Social Determinants of Health

According to the United States Department of Health and Human Services, Office of Disease Prevention and Health Promotion, social determinants of health (SDOH) “are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” SDOH are categorized into 5 domains: Economic Stability, Education Access and Quality, Social and Community Context, Health Care Access and Quality, and Neighborhood and Built Environment. In this month’s COVID-19 Health Equity post, I’ll be discussing recent COVID-19 literature related to SDOH domains.

Economic Stability, Education Access and Quality, and Social and Community Context

A county level analysis of 756 United States counties estimated the relationship between social determinants of health and racial disparities in COVID-19 vaccinations. Analyses included vaccination data from April 19, 2021. “Vaccine disparity was measured as the rates of those receiving at least one vaccination dose for White people less that for Black people, where a higher value suggests greater disparities for Black people.” In regards to economic stability, education access and quality, and social and community context SDOH domains: Vaccination disparities were negatively associated with median income (estimate [Est.] = −2.20, SE = 0.99). Disparity in high school graduation was associated with increased vaccination disparities (Est. = 2.01, SE = 0.41). Results for social and community context variables indicated that political ideology (proportion of the 2020 presidential election votes for the Republican candidate) was strongly and negatively associated with vaccination disparities (Est. = −6.45, SE = 1.73). Study findings point to areas in which concerted efforts should be made regarding COVID-19 vaccine outreach, education and awareness efforts to overcome these structural and social barriers.

Healthcare Access and Quality

Across the United States, the ways in which individuals accessed healthcare drastically changed during the COVID-19 pandemic. This begs the question if said changes impact the quality of care received. Birthing people who identify as Black, Indigenous, and people of color (BIPOC) in the United States experience higher rates of maternal morbidity and mortality. BIPOC communities have also experienced disproportionate rates of COVID-19-related morbidity and mortality. Inequities in quality perinatal care have been attributed to systemic and structural racism. A recent national survey study conducted in the United States explored the quality of perinatal care received during the COVID-19 pandemic. Eligible participants included adults who gave birth in the United States after March 15, 2020. Of the 706 respondents, 33% reported not experiencing high-quality perinatal care and compared to White, non-Latinx respondents, BIPOC respondents were 42% less likely to experience high-quality perinatal care. In response, the authors call for more training in respectful perinatal care, particularly in quickly altering or ambiguous situations and a national mandate to incorporate antiracist, cultural humility, and structural competency into physician, midwifery, and nursing curricula.

Neighborhood and Built Environment

The Neighborhood and Built Environment SDOH domain includes characteristics of where a person lives such as housing, air, and water quality or access to transportation and healthy foods. Persons with low incomes and from racial/ethnic minority backgrounds are more likely to live in neighborhoods with environmental health and safety risks. A recent study in Illinois evaluated the spatial relationship between incidence rates of COVID-19 and environmental and demographic factors. The Northeastern Illinois metropolitan area has not only been identified as a COVID-19 hot spot but it is also ethnically/racially diverse and known to have various environmental pollution sources such as major highways, manufacturing and industrial factories. In this study, zip codes were ranked by vulnerability based on 11 environmental indicators (e.g., air toxins, traffic proximity, and hazardous waste facilities) and 6 demographic indicators (e.g., income, race/ethnicity, and education). Study findings indicated a moderate positive relationship (Spearman’s ρ = 0.65) between COVID-19 incidence rate and combined environmental and demographic indicator rankings. These findings could be used to better inform more equitable COVID-19 resource allocation efforts.

Study key findings and calls for action mentioned in this article are summarized by SDOH domain below in this month’s “Tools for the Toolkit.”

Tools for the Toolkit