scholarly journals A Geography of Risk: Structural Racism and COVID-19 Mortality in the United States

2021 ◽  
Author(s):  
Lauren C Zalla ◽  
Chantel L Martin ◽  
Jessie K Edwards ◽  
Danielle R Gartner ◽  
Grace A Noppert
Keyword(s):  
Minority Groups ◽  
Ethnic Disparities ◽  
The United States ◽  
Structural Racism ◽  
Public Health Response ◽  
Health Response ◽  
The Us ◽  
Racialized Minority ◽  
Racial And Ethnic Minority ◽  
Disproportionate Burden

Abstract Coronavirus disease 2019 (COVID-19) is disproportionately burdening racial and ethnic minority groups in the US. Higher risks of infection and mortality among racialized minorities are a consequence of structural racism, reflected in specific policies that date back centuries and persist today. Yet, our surveillance activities do not reflect what we know about how racism structures risk. When measuring racial and ethnic disparities in deaths due to COVID-19, the CDC statistically accounts for the geographic distribution of deaths throughout the US to reflect the fact that deaths are concentrated in areas with different racial and ethnic distributions than that of the larger US. In this commentary, we argue that such an approach misses an important driver of disparities in COVID-19 mortality, namely the historical forces that determine where individuals live, work, and play, and consequently determine their risk of dying from COVID-19. We explain why controlling for geography downplays the disproportionate burden of COVID-19 on racialized minority groups in the US. Finally, we offer recommendations for the analysis of surveillance data to estimate racial disparities, including shifting from distribution-based to risk-based measures, to help inform a more effective and equitable public health response to the pandemic.

scholarly journals Changing the Narrative: Structural Barriers and Racial and Ethnic Inequities in COVID-19 Vaccination

2021 ◽  
Vol 18 (18) ◽  
pp. 9904
Author(s):  
Anuli Njoku ◽  
Marcelin Joseph ◽  
Rochelle Felix
Keyword(s):  
Minority Groups ◽  
Ethnic Disparities ◽  
The United States ◽  
Vaccine Uptake ◽  
Vaccine Hesitancy ◽  
Structural Barriers ◽  
Structural Racism ◽  
Vaccination Rates ◽  
Promising Solution ◽  
The Impact

The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups in the United States. Although a promising solution of the COVID-19 vaccination offers hope, disparities in access again threaten the health of these communities. Various explanations have arisen for the cause of disparate vaccination rates among racial and ethnic minorities, including discussion of vaccine hesitancy. Conversely, the role of vaccine accessibility rooted in structural racism as a driver in these disparities should be further explored. This paper discusses the impact of structural barriers on racial and ethnic disparities in COVID-19 vaccine uptake. We also recommend public health, health system, and community-engaged approaches to reduce racial disparities in COVID-19 disease and mortality.

scholarly journals Early COVID-19 Interventions Failed to Replicate 1918 St. Louis vs. Philadelphia Outcomes in the United States

2020 ◽  
Author(s):  
Aliea M. Jalali ◽  
Brent M. Peterson ◽  
Thushara Galbadage
Keyword(s):  
Public Health ◽  
United States ◽  
State Level ◽  
The United States ◽  
The State ◽  
Health Interventions ◽  
Public Health Interventions ◽  
Public Health Response ◽  
Health Response ◽  
The Us

The Coronavirus disease 2019 (COVID-19) pandemic has elicited an abrupt pause in the United States in multiple sectors of commerce and social activity. As the US faces this health crisis, the magnitude, and rigor of their initial public health response was unprecedented. As a response, the entire nation shutdown at the state-level for the duration of approximately one to three months. These public health interventions, however, were not arbitrarily decided, but rather, implemented as a result of evidence-based practices. These practices were a result of lessons learned during the 1918 influenza pandemic and the city-level non-pharmaceutical interventions (NPIs) taken across the US. During the 1918 pandemic, two model cities, St. Louis, MO, and Philadelphia, PA, carried out two different approaches to address the spreading disease, which resulted in two distinctly different outcomes. Our group has evaluated the state-level public health response adopted by states across the US, with a focus on New York, California, Florida, and Texas, and compared the effectiveness of reducing the spread of COVID-19. Our assessments show that while the states mentioned above benefited from the implementations of early preventative measures, they inadequately replicated the desired outcomes observed in St. Louis during the 1918 crisis. Our study indicates that there are other factors, including health disparities that may influence the effectiveness of public health interventions applied. Identifying more specific health determinants may help implement targeted interventions aimed at preventing the spread of COVID-19 and improving health equity.

