Moving health education and behavior upstream: Lessons from COVID-19 for addressing structural drivers of health inequities

In this Perspective, we build on social justice and emancipatory traditions within the field of health education, and the field's long-standing commitment to building knowledge and shared power to promote health equity, to examine lessons and opportunities for health education emerging from the COVID-19 pandemic. Examining patterns that emerged as the pandemic unfolded in Metropolitan Detroit, with disproportionate impacts on African American and low-income communities, we consider conditions that contributed to excess exposure, mortality, and reduced access to critical health protective resources. Using a life course framework, we consider enduring impacts of the pandemic for health equity. Finally, we suggest several strategic actions in three focal areas-environment, occupation, and housing-that can be taken by health educators working in partnership with community members, researchers, and decision makers, using, for example, a community-based participatory research approach, to reduce adverse impacts of COVID-19 and promote long-term equity in health. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

An exploration of structural determinants driving racial disparities in COVID-19 deaths in Michigan.

Aim: Racial disparities in COVID-19 death rates have largely been driven by structural racism in health, housing, and labor systems that place Black, Brown, and Indigenous populations at greater risk for COVID-19 exposure, transmission, and severe illness, compared to non-Hispanic White populations. Here we examine the association between taxable property values per capita, an indicator influenced by historical and contemporary housing policies that have disproportionately impacted people of color, and COVID-19 deaths. Methods: Taxable values serve as a proxy for fiscal health providing insight on the county's ability to address imminent needs, including COVID-19 responses. Therefore, higher taxable values indicate local governments that are better equipped to deliver these public services. We used county-level data from the American Community Survey, the Michigan Community Financial Dashboard, The Atlantic's COVID Tracking Project, and the Community Health Rankings and Roadmap for this cross-sectional study. Maps were created to examine the geographic distribution of cumulative death rates and taxable values per capita, and regression models were used to examine the association between the two while controlling for population density, age, education, race, income, obesity, diabetes, and smoking rates. Results: Seventy-five counties were included. The mean taxable value per capita was $43,764.50 and the mean cumulative death rate was 171.86. Findings from the regression analysis showed that counties with higher taxable values were associated with lower COVID-19 death rates (B = -2.45, P < 0.001). Conclusion: Our findings reveal a need to reevaluate current policies surrounding taxable property values in the state of Michigan, not solely for their inequitable impact on local governments' financial solvency and service quality, but also for their negative consequences for population health and racial health equity. Supplementary Information: The online version contains supplementary material available at 10.1007/s10389-022-01817-w.

An exploration of structural determinants driving racial disparities in COVID-19 deaths in Michigan

Aim Racial disparities in COVID-19 death rates have largely been driven by structural racism in health, housing, and labor systems that place Black, Brown, and Indigenous populations at greater risk for COVID-19 exposure, transmission, and severe illness, compared to non-Hispanic White populations. Here we examine the association between taxable property values per capita, an indicator influenced by historical and contemporary housing policies that have disproportionately impacted people of color, and COVID-19 deaths. Methods Taxable values serve as a proxy for fiscal health providing insight on the county's ability to address imminent needs, including COVID-19 responses. Therefore, higher taxable values indicate local governments that are better equipped to deliver these public services. We used county-level data from the American Community Survey, the Michigan Community Financial Dashboard, The Atlantic's COVID Tracking Project, and the Community Health Rankings and Roadmap for this cross-sectional study. Maps were created to examine the geographic distribution of cumulative death rates and taxable values per capita, and regression models were used to examine the association between the two while controlling for population density, age, education, race, income, obesity, diabetes, and smoking rates. Results Seventy-five counties were included. The mean taxable value per capita was $43,764.50 and the mean cumulative death rate was 171.86. Findings from the regression analysis showed that counties with higher taxable values were associated with lower COVID-19 death rates (B = –2.45, P < 0.001) Conclusion Our findings reveal a need to reevaluate current policies surrounding taxable property values in the state of Michigan, not solely for their inequitable impact on local governments' financial solvency and service quality, but also for their negative consequences for population health and racial health equity. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-022-01817-w.

Impacts of the COVID-19 pandemic on unmet social needs, self-care, and outcomes among people with diabetes and poor glycemic control.

