Acknowledging and Addressing COVID-19 Health Disparities in the American South

To the Editor: The COVID-19 crisis escalated rapidly; between March 1 and March 31, 2020, the number of confirmed cases rose from 30 to >180,000.¹ As the novel coronavirus spreads, reports suggest that the American South may be hit harder than other areas in the United States. For example, southeast Louisiana has one of the highest COVID-19 case fatality rates in the nation.² Southerners are more likely than people in other regions to live in poverty, have chronic illnesses such as diabetes mellitus and obesity, and be uninsured.³ Social determinants of health, such as access to broadband Internet and the ability to work from home, compound the health challenges faced by southern populations. For example, without access to paid sick leave, workers may be more likely to continue working while sick. A March 2020 Pew analysis found wide geographic variations in access to paid sick leave, with only 71% of employees in the South Atlantic (MD, DE, DC, VA, WV, NC, SC, GA, and FL) and 67% of those in the East South Central United States (KY, TN, MS, and AL) having access to paid sick leave in 2019.⁴

Pandemics can amplify health disparities; for all its strengths as a vibrant, multicultural region, the American South is still grappling with the legacy of the Jim Crow era and policies that perpetuate social, economic, and health disparities. The uneven enforcement of civil rights legislation has led to unequal advances in health care, education, and housing.⁵ A closer look at the COVID-19 data reveals a disproportionate number of confirmed cases among African Americans.⁶ These findings do not suggest greater genetic susceptibility to COVID-19; rather, they highlight how preventive measures such as social distancing privilege some populations while further marginalizing others.

As we work to respond to this pandemic, it is critical that we address issues of health equity. Researchers, policymakers, and practitioners can make a meaningful impact in several ways, including tracking the disproportionate effect of the pandemic on marginalized populations by linking to socioeconomic data, building infrastructure for telehealth, providing financial support to low-income residents and nonprofits, and engaging community health workers. COVID-19 is laying bare racial and socioeconomic health disparities and cracks in our healthcare system and social safety net. As Devakumar and colleagues wrote in The Lancet, “The strength of a health system is inseparable from broader social systems that surround it.”⁷ Acknowledging and working to mitigate COVID-19 disparities should be a priority as we combat this pandemic.

Jennifer Mandelbaum, MPH
Department of Health Promotion, Education and Behavior University of South Carolina Columbia, SC