scholarly journals Genetic characterization of the Zika virus epidemic in the US Virgin Islands

2017 ◽  
Author(s):  
Allison Black ◽  
Barney Potter ◽  
Gytis Dudas ◽  
Leora Feldstein ◽  
Nathan D Grubaugh ◽  
...  
Keyword(s):  
Zika Virus ◽  
Draft Genome ◽  
Virus Transmission ◽  
The United States ◽  
Virgin Islands ◽  
Public Health Response ◽  
Us Virgin Islands ◽  
Department Of Health ◽  
Health Response ◽  
The Us

AbstractHere we release draft genome sequences of Zika virus (ZIKV) that were sequenced from PCR-positive diagnostic specimens collected by the United States Virgin Islands Department of Health (USVI DoH) as part of their ongoing response to the ZIKV outbreak. We will use these sequences to conduct a genomic epidemiological study of ZIKV transmission in the USVI. We are releasing these genomes in the hope that they are useful for those individuals involved in the public health response to ZIKV and to other groups working to understand Zika virus transmission and evolution.

The emergence of SARS-CoV-2 in Europe and the US

2020 ◽  
Author(s):  
Michael Worobey ◽  
Jonathan Pekar ◽  
Brendan B. Larsen ◽  
Martha I. Nelson ◽  
Verity Hill ◽  
...  
Keyword(s):  
Extended Period ◽  
The United States ◽  
Washington State ◽  
Contact Tracing ◽  
Emerging Viruses ◽  
Public Health Response ◽  
Transmission Networks ◽  
Health Response ◽  
The Us ◽  
Missed Opportunity

AbstractAccurate understanding of the global spread of emerging viruses is critically important for public health response and for anticipating and preventing future outbreaks. Here, we elucidate when, where and how the earliest sustained SARS-CoV-2 transmission networks became established in Europe and the United States (US). Our results refute prior findings erroneously linking cases in January 2020 with outbreaks that occurred weeks later. Instead, rapid interventions successfully prevented onward transmission of those early cases in Germany and Washington State. Other, later introductions of the virus from China to both Italy and Washington State founded the earliest sustained European and US transmission networks. Our analyses reveal an extended period of missed opportunity when intensive testing and contact tracing could have prevented SARS-CoV-2 from becoming established in the US and Europe.

scholarly journals Racial and Ethnic Disparities in Patient Experiences in the United States: 4-Year Content Analysis of Twitter

10.2196/17048 ◽  
2020 ◽  
Vol 22 (8) ◽  
pp. e17048
Author(s):  
Yulin Hswen ◽  
Jared B Hawkins ◽  
Kara Sewalk ◽  
Gaurav Tuli ◽  
David R Williams ◽  
...  
Keyword(s):  
United States ◽  
Ethnic Groups ◽  
Patient Experience ◽  
Minority Groups ◽  
Ethnic Disparities ◽  
The United States ◽  
Patient Experiences ◽  
Ethnic Minority Groups ◽  
Twitter Users ◽  
Racial And Ethnic Minority

