En español | It's a scene playing out in disadvantaged neighborhoods across the country: Clinics typically filled with Black and Latino residents are now brimming with older white adults from other areas eager to get the coveted COVID-19 vaccine. The latest data analyzed by the Kaiser Family Foundation (KFF) shows a national pattern of African Americans and Hispanics receiving fewer vaccinations compared with their share of COVID-19 cases and deaths, as well as with their total population. “This really aligns with what we've seen throughout this entire pandemic: It's disproportionately affected older adults, but especially those from communities of color,” says Tricia Neuman, senior vice president of KFF. Both Black and Latino Americans are more than twice as likely as white Americans to die from complications of COVID-19, at every age, and Black people are dying from COVID at roughly the same rate as white people more than a decade older.
But the pandemic simply exacerbates what health care advocates have long known. “These are not new problems — we have seen these health disparities in pretty much all the diseases that impact older adults, whether it's cataracts or type 2 diabetes,” notes Folasade May, M.D., assistant professor of medicine at UCLA. This in turn impacts longevity in key ways. A study published in January in JAMA found that nationwide death rates among Black populations for all causes were 24 percent higher than among white populations, resulting in almost 75,000 more deaths each year among Black Americans. But May stresses that it's not about race or color. Instead, the troubling statistics boil down to the socioeconomic and environmental context of these communities.
Why this population is so vulnerable
White people in the U.S. live, on average, about 3.6 years longer than Black Americans, according to the Centers for Disease Control and Prevention (CDC), with life expectancies of 79.1 and 75.5, respectively. One reason is that Black and Hispanic Americans have higher rates of chronic diseases such as high blood pressure and type 2 diabetes. “Unfortunately, when you are poor, you are more likely to be Black or brown, with less access to things such as healthy food or a gym for exercise,” May says. “This group also has lower rates of cancer screening: My patients say to me that they have so many competing demands in their life, that it's the last thing they have time for. That's so different from more affluent patients, who walk into their doctor's office wanting to know everything they need to do to optimize their health.” This is one reason why cancer rates are higher among Black Americans, she notes.
Then there are the actual neighborhoods people live in. “Racial and ethnic minorities are often more likely to live in neighborhoods with high rates of violence, unsafe air or water, and they may also be exposed to things at work that can harm their health, like secondhand smoke or loud noises,” May says. This has been particularly magnified during the COVID-19 pandemic, as many people of color work in essential jobs in health care facilities, grocery stores and public transportation, thus raising their risk of exposure to the virus. They may also live in crowded multigenerational homes, where there is more opportunity to spread disease.
All of these factors, known as social determinants of health, together take a toll. “Years of struggling with the stressors of life, including systemic racism and sexism, can really wear a person's body down,” May says.
Another problem is the general distrust of the COVID-19 vaccine in Black and brown communities, May says. A report released in the fall by the COVID Collaborative, a national organization combining health experts and policy leaders, found that less than a fifth of Black Americans and just over a third of Latinos trust that a COVID-19 vaccine will be safe and effective. “One reason may be because communities of color haven't been given enough information about the vaccine, such as the fact that there were many Black and Latino participants in clinical trials,” May explains.
There's also been a longtime distrust of medical studies, based on historical injustices. Case in point: The Tuskegee Syphilis Study, which ran from 1932 to 1972 at the Tuskegee Institute in Alabama, withheld treatment from Black male participants sickened by syphilis.
There are other barriers, too. Even when older adults of color do try to get the vaccine, they run into obstacles: “In some cases, a patient has to be connected to a health center to get a vaccine, but many of these people may not have a primary care provider, and even then they may still not have access to technology that allows them to make an appointment,” adds May.
How to decrease health disparities
While the COVID-19 pandemic has laid bare the issue of health inequities, it also may be the clarion call our nation needs to institute change, says Gelila Selassie, a staff attorney at the national nonprofit legal advocacy organization Justice in Aging. She suggests some ways to do this:
Increase access to home- and community-based services. While all nursing homes have been hit hard by the COVID-19 pandemic, it has been particularly devastating for majority-Black nursing homes, Selassie says. “Even prior to the pandemic, we have always known older adults of color are more likely to be put in a nursing home due to their not being able to afford home-based care, and to be put in a lower-quality nursing home,” she adds. One way to increase access is to require states to cover home- and community-based services (HCBS) via Medicaid, just as they are required to pay for institutional care. “Studies have shown that people who access HCBS compared to a lower-quality nursing home are less likely to be hospitalized and have lower mortality rates,” she says.
Bridge the digital divide. While telehealth has been an effective way to reach many older adults, it may prove to be just another barrier to health care for Americans of color who don't have access to technology or have trouble understanding English, Selassie says. Her organization is lobbying to reinstate a language access requirement for all health systems so users would receive help with issues such as navigating a telehealth portal in a language they understand. Her organization also seeks to increase community access to Wi-Fi and assistance for impoverished older adults who may have difficulty using technology.
Build trust. People of color have reason to be skeptical of the medical system, May says, as they are more likely to experience health discrimination and racial bias. “The older adults I work with have so much distrust because they remember a time when there were Black and white hospitals, and when people walked into a Black one, they died,” she says. “But if we have Black and brown leadership, including churches, community nonprofits — and physicians themselves — encouraging people to get their needed health care, we can make huge strides in advancing health."