrant, and low-income communities are facing particularly high rates of coronavirus, but are also the groups that face discrimination from medical providers, and lack high-quality, culturally competent health care, they noted.
Black patients with COVID-19 symptoms were less likely to receive a test order than white patients, and some drive-through testing sites were less accessible to patients without vehicles.
Due to redlining and restrictive zoning, Black and Latino families face more obstacles to homeownership and are more likely to rent their homes, the DataHaven researchers pointed out. Renters disproportionately live in overcrowded households. Subsidized and lower-cost housing is concentrated in low-income, urban areas.
Households led by a Black or Latino adult are less than half as likely to own their home than those led by white adults. Households led by a single woman have similarly low rates of home ownership.
In 2018, more than 10% of Black and Latino adults, young adults, and those with children reported being unable to pay for housing. Seven percent of renters who had moved in the past three years reported being evicted, a number that was higher for Black and Latino adults.
With the loss of work during the pandemic, “many Connecticut residents are facing housing insecurity due to inability to pay rent or mortgages,” the authors wrote. “Evictions and foreclosures are temporarily prohibited, but it is still unknown whether families will be asked to leave their homes if they are unable to pay past-due rent after the hold is lifted.”
According to the report, one-in-three Connecticut adults earning less than $30,000 said they were unable to afford food at least once in the past year.
While programs like Supplemental Nutrition Assistance Program (SNAP) make food more affordable, the cost of food in Connecticut was 40% to 50% higher than SNAP benefits in 2015.
Inadequate access to nutritious food leads to chronic health conditions like obesity and diabetes, which are prevalent in urban areas and among low-income adults in Connecticut.
Since the start of the COVID-19 crisis, food insecurity has increased as families have been cut off from school-based free food programs. Chronic health conditions that stem from poor nutrition are often considered to be comorbidities of severe COVID-19 cases.
What can be done?
The authors of the study offered a range of suggestions for reform, including expanding insurance coverage; closing gaps in educational opportunities (beginning in youth); boosting economic opportunities and access to food, housing, and comprehensive social services; and reducing discrimination in employment, health care, policing, and urban planning.
“Addressing social needs – especially those related to basic necessities such as food and housing – can improve individual and public health,” they wrote. “When individuals spend less time and energy worrying about how to survive day to day, they can invest more time in improving their overall health and quality of life.
“During the current pandemic, the struggle to obtain food and pay for housing has become a reality for some who previously had only considered these needs in the abstract.”
New policies should be implemented in tandem with community-based organizations, which already work to reduce the legacy of discrimination, the researchers said.
Read the full report here.