Background Racial and ethnic minority groups often face worse patient experiences compared with the general population, which is directly related to poorer health outcomes within these minority populations. Evaluation of patient experience among racial and ethnic minority groups has been difficult due to lack of representation in traditional health care surveys. Objective This study aims to assess the feasibility of Twitter for identifying racial and ethnic disparities in patient experience across the United States from 2013 to 2016. Methods In total, 851,973 patient experience tweets with geographic location information from the United States were collected from 2013 to 2016. Patient experience tweets included discussions related to care received in a hospital, urgent care, or any other health institution. Ordinary least squares multiple regression was used to model patient experience sentiment and racial and ethnic groups over the 2013 to 2016 period and in relation to the implementation of the Patient Protection and Affordable Care Act (ACA) in 2014. Results Racial and ethnic distribution of users on Twitter was highly correlated with population estimates from the United States Census Bureau’s 5-year survey from 2016 (r2=0.99; P<.001). From 2013 to 2016, the average patient experience sentiment was highest for White patients, followed by Asian/Pacific Islander, Hispanic/Latino, and American Indian/Alaska Native patients. A reduction in negative patient experience sentiment on Twitter for all racial and ethnic groups was seen from 2013 to 2016. Twitter users who identified as Hispanic/Latino showed the greatest improvement in patient experience, with a 1.5 times greater increase (P<.001) than Twitter users who identified as White. Twitter users who identified as Black had the highest increase in patient experience postimplementation of the ACA (2014-2016) compared with preimplementation of the ACA (2013), and this change was 2.2 times (P<.001) greater than Twitter users who identified as White. Conclusions The ACA mandated the implementation of the measurement of patient experience of care delivery. Considering that quality assessment of care is required, Twitter may offer the ability to monitor patient experiences across diverse racial and ethnic groups and inform the evaluation of health policies like the ACA.

scholarly journals Racial and Ethnic Disparities in Patient Experiences in the United States: 4-Year Content Analysis of Twitter (Preprint)

2019 ◽  
Author(s):  
Yulin Hswen ◽  
Jared B Hawkins ◽  
Kara Sewalk ◽  
Gaurav Tuli ◽  
David R Williams ◽  
...  
Keyword(s):  
United States ◽  
Ethnic Groups ◽  
Patient Experience ◽  
Minority Groups ◽  
Ethnic Disparities ◽  
The United States ◽  
Patient Experiences ◽  
Ethnic Minority Groups ◽  
Twitter Users ◽  
Racial And Ethnic Minority

BACKGROUND Racial and ethnic minority groups often face worse patient experiences compared with the general population, which is directly related to poorer health outcomes within these minority populations. Evaluation of patient experience among racial and ethnic minority groups has been difficult due to lack of representation in traditional health care surveys. OBJECTIVE This study aims to assess the feasibility of Twitter for identifying racial and ethnic disparities in patient experience across the United States from 2013 to 2016. METHODS In total, 851,973 patient experience tweets with geographic location information from the United States were collected from 2013 to 2016. Patient experience tweets included discussions related to care received in a hospital, urgent care, or any other health institution. Ordinary least squares multiple regression was used to model patient experience sentiment and racial and ethnic groups over the 2013 to 2016 period and in relation to the implementation of the Patient Protection and Affordable Care Act (ACA) in 2014. RESULTS Racial and ethnic distribution of users on Twitter was highly correlated with population estimates from the United States Census Bureau’s 5-year survey from 2016 (<i>r</i><sup>2</sup>=0.99; <i>P</i>&lt;.001). From 2013 to 2016, the average patient experience sentiment was highest for White patients, followed by Asian/Pacific Islander, Hispanic/Latino, and American Indian/Alaska Native patients. A reduction in negative patient experience sentiment on Twitter for all racial and ethnic groups was seen from 2013 to 2016. Twitter users who identified as Hispanic/Latino showed the greatest improvement in patient experience, with a 1.5 times greater increase (<i>P</i>&lt;.001) than Twitter users who identified as White. Twitter users who identified as Black had the highest increase in patient experience postimplementation of the ACA (2014-2016) compared with preimplementation of the ACA (2013), and this change was 2.2 times (<i>P</i>&lt;.001) greater than Twitter users who identified as White. CONCLUSIONS The ACA mandated the implementation of the measurement of patient experience of care delivery. Considering that quality assessment of care is required, Twitter may offer the ability to monitor patient experiences across diverse racial and ethnic groups and inform the evaluation of health policies like the ACA.

