From Stress to Healthcare: How COVID-19 Is Impacting People of Color Differently

Healthline recently conducted a survey that reveals health inequities by ethnicity.

Comparing data from 1,533 U.S. adults collected in February 2020 with data from 1,577 adults in December 2020, the survey revealed that People of Color (POC) are less likely to rate their overall health and wellness as “excellent” or “very good” compared with white Americans.

Moreover, COVID-19 specifically impacted the physical and mental health of POC.

“COVID-19 has brought to the forefront a tale of two pandemics. One of which has impacted every major system within our [country]: systemic racism. The other [pandemic], COVID-19, has made the general public aware of the inequities that exist within our systems of care as Black Indigenous Persons of Color (BIPOC) and those that identify as Latino or Latinx have always experienced disproportionate inequities in healthcare,” Andrea Heyward, deputy director of the Center for Community Health Alignment, told Healthline.

Healthline’s study revealed the following inequalities.

Access to healthcare

Asian, Hispanic, and Black populations have had more difficulties accessing medical professionals since the pandemic in the following ways:

Inability to see doctors or get treatments:

  • Asians: 22 percent
  • Hispanics: 20 percent
  • African Americans: 17 percent
  • Whites: 16 percent

Delayed doctor or medical appointments due to lack of availability:

  • Hispanics: 37 percent
  • Asians: 36 percent
  • Whites: 36 percent
  • African Americans: 31 percent

Dr. Michelle Ogunwole, health disparities researcher in San Antonio, Texas, noted that some access problems during the early days of the pandemic were due to patient-related reasons, such as being afraid to go to a doctor’s office for fear of contracting the virus.

Physicians, such as primary care doctors, called to help COVID-19 patients and, therefore, taking appointments only with those who had urgent needs is another reason, she said.

“Think about people who get care at federally qualified health centers where the physicians there are already stretched to capacity — add in COVID-19, and so it will be difficult to get appointments, and you might have to wait a long time,” Ogunwole told Healthline.

Still, she stressed that other reasons related to structural racism are also to blame for lack of access.

“Our nation was set up this way. Black and Brown communities live in different areas of town because of redlining and residential segregation, so they’ve always had less resources, and the pandemic magnifies this,” she said.

For example, hospitals for Black and Brown people have historically been built in the poor parts of town and not invested in. So less innovation occurs, and fewer researchers are inclined to invest in the hospital.

“It’s a snowball effect. It matters in terms of the quality of care,” said Ogunwole.

Dr. Kunjana Mavunda, a pediatric pulmonologist in Miami, agreed. She explained that before the pandemic, clinics that provide care to poor, marginalized groups tend to have long wait times to get appointments, the physical facilities are not well-kept, and the education of the staff might be inadequate.

“Due to inadequate financial support, these clinics may not have adequate preventative programs, and when appointments are given, patients have to wait for a long time to be seen — which means that a person would have to take a whole day off from work in order to get medical attention,” Mavunda told Healthline.

“Because of this, patients tend to seek care only when they are sick, and then, they are more likely to go to an urgent care center or emergency room. So, the patient is not able to develop a working relationship with a primary care provider, care is episodic, and there is no continuity of care,” she said.

Also, poverty and transportation problems increased during the pandemic, making it difficult for people to keep appointments.

“Add in the fact that there is racism and implicit bias on the individual level. There are studies that have shown that people’s biases affect their ability to give the same standard of care to patients,” Ogunwole said.

Stress and anxiety

The Healthline survey showed that most POC have felt more anxious and stressed than white Americans over the past few months:

  • Asians: 75 percent
  • Hispanics: 72 percent
  • Whites: 68 percent
  • African Americans: 59 percent

For example, a higher percentage of Asian Americans said they feel stressed. Asians have been falsely blamed for spreading COVID-19 and have been the targets of a higher number of hate crimes during the pandemic.

“The COVID-19 pandemic has reinforced not just the longstanding pressure for minorities to assimilate and acculturate in America, but also the absolute demand to assimilate in a way that completely erases cultural history, identities, and practices,” Elizabeth Keohan, a licensed certified social worker at Talkspace, told Healthline.

As a result, marginalized groups experience significant levels of stress, anxiety, and depression at a time when personal safety is a persistent concern during everyday life, she said.

“It can already be a challenging personal struggle to feel different, separate, and isolated, but when the larger society perceives you as a ‘foreigner’ in your own land, then emotional stress is raised even higher to a level that can border on an inability to live one’s life free of fear,” said Keohan.

Heyward added that existing and continuous racial injustices in the United States call for movements such as Black Lives Matter and Stop Asian Hate.

“What we know to be true is that stress impacts the health of individuals across a spectrum of conditions,” Heyward said. “In fact, it is far from surprising that any individual experiencing the stress of COVID-19, lack of access to healthcare, social determinants of health, in addition to experiencing the trauma of prejudice and racism would be impacted physically, emotionally, and psychologically.”

How we can level the healthcare playing field for POC

While access to healthcare is complicated in many ways, Ogunwole said, the pandemic has shown that change can happen fast.

“Systemic change can happen rapidly and overnight because that’s what our healthcare system has done this past year,” she said.

