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The pandemic’s fault lines have not been random. Coronavirus has hit society’s most vulnerable–the poor, elderly, minorities–the hardest.

As our fractures are laid bare, the healthcare community must use this as an opportunity to study how we should’ve been hyper aware of social determinants of health (SDOH) all along. Some have, fortunately, already learned that SDOHs are integral to our way out of the pandemic.

The Centers for Disease Control and Prevention (CDC) define SDOHs as the conditions in the places where people live, learn, work and play that affect a wide range of health risks and outcomes. Some of these conditions are disproportionate for certain minority groups, such as African Americans.

As stated by Rashawn Ray for the Brookings Institution, “Blacks, relative to Whites, are more likely to live in neighborhoods with a lack of healthy food options, green spaces, recreational facilities, lighting, and safety.”

These structural conditions, or SDOHs, that inform pre-existing conditions and health disparities for African Americans are undoubtedly part of the reason why blacks in every state with racial data available have higher contraction rates and death rates of COVID-19. For example, in Louisiana, African Americans represent about one-third of the population but make up 70% of COVID-19 deaths.

Dr. Fauci, the director of the National Institute of Allergy and Infectious Diseases, stated, “It really does have, ultimately, shined a very bright light on some of the real weaknesses and foibles in our society.”

Which SDOHs have been especially relevant for COVID-19?

  • Housing: If one is homeless or housing insecure, it is difficult to adhere to social distancing guidelines when they have nowhere to go. The homeless or housing insecure population is therefore especially susceptible to COVID-19.
  • Food security: Those not near a grocery store, unable to afford grocery store stockpiling or too old to brave the grocery store storms without putting themselves at a greater risk put their immune systems in harm’s way for the virus.
  • Internet and broadband connection in rural areas: As the medical community has shifted to telehealth, those in rural communities who have limited access to efficient broadband connection yet need healthcare suffer.
  • Social isolation: Social distancing guidelines are also exacerbating loneliness and its deleterious effects on health. Long-term distancing can be as lethal as smoking a pack of cigarettes a day. Loneliness is particularly an issue for the elderly.
  • Access to paid leave: The United States still does not have a federal paid leave policy, leaving 89% of civilian workers in the precarious spot of having to choose their health or their paycheck. As many of these low-to moderate-income jobs are located in the public sphere, forcing workers to break social distancing guidelines, these workers are at greater risk of catching the virus.

Some health organizations already have programs and funding in place to address SDOHs during the crisis. In South Carolina, for example, a health organization funded a grant to deliver job training and improve English language proficiency to give people key skills as they face unemployment or job insecurity. Another organization has been donating to food banks to address food insecurity.

It’s never been more important to pay attention to SDOHs. They must be considered if we want to save our nation’s health now and into the future.



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