scholarly journals United States response to the COVID-19 pandemic, January–November 2020

2021 ◽  
pp. 1-14
Author(s):  
Mathew Alexander ◽  
Lynn Unruh ◽  
Andriy Koval ◽  
William Belanger
Keyword(s):  
United States ◽  
The United States ◽  
Contact Tracing ◽  
Public Health Response ◽  
The Public ◽  
The Past ◽  
Health Response ◽  
Physical Infrastructure ◽  
Key Policy ◽  
United States Healthcare

Abstract As of November 2020, the United States leads the world in confirmed coronavirus disease 2019 (COVID-19) cases and deaths. Over the past 10 months, the United States has experienced three peaks in new cases, with the most recent spike in November setting new records. Inaction and the lack of a scientifically informed, unified response have contributed to the sustained spread of COVID-19 in the United States. This paper describes major events and findings from the domestic response to COVID-19 from January to November 2020, including on preventing transmission, COVID-19 testing and contact tracing, ensuring sufficient physical infrastructure and healthcare workforce, paying for services, and governance. We further reflect on the public health response to-date and analyse the link between key policy decisions (e.g. closing, reopening) and COVID-19 cases in three states that are representative of the broader regions that have experienced spikes in cases. Finally, as we approach the winter months and undergo a change in national leadership, we highlight some considerations for the ongoing COVID-19 response and the broader United States healthcare system. These findings describe why the United States has failed to contain COVID-19 effectively to-date and can serve as a reference in the continued response to COVID-19 and future pandemics.

Racial Health Disparities and Questions of Evidence

2016 ◽  
Author(s):  
Carolyn Moxley Rouse
Keyword(s):  
Health Disparities ◽  
Minority Groups ◽  
Ethnic Disparities ◽  
Structural Data ◽  
The United States ◽  
National Average ◽  
Healthy People ◽  
Making Sense ◽  
Socially Constructed ◽  
Healthy People 2010

The United States Healthy People 2010 initiative, designed to focus nationally funded health research and care on achieving a set of nationwide goals, was directed toward the elimination of racial and ethnic health disparities. While racial and ethnic disparities are complex (with the health of some minority groups surpassing the national average), the health of black Americans continues to fall short of the national average. By focusing on the presumptions embedded in the design of health disparities research, this chapter addresses why Healthy People 2010 largely failed to reduce racial health inequality. Importantly, in thinking about health inequalities, researchers initially failed to consider how race is socially constructed; how data collection is never value-neutral (see King, chapter 8, this volume); and, finally, the limits of randomized control trials (deductive methods) when it comes to making sense of complex behavioral and structural data. The chapter ends by describing how ethnographic insights can help complicate the assumptions and conclusions of health disparities research.

Politics, Power, and Money

2021 ◽  
pp. 98-118
Author(s):  
Sandro Galea
Keyword(s):  
Low Income ◽  
The United States ◽  
Political Leaders ◽  
The Public ◽  
Political Dynamics ◽  
Public Health Infrastructure ◽  
The Us ◽  
Data Informed ◽  
Disproportionate Burden ◽  
Trump Administration

This chapter investigates how politics and power shape health outcomes, with special emphasis on how these forces intersect with economic inequality and the disproportionate burden of sickness experienced by low-income populations. During the spread of COVID-19, American political leadership faced a test of its ability to respond to sudden crisis. Rising to such a difficult occasion requires detailed plans for what to do in such a scenario, robust public health infrastructure, and leadership which takes decisive, data-informed action, listening to experts and communicating clearly and consistently with the public. Tragically, COVID-19 found the United States lacking in all these areas. Political leaders are in a position to mold public opinion, nudging the public mind towards new ways of thinking. The precise term for this is “shifting the Overton window.” By helping to mainstream a cavalier attitude towards COVID-19, the Trump administration shifted the Overton window towards greater acceptance of behaviors which create poorer health. The chapter then looks at the failure to adequately address race in the US. Among the factors that shape health, the area of race is particularly sensitive to political dynamics.

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