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Barriers and Opportunities to Address Geographic Inequity in a Pandemic

Urban and Rural Communities

September 17, 2020

Alina S. Schnake-Mahl, ScD, MPH, postdoctoral research fellow at the UHC, recently published Places and the Pandemic – Barriers and Opportunities to Address Geographic Inequity. The beginning of the pandemic saw urban areas as hotspots for COVID-19, however, many rural and suburban areas across the country have experienced similar infection and mortality rates. COVID-19 does not respect geographic boundaries, but racial and socioeconomic inequalities that existed long before the novel coronavirus have maintained their persistent patterns. 

Across cities, suburbs, and the countryside, the pandemic has hit hardest in racially and economically segregated areas. Decades of research have identified the harms of residential segregation, a form of institutional racism. Racial segregation shapes health by determining access to education and economic opportunity, quality housing, and health care. These same factors elevate the risk of contracting COVID-19 and developing complications from the disease. In these segregated communities, limited access to testing and to quality care can contribute to lower COVID-19 survival rates, compared to higher-income neighborhoods. In addition, Hispanic and Latinx residents have been found to have up to 3.8 times higher chances of infection compared to white residents. These structural barriers to health care and neighborhood conditions have led to larger case numbers and are implicated in higher death rates in minority communities.

An estimated 5.5 million undocumented immigrants are considered essential workers, putting this large population at high risk of exposure.  And, current federal policy excludes undocumented immigrants from receiving disaster response funds or Medicaid coverage due to their non-citizen status. Together, these policies put the undocumented population at high risk of exposure and without services or benefits to support them during the crisis.

While there’s been an incredible proliferation of research on COVID-19,  further research is still needed to help state and local governments understand why certain populations and geographic areas are at greatest risk of infection, hospitalization, and death—and which policy levers will be most effective at eliminating disparities. Where you live has always mattered for health, but in the current COVID-19 pandemic, the stakes are even higher.