Health Equity

Health equity is when all members of society enjoy a fair and just opportunity to be as healthy as possible. Public health policies and programs centered around the specific needs of communities can promote health equity.

The COVID-19 pandemic has brought social and racial injustice and inequity to the forefront of public health. It has highlighted that health equity is still not a reality as COVID-19 has unequally affected many racial and ethnic minority groups, putting them more at risk of getting sick and dying from COVID-19.^[1]^,^[2] The term “racial and ethnic minority groups” includes people of color with a wide variety of backgrounds and experiences. Negative experiences are common to many people within these groups, and some social determinants of health have historically prevented them from having fair opportunities for economic, physical, and emotional health.^[3] Social determinants of health are the conditions in the places where people live, learn, work, play, and worship that affect a wide range of health risks and outcomes.

Factors affecting health equity

To achieve health equity, CDC is committed to understanding and appropriately addressing the needs of all populations, according to specific cultural, linguistic, and environmental factors. By ensuring health equity is integrated across all public health efforts, all communities will be stronger, safer, healthier, and more resilient.

Some of the many inequities in the social determinants of health that put racial and ethnic minority groups at increased risk of getting sick and dying from COVID-19 include:

Unfortunately, discrimination exists in systems meant to protect well-being or health. Examples of such systems include health care, housing, education, criminal justice, and finance. Discrimination, which includes racism, can lead to chronic and toxic stress. This shapes social and economic factors that put some people from racial and ethnic minority groups at increased risk for COVID-19.^[4],[5]

People from some racial and ethnic minority groups face multiple barriers to accessing health care. Issues such as lack of insurance^[6], transportation, child care, or ability to take time off of work can make it hard to go to the doctor. Cultural differences between patients and providers as well as language barriers affect patient-provider interactions and health care quality.^[7] Inequities in treatment^[8] and historical events, like the Tuskegee Study of Untreated Syphilis in the African American Male and sterilization without people’s permission, might also explain why some people from racial and ethnic minority groups do not trust healthcare systems and the government.^[9]^,[10]^,[11]^,[12]

People in racial and ethnic minority groups often work in essential worker settings, such as healthcare facilities, farms, factories, grocery stores, and public transportation.^[13] Working in these settings can lead to more chances of exposure to COVID-19, which might be contributing to COVID-19 racial and ethnic health disparities. Essential workers are inherently at higher risk of being exposed to the virus that causes COVID-19 due to the nature of their work. Essential workers conduct a range of operations and services in industries that are essential to ensure the continuity of critical functions in the United States from keeping us safe, to ensuring food is available, to taking care of the sick.

Overall, people from some racial and ethnic minority groups have less access to high-quality education. Without a high-quality education, people face greater challenges in getting jobs that offer options for minimizing exposure to COVID-19.^[14] People with limited job options likely have less flexibility to leave jobs that might put them at a higher risk of exposure to the virus that causes COVID-19. They often cannot afford to miss work, even if they’re sick, because they may not have paid sick days or enough money saved up for essential items like food and other important living needs.

Living in crowded conditions can make it very difficult to separate when you are or may be sick. A higher percentage of people from racial and ethnic minority groups live in crowded housing as compared to non-Hispanic White people and therefore may be more likely to be exposed to the virus that causes COVID-19.

These factors and others are associated with more COVID-19 cases, hospitalizations, and deaths in areas where racial and ethnic minority groups live, learn, work, play, and worship.^{[6],[15],[16]} They have also contributed to higher rates of some medical conditions that increase one’s risk of severe illness from COVID-19. In addition, community strategies to slow the spread of COVID-19 might cause unintentional harm, such as lost wages, reduced access to services, and increased stress, for some racial and ethnic minority groups.^[17]

We all have a part in helping to prevent the spread of COVID-19 and promoting fair access to health. To do this, we have to work together to ensure that people have resources to maintain and manage their physical and mental health in ways that fit the communities where people live, learn, work, play, and worship. Below are additional considerations for community leaders supporting individuals who experience discrimination in healthcare systems.

