COVID-19 double jeopardy: the overwhelming impact of the social determinants of health

• Published in: International journal for equity in health Vol. 21; no. 1; p. 76
• Main Authors: Badalov, Elizabeth, Blackler, Liz, Scharf, Amy E, Matsoukas, Konstantina, Chawla, Sanjay, Voigt, Louis P, Kuflik, Arthur
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 24-05-2022; BioMed Central; BMC
• Subjects: Allocation; Allocation guidelines; Analysis; Coronaviruses; COVID-19; Decision making; Demographic aspects; Epidemics; Health care; Health care disparities; Health care policy; Health services; Hospitalization; Humans; Inequities; Medical personnel; Minority & ethnic groups; Minority Groups; Mortality; Mortality patterns; Mortality rates; Pandemic; Pandemics; Physicians; Population; Public health; Quality of care; Rawls, John (1921-2002); Reforming; Review; Scarcity; Severe acute respiratory syndrome coronavirus 2; Social aspects; Social Determinants of Health; Social Justice; Society; Socioeconomic factors; United States; Utilitarianism; United States; New York; United States > US; COVID-19; Social determinants of health; Pandemic; Inequities; Allocation guidelines
• ISSN: 1475-9276; 1475-9276
• DOI: 10.1186/s12939-022-01629-0

The COVID-19 pandemic has strained healthcare systems by creating a tragic imbalance between needs and resources. Governments and healthcare organizations have adapted to this pronounced scarcity by applying allocation guidelines to facilitate life-or-death decision-making, reduce bias, and save as many lives as possible. However, we argue that in societies beset by longstanding inequities, these approaches fall short as mortality patterns for historically discriminated against communities have been disturbingly higher than in the general population.
We review attack and fatality rates; survey allocation protocols designed to deal with the extreme scarcity characteristic of the earliest phases of the pandemic; and highlight the larger ethical perspectives (Utilitarianism, non-Utilitarian Rawlsian justice) that might justify such allocation practices.
The COVID-19 pandemic has dramatically amplified the dire effects of disparities with respect to the social determinants of health. Patients in historically marginalized groups not only have significantly poorer health prospects but also lower prospects of accessing high quality medical care and benefitting from it even when available. Thus, mortality among minority groups has ranged from 1.9 to 2.4 times greater than the rest of the population. Standard allocation schemas, that prioritize those most likely to benefit, perpetuate and may even exacerbate preexisting systemic injustices.
To be better prepared for the inevitable next pandemic, we must urgently begin the monumental project of addressing and reforming the structural inequities in US society that account for the strikingly disparate mortality rates we have witnessed over the course of the current pandemic.