How the Coronavirus Affects Social Determinants of Health
The social determinants of health are coming front and center as the public health community works to address the coronavirus.
The coronavirus pandemic has shone a light on some of the gaps in the social safety net, exacerbating key social determinants of health that make it hard for people to be healthy.
As public health leaders look for ways to put a cap on virus spread – primarily through social distancing practices and in some cases shelter in place protocol – the nation is seeing just how deep health disparities run. There are clear delineations between different social groups and how they are faring in the new normal that coronavirus has dawned.
The issue of social distancing, coupled with questions about access to care and other health resources, have specifically highlighted disparities for individuals who are homeless or housing insecure, who have limited food security, and who live in rural regions.
Below, PatientEngagementHIT outlines key social determinants of health and how the coronavirus outbreak has exacerbated them.
QUELLING SPREAD IN HOUSING INSECURE POPULATIONS
The challenge for individuals who are homeless is clear: it is hard to social distance when a patient has nowhere to go.
Just under a half a million individuals went homeless on any given night in the United States during 2018, the most recent years for which federal agencies have data. According to a September 2019 White House report on homelessness, which used that 2018 data, about 35 percent are found without shelter. The remaining 65 percent typically find refuge in homeless shelters, transitional housing, or other emergency shelters.
In all of those cases, it’s hard to social distance, a tactic public health officials are currently hailing as the gold standard in quelling the spread of COVID-19. When social distancing, individuals are limiting gatherings in large numbers, avoiding public spaces that are not essential, and keeping a safe six-foot distance from other individuals.
Because it’s hard for individuals experiencing homelessness to adhere to those guidelines, many fear this population could be especially vulnerable to coronavirus spread.
“Homelessness services systems should be working closely with their city and county governments and public health systems to prepare for COVID-19 disease outbreaks among people experiencing homelessness,” says a resource from the United States Interagency Council on Homelessness.
Local municipalities in charge of housing individuals who are homeless are working with guidelines from specific federal agencies, including the USICH and the CDC.
During the coronavirus outbreak – the phase which, at publication time, most communities have reached – CDC recommends local municipalities stay abreast of the outbreak status, stay in communication with local health authorities, work on community education and outreach, minimize the use of staff or volunteers (especially those that fall into high-risk pools), and limit visitors.
CDC also recommends local homelessness agencies place mats and beds at least three feet apart; provide access to cleaning supplies, tissues, and plastic bags; ensure bathrooms are fully stocked with soap; check in with individuals displaying symptoms of COVID-19; confine clients who display symptoms; and refer clients with severe symptoms to healthcare facilities.
FOOD SECURITY FOR ELDERLY, VULNERABLE POPULATIONS
With the push for social distancing comes questions about food security and the ability for vulnerable or high-risk individuals to obtain access to food.
Seniors, for example, may be apprehensive to go to the grocery store amid the panic of COVID-19 spread, or else get to the grocery store and find bare shelves. Others cannot afford to “stockpile” on nonperishable groceries.
Low-income individuals or individuals who are homeless may experience similar situations.
“Although social distancing is necessary to help limit the spread of the virus, anything that deters people from accessing group meals at senior centers or food banks puts low-income seniors in danger of malnutrition and hunger,” Annelies Groger, a David M. Rubenstein Fellow at the Brookings Institute, wrote in a recent post. “Millions of them also typically cannot afford to stock up on food or supplies, and if they can, many need transportation assistance to and from grocery stores.”
Just over 8 percent of households with an elderly individual living in it are food insecure, totaling to 2.9 million households without adequate access to food. At the same time, 7.2 million adults live at 100 percent of the federal poverty level and 21.4 million live at 200 percent of the federal poverty level, Groger wrote, citing statistics from the Center on Budget and Policy Priorities and the Kaiser Family Foundation, respectively.
Older adults are also less likely to receive food assistance, such as through SNAP benefits, because they have not received the education or outreach necessary to make it easy to enroll.
Proposals to make the food security question easier for older adults and others who are vulnerable during this time include:
- Creating meal delivery systems
- Encouraging utilities companies to not turn off heat, electricity, or water due to missed payments
- Launch awareness campaigns about food security
- Increase funding for food security programs, such as SNAP
There are also long-term efforts to address this issue and potentially prevent it in the future, Groger said. Those include creating permanent food delivery programs, increasing minimum SNAP requirements, expanding access to telehealth and virtual care, creating frozen meal options, streamlining enrollment for benefits, and expanding the use of consumer-facing apps for meal delivery.
ACCESS TO CARE IN RURAL AREAS
Although individuals living in rural regions may not be struggling quite as much with social distancing protocol – many already live miles away from urban epicenters and even their neighbors – they still face several other sets of challenges due to that very distance.
Rural healthcare has long been challenging. Patients live insurmountable distances from the nearest provider, making geography a major barrier to care. This issue is being exacerbated during the coronavirus outbreak, when individuals need access to providers to assess health status or access to a test.
Telehealth has emerged as an essential tool combatting the coronavirus outbreak regardless of rurality. But new guidance that expands interstate licensure and reimbursement makes it even easier for individuals to access telehealth, even in rural areas.
But individuals living in rural areas face another set of problems: limited access to efficient broadband connection. While telehealth can help connect them to a qualified provider, broadband and internet are necessary to connect to telehealth.
Rural health also faces threats due to fewer healthcare resources and a high population of older adults with multiple chronic conditions who may be at higher risk for coronavirus.
The question of the social determinants of health amid the coronavirus outbreak are expected to continue. As the economy takes a hit after businesses deemed non-essential must shutter their doors, job security becomes precarious. And with that, incomes plummet and the social safety-net could falter.
By Sara Heath | March 24, 2020 | Source