Impact of Racial Inequities on Our Nation’s Health

black doctor and LTC patient wearing masks

Racism, either structural or interpersonal, negatively affects the mental and physical health of millions of people, preventing them from attaining their highest level of health, and consequently, affecting the health of our nation. A growing body of research shows that centuries of racism in this country has had a profound and negative impact on communities of color. The COVID-19 pandemic and its disproportionate impact on people from some racial and ethnic groups is a stark example of these enduring health disparities. COVID-19 data shows that Black/African American, Hispanic/Latino, American Indian and Alaska Native persons in the United States experience higher rates of COVID-19-related hospitalization and death compared with non-Hispanic White populations.^[18] These disparities persist even when accounting for other demographic and socioeconomic factors.

Both historical and current experiences of racism and discrimination contribute to mistrust of the healthcare system among racial and ethnic minority groups. This mistrust may extend to vaccines, vaccination providers, and the institutions that make recommendations for the use of vaccines. To prevent widening health inequities, healthcare providers should engage with communities to tailor strategies aimed at overcoming mistrust and delivering evidence-based information to encourage uptake of COVID-19 vaccination, testing, and treatment.^[19] Inequities in COVID-19 impact can worsen mistrust and lead to suboptimal healthcare behaviors.^[19]

Strategies to Help Increase COVID-19 Vaccine Confidence

Various strategies can help communities increase COVID-19 vaccine confidence and advance vaccine equity, but some may be particularly helpful when addressing individuals with mistrust.

Focusing on effective messaging delivered by trusted messengers (offering recommendations provided by trusted healthcare professionals).
Using tactics to address misinformation and hesitancy within the population of focus.
Tailoring strategies for the specific community.
Building vaccine confidence to help eliminate stigmas associated with receiving COVID-19 vaccination while also fostering relationships between community members and public health entities.

Address community concerns

Use clear, easy to read, transparent, and consistent information
that addresses specific misinformation or perceived concerns,^[20] such as:

Vaccine side effects or risk (including boosters)
Newness and effectiveness of vaccine
Rapidly changing information (e.g., mask use, guidance for gatherings, etc.)

Partner with trusted messengers

Trusted messengers are key to the delivery of critical information for communities to continue advocating for positive change regarding COVID-19 vaccine efforts:

Ensure that people whose images are included in materials and leading COVID-19 outreach efforts look like, are known to, and can effectively collect input from communities where the outreach initiatives are occurring.^[20]
Engage trusted faith leaders or vaccine workers who share the same race/ethnicity, sexual orientation, and cultural/religious beliefs as the community to share information, promote the benefits of immunization, administer vaccines, and be present at vaccination sites.^[20]

Develop culturally relevant materials

Arts and cultural engagement can generate community demand for COVID-19 vaccines by making vaccination an accessible and socially supported choice.^[21]
Provide messaging and tone that is culturally relevant and in predominant languages spoken in the community.^[20]

