How does a Global Pandemic exacerbate the health disparities in Indiana and American society in general?

By Barnabas Obeng-Gyasi and Nathan LeRoy

The COVID-19 pandemic was devastating for everyone involved. But, particular groups were hit harder than others. Certain demographics struggled to navigate the never before seen health crisis due to their financial position, their line of work, and their limited access to health care. Below we present data that shows how the the pandemic progressed through the State of Indiana starting March 1st of 2020 through June 20th of 2021. We are examining this data through the lens of health disparities and socal inequities. We want to show how it really wasn't the same COVID-19 pandemic for everyone.

Cases
Deaths
Hospitalized
Tests
Data from NYTimes

What is a Health Disparity?

The Department of Health and Human Services Healthypeople2020.gov defines health equity as “attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.”2.

Race and ethnicity are often a focus when attempting to understand health disparities and achieve health equity. Race and ethnicity themselves are simply “socially constructed categories that have tangible effects on the lives of individuals who are defined by how one perceives one's self and how one is perceived by others.”3.Still, race and ethnicity serve an important role in understanding how large clusters of populations are being treated within the medical system. Racial and ethnic minorities suffer higher rates of “health disparities [which] take on many forms, including higher rates of chronic disease and premature death compared to the rates among whites.”4. The following data and graphs help illustrate the current disparity in Covid-19 cases numbers and death rates in Indiana.

In total Indiana saw 750,432 cases, 43,217 hopsitalizations, and 13,764 deaths. Not everyone was affected equally.

The Department of Health and Human Services(HHS)’s Health.gov defines a health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”1.

The COVID-19 pandemic has presented a unique situation where can see throughout Indiana how a widespread disease is affecting populations that are historically subject to disparities in healthcare. The Department of Health and Human Services believes one of the actionable methods we can use to close these disparities is first measuring the “disparities in health status, health care, and the physical and social determinants of health-especially in relation to institutional policies and practices. HHS believes that if we hope to achieve health equity it would require measuring these changes.

Not only do minorities make up a disproportionate amount of cases, but they also have disproportionate outcomes.

On the surface, it's easy to see how those who are socially and economically disadvantaged might find themselves experiencing a disproportionately large portion of the COVID-19 cases in Indiana. Working more "essential jobs" and owning smaller/weaker economic safety nets puts minorities at a much greater risk for exposing themselves to SARS-CoV-2 and contracting the disease in their day to day life. Not only that, but lack of awareness and proper PPE pushes this risk even further.

This issue can be examined one level deeper, however. Not only do at-risk populations have a higher chance of contracting the disease, but once exposed, they have greater potential for experiencing poor outcomes and long-term complications. This can be seen easily when looking at Multisystem inflammatory syndrome in children (MIS-C). This graph shows how, in Indiana, white adolescents make up 84.8% of the population while only accounting for 49% of MIS-C presentations in the clinic. In contrast, adolsecents who identify as black make up about 10% of the population while accounting for almost a quarter of all MIS-C cases in Indiana.

What is the Social Vulernability Index?

The Social Vulnerability Index (SVI) uses U.S. Census data to determine the social vulnerability of every county and tract. CDC SVI ranks each county and tract on 15 social factors, including poverty, lack of vehicle access, and crowded housing, and groups them into four related themes:

  • Socioeconomic
  • Housing Composition and Disability
  • Minority Status and Language
  • Housing and Transportation
The CDC ranked counties and tracts for the entire United States against one another. Percentile ranking values range from 0 to 1, with higher values indicating greater vulnerability. For each county and tract, the CDC generated its percentile rank among all counties and tracts for:
  1. The fifteen individual variables
  2. The four themes
  3. Its overall position.
Evaluating the coronavirus cases in conjunction with the vulnerability index shows a dynamic picture of how the Coronavirus pandemic is adversely affecting certain demographic populations. The SVI provides an avenue to better understand the intersection between social vulnerability and health.

COVID-19 Cases:

Social Vulnerability:

People were struggling to get access to healthcare when they needed it most

Access to healthcare is an important social determinant of health. It is influenced by factors such as insurance and geography (rural versus urban). In Indiana, the Healthy Indiana Plan is a state program to increase access to healthcare among low-income individuals. In the midst of this pandemic, evaluation of these programs is necessary to identify and address gaps.

A global pandemic not only puts your physical health at risk, but also your mental health.

During a global pandemic it is easy to focus all of our attention on our physical health. However, often forgotten is how our mental health may be affected by a global pandemic such as this. Fear and anxiety over a novel virus can cause a lot of overwhelming stress in both adults, adolescents and children. In addition, public health measures taken such as social distancing and isolation only further perpetuate these feelings of anxiety, depression, and loneliness. Taking care of one's mental health should be taken just as seriously as one's physical health in a time such as this.

Historically marginalized groups who are systematically experiencing greater obstacles to health based on their racial or ethnic group are also experiencing these problems with mental health care. In 2001 the Federal Collaborative for Health Disparities Research chose mental health disparity as one of four topics warranting its immediate national research attention. Unequal access to resources like remote therapy, support groups, and counseling perpetuates the onset of mental and subsequent physical health inequities as well.

Access to Food

The pandemic caused a large surge of unemployment and homelessness that disproportionately affected-already-vulnerable populations. Food banks have been overrun for several months across Indiana and the Country. Below is the Indiana Food Assistance Search Tool to find a local Food bank as well as a links to donate