AIMS: The purpose of this study was to examine whether pandemic exposure impacted unmet social and diabetes needs, self-care behaviors, and diabetes outcomes in a sample with diabetes and poor glycemic control. METHODS: This was a cross-sectional analysis of participants with diabetes and poor glycemic control in an ongoing trial (n = 353). We compared the prevalence of unmet needs, self-care behaviors, and diabetes outcomes in successive cohorts of enrollees surveyed pre-pandemic (prior to March 11, 2020, n = 182), in the early stages of the pandemic (May-September, 2020, n = 75), and later (September 2020-January 2021, n = 96) stratified by income and gender. Adjusted multivariable regression models were used to examine trends. RESULTS: More participants with low income reported food insecurity (70% vs. 83%, p < 0.05) and needs related to access to blood glucose supplies (19% vs. 67%, p < 0.05) during the pandemic compared to pre-pandemic levels. In adjusted models among people with low incomes, the odds of housing insecurity increased among participants during the early pandemic months compared with participants pre-pandemic (OR 20.2 [95% CI 2.8-145.2], p < 0.01). A1c levels were better among participants later in the pandemic than those pre-pandemic (ß = -1.1 [95% CI -1.8 to -0.4], p < 0.01), but systolic blood pressure control was substantially worse (ß = 11.5 [95% CI 4.2-18.8, p < 0.001). CONCLUSION: Adults with low-incomes and diabetes were most impacted by the pandemic. A1c may not fully capture challenges that people with diabetes are facing to manage their condition; systolic blood pressures may have worsened and problems with self-care may forebode longer-term challenges in diabetes control.

Housing and health inequities during COVID-19: findings from the national Household Pulse Survey.

BACKGROUND: COVID-19 has exploited the inequities within the US housing system. Examining the association between housing and health during the pandemic is imperative to reducing health inequities and improving population health. METHODS: We analysed 957 714 responses from the Household Pulse Survey Study, collected between April and July 2020. Using survey-weighted multivariable regression analyses, we assessed the relationships between housing tenure and health, both on average and over time, as well as how these relationships were moderated by COVID-19-related hardships including job loss, food insecurity and inability to afford housing-related costs. We controlled for a variety of potential socioeconomic and demographic confounding factors. RESULTS: We found that housing tenure was significantly associated with both self-rated health and mental distress. Compared with homeowners without mortgage debt, homeowners with mortgage debt reported worse self-rated health (ß=-0.13; 95% CI -0.15 to -0.12, p<0.001) and greater mental distress (ß=0.50; 95% CI 0.44 to 0.55, p<0.001). Renters also reported worse self-rated health (ß=-0.18; 95% CI -0.20 to -0.16, p<0.001) and greater mental distress (ß=0.76; 95% CI 0.69 to 0.83, p<0.001) than homeowners without mortgage debt. Across all tenure groups, self-rated health decreased (ß=-0.007; 95% CI -0.011 to -0.004, p<0.001) and mental distress increased (ß=0.05; 95% CI 0.05 to 0.06, p<0.001) over this period. Additionally, time and COVID-19-related hardships compounded differences in health status between homeowners and renters. CONCLUSIONS: These results add to a limited body of evidence suggesting that, during this period, housing instability and COVID-19-related hardships have contributed to an increase in health inequities in the USA.

Students' Perspectives: How Will COVID-19 Shape the Social Determinants of Health and Our Future as Public Health Practitioners?

We are the next generation of public health practitioners. As public health students, we acknowledge that the COVID-19 (coronavirus disease 2019) pandemic will continue to fundamentally alter the field that we are preparing to enter. We will be the first wave of public health professionals whose education is being shaped by this pandemic. For decades to come, we will be working to address the impacts of this pandemic. In this commentary, we are lending our voice to discuss and highlight the importance of considering the intersections of various determinants of health and COVID-19, including education, food insecurity, housing instability, and economic hardship. We provide a discussion on what is being done across the United States in attempts to reduce the growing health inequities. As the next generation of public health leaders, we believe that only by investing in these issues can we begin to address the social and economic impact of the COVID-19 pandemic.