Data on COVID-19 and Race and Ethnicity

CDC resources

Other resources

References

[1] Stokes EK, Zambrano LD, Anderson KN, et al. Coronavirus Disease 2019 Case Surveillance — United States, January 22–May 30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:759–765. DOI: http://dx.doi.org/10.15585/mmwr.mm6924e2external icon.
[2] Killerby ME, Link-Gelles R, Haight SC, et al. Characteristics Associated with Hospitalization Among Patients with COVID-19 — Metropolitan Atlanta, Georgia, March–April 2020. MMWR Morb Mortal Wkly Rep. ePub: 17 June 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6925e1external icon.
[3] U.S. Department of Health and Human Services. Social Determinants of Health [online]. 2020 [cited 2020 Jun 20]. available from https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-healthexternal icon
[4] Paradies Y. A systematic review of empirical research on self-reported racism and health. Int J Epidemiol. 2006; 35(4):888–901. DOI: https://doi.org/10.1093/ije/dyl056external icon.
[5] Simons RL, Lei MK, Beach SRH, et al. Discrimination, segregation, and chronic inflammation: Testing the weathering explanation for the poor health of Black Americans. Dev Psychol. 2018;54(10):1993-2006. DOI: https://doi.org/10.1037/dev0000511external icon.
[6] Berchick, Edward R., Jessica C. Barnett, and Rachel D. Upton Current Population Reports, P60-267(RV), Health Insurance Coverage in the United States: 2018, U.S. Government Printing Office, Washington, DC, 2019.
[7] Institute of Medicine (US) Committee on the Consequences of Uninsurance. Care Without Coverage: Too Little, Too Late. Washington (DC): National Academies Press (US); 2002. DOI: https://doi.org/10.17226/10367external icon.
[8] Institute of Medicine. 2003. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: The National Academies Press. DOI: https://doi.org/10.17226/10260external icon.
[9] U.S. National Library of Medicine. Native Voices: Timeline: Government admits forced sterilization of Indian Women [online]. 2011 [cited 2020 Jun 24]. Available from URL: [10] Novak NL, Lira N, O’Connor KE, Harlow SD, Kardia SLR, Stern AM. Disproportionate Sterilization of Latinos Under California’s Eugenic Sterilization Program, 1920-1945. Am J Public Health. 2018;108(5):611-613. DOI: [11] Stern AM. Sterilized in the name of public health: race, immigration, and reproductive control in modern California. Am J Public Health. 2005 Jul;95(7):1128-38. DOI: [12] Prather C, Fuller TR, Jeffries WL 4th, et al. Racism, African American Women, and Their Sexual and Reproductive Health: A Review of Historical and Contemporary Evidence and Implications for Health Equity. Health Equity. 2018;2(1):249-259. DOI: [13] U.S. Bureau of Labor Statistics. Labor force characteristics by race and ethnicity, 2018 [online]. 2019 [cited 2020 Jun 24]. Available from URL: [14] The Annie E. Casey Foundation. Unequal Opportunities in Education [online]. 2006 [cited 2020 Jun 24]. Available from: [15] Wadhera RK, Wadhera P, Gaba P, Figueroa JF, Joynt Maddox KE, Yeh RW, & Shen C. Variation in COVID-19 Hospitalizations and Deaths Across New York City Boroughs. JAMA. 2020;323(21),2192–2195. [16] Kim SJ, Bostwick W. Social Vulnerability and Racial Inequality in COVID-19 Deaths in Chicago. Health Educ Behav. 2020;47(4):509-513. DOI: [17] Webb Hooper M, Nápoles AM, Pérez-Stable EJ. COVID-19 and Racial/Ethnic Disparities. JAMA. 2020;323(24):2466–2467. DOI: [18] Centers for Disease Control and Prevention. Impact of Racism on our Nation’s Health [online]. 2021 [cited 2021 Nov 12]. available from [19] Bogart LM, Ojikutu BO, Tyagi K, et al. COVID-19 Related Medical Mistrust, Health Impacts, and Potential Vaccine Hesitancy Among Black Americans Living With HIV. J Acquir Immune Defic Syndr. 2021;86(2):200-207. [20] Centers for Disease Control and Prevention. A Guide for Community Partners-Increasing COVID-19 Vaccine Uptake Among Racial and Ethnic Minority Communities [online]. 2021 [cited 2021 Nov 12]. Available from: [21] Centers for Disease Control and Prevention. How to Engage the Arts to Build COVID-19 Vaccine Confidence [online]. 2021 [cited 2021 Nov 12]. available from https://www.cdc.gov/vaccines/covid-19/vaccinate-with-confidence/art.html

Factors affecting health equity

Impact of Racial Inequities on Our Nation’s Health

Strategies to Help Increase COVID-19 Vaccine Confidence

Address community concerns

Partner with trusted messengers

Develop culturally relevant materials

Data on COVID-19 and Race and Ethnicity

References

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