For instance, telemedicine being covered by Medicaid during the pandemic helped many people.

However, a lot of work needs to be done to help with healthcare disparities long term. Experts believe the following ways can make a difference.

Talk it out and really listen.

For change to happen, the first step involves intentional and meaningful engagement of people who experience health inequities and racial injustices, said Heyward.

“This includes being open to hearing collective voice and tapping into the power of individuals that experience prejudice and racism for any substantial change to happen,” she said.

Keohan noted that dialogue connects and sustains people.

“Certainly, as humans we cannot heal from what we do not talk about. And after a year of isolation, the wounds of vulnerability have come to the surface, exposing biases, negative worldviews, insecurities, even our own, that may have permeated before now,” said Keohan.

Elevating the conversation toward understanding each other can lead to less division and more support for those who need it.

“We need to identify and recognize the harshness of our reality, acceptance of what is true and real for so many — the ongoing and the wide gaps and disparities in systems of care,” Keohan said.

2. Understand POC are not one and the same.

African Americans and Hispanics are often thought of as one unified group, Mavunda said. However, she believes this needs to change.

“The thinking process of different groups is different, and it will be more meaningful to look at the groups separately,” she said.

For example, American-born African Americans are different from Caribbean Blacks, who are different from Haitian Blacks, who are different from Africans.

“Experiences these societies have had for at least the past two to three generations dictate their approach to healthcare,” said Mavunda. “The same applies to Hispanics — recently arrived Cubans are different than Cubans who have grown up in the United States. Puerto Ricans are different than the Mexicans who are different than the Central or South Americans who are different than the Dominicans.”

Ogunwole sees differences between POC in her research.

“For example, this is a broad generalization, but as a health disparities researcher, a lot of times when you look at the Asian population’s health outcomes, if you broke them down into specific subgroups, you would see even more disparities. But they usually tend to be closer to white people than Black and Hispanic people in terms of disparities that we see,” she said.

Moreover, she explained that the way People of Color experience racism is different.

“We have a shared sense of marginalization, certainly, but the historic roots of racism are very different in the Black community, Latinx community, and the Asian community. In the Black community, it was slavery. In the Asian community, it was the Chinese Exclusions Act. Understanding this is important,” she said.

3. Increase diversity in the medical field.

Only 5 percent of U.S. doctors are Black, and according to research from The University of California, Los Angeles (UCLA), the number of doctors who are Black men remains unchanged since 1940.

“We know that diversity helps, yet in my specialty, which is internal medicine, the physician population does not yet reflect the patients we see,” said Ogunwole.

She explained that physician diversity matters because physicians of color bring new perspectives to medicine and are more likely to work in communities of color.

There’s evidence of increased patient satisfaction when patients share not only racial concordance but language concordance with their doctor, Ogunwole said.

“When you look at the projectory of this country, the census is predicting that it’s going to be a minority-majority by 2050, 2060. We’re a melting pot, so we need to have physicians who are reflective of the rich diversity of this country,” said Ogunwole.

4. Vote for policy changes.

Being aware of legislation that can impact health and access to health is one way everyone can help, says Mavunda.

“Many of our political leaders work to make access to healthcare more difficult. An example is the Florida Legislature. Many years ago, the federal government offered to provide monies to the states to expand Medicaid for the poor and the disabled. Florida has chosen not to accept the money,” she said.

She recommended supporting leaders who aim to address disparities as a systemic problem by establishing adequate medical facilities in neighborhoods where people need healthcare and who provide opportunities for patients to build trust with providers.

“Unfortunately, this requires money, and changes need to be made at governmental levels — state, federal, local, etc. Not all leaders are willing to make changes or spend money on all communities. We know that this will work because we have pockets where this is already happening, e.g., clinics that treat the migrants and federally funded clinics located in poor neighborhoods,” Mavunda said.

How POC can find the healthcare they need

For mental healthcare needs, Keohan suggested identifying what is available to you, within your own network of care, and also within your community to help ease the search.

When performing an online search, enter “clinician of color” or “BIPOC therapist of color.”

“Ask questions about worldviews, approach and style to understand that a particular provider might be better equipped to understand and validate the stressors you might be experiencing both personally and also through a broader scope of gender, race, faith, and sexuality,” said Keohan.

Once you can identify what matters to you, it can be easier to eliminate the wrong provider and find one who can support and compliment your value, she added.

When scheduling visits with a new clinic, Ogunwole said there is nothing wrong with saying, “I’d like to request a bilingual provider,” or “I’d like to request a Black woman provider,” or “I’d like to request a provider who is comfortable treating transgender youth.”

“It’s not always that you’ll get a doctor who looks exactly like you. It’s about finding a doctor who cares about your well-being, and who can suspend judgment, and who is willing to listen to you and include you in the conversation about your health,” Keohan said.

Heyward suggested reaching out to a community health worker (CHWs), people with lived experience who have strong ties to the community they serve.

“As community leaders and advocates in many areas, CHWs help individuals every day in navigating healthcare and social needs,” she said.

To learn more about CHWs and other community resources, including those for COVID-19, visit their website.