How Regional, Social And Financial Inequities Contribute To Uneven COVID-19 Impacts

Anne Sosin studies epidemiological data at the Dartmouth Center for Health Equity. Over the course of the pandemic, she has looked at how state policies and social identities influence how people are affected. This hour, Sosin helps us understand the impact of the COVID-19 pandemic on Vermont's most marginalized community members, such as BIPOC Vermonters, rural residents and people without housing.

Our guest is:

• Anne Sosin, program director for the Dartmouth Center for Global Health Equity

Broadcast live on Tuesday, Jan. 26, 2021 at noon; rebroadcast at 7 p.m.

Jane Lindholm: What does it mean to study health equity?

So when we're thinking about equity and health equity, we're thinking about much more than the prevalence of disease or biomedical treatments to it. We're thinking about a range of things that influence health and poor health outcomes. We're thinking about housing, food, we're thinking about the communities that we live in, discrimination, the natural environment, and all the ways that these factors come together to produce the state of our health. And so when we think about issues of equity, we see that some people and some groups are disproportionately and negatively impacted by these factors.

When I think about equity in the context of COVID-19 in particular, I think about vulnerability and the factors that shape vulnerability to the coronavirus as well as to the secondary impacts [it has on] health and wellbeing. And I think about that both in the context of health care, as well as in those broader factors that shape our health.

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What have you learned about the benefits and challenges for rural states like Vermont, when it comes to addressing COVID-19?

There's a dual narrative, I think, that rurality confers protection and that institutions are fragile, and I think it's really the reverse that has been borne out by the experience of COVID-19. We see that rural regions have distinct risk factors, many of which are common with urban areas, but are really underappreciated [in a rural setting].

[For example], we see the presence of a range of congregate living facilities, including the long term care facilities that have seen such devastating outbreaks. We see factories and prisons and other settings.

We see that there is very high workforce mobility, so even though people are living spread apart from one another, they're moving quite a bit and have a high number of contacts. And that's really what structures risk — it's  how many contacts you have, not where you're located.

We also see quite a bit of housing insecurity and crowding, and that's another thing that structures risk to COVID-19. And I think now, as we see the devastation in rural parts of America, we are starting to understand that rurality is not protective. But early on, many thought that we were just naturally physically defensive and had just missed the pandemic in this part of the region.

That said, we see really strong, real protective factors emerging. The close social networks, institutional networks have enabled a very robust response across rural Vermont. And we've also observed that in our work in rural New Hampshire, as well.

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In many of the very rural parts of the state, there are networks that bring together the health systems [with] public health entities, community organizations and other groups. And some of these groups were engaged in other work prior to the pandemic and rapidly mobilized, and others formed in response to the pandemic. And so we saw them mobilizing to increase critical care capacity at the small critical access hospitals. They were also engaged in the public health response and in meeting the needs of vulnerable populations across their communities.

I think about the response in the Northeast Kingdom of the state, which has been one of the most effective across the bi-state region. And it was the presence of those strong networks that were in place that really allowed that region of the state to respond very swiftly to the threat of the pandemic.

How should Vermont be addressing racial equity and disparities when it comes to COVID-19?

I want to back up just a little bit and say that it's not biological factors that make communities of color more vulnerable to COVID-19; it's structural factors. So we need to talk about structural racism and not race, and the ways in which that shapes vulnerability and the really extraordinary disparities that we see in infection rates and death.

Here in Vermont, we see that Black Vermonters have infection rates that are more than six times higher than white Vermonters. Those are enormous disparities that can't go unnoticed and need to come into the conversation around vaccine prioritization and delivery.

Credit The Vermont Department of Health, Courtesy

Find more demographic data about COVID-19 from the Vermont Department of Health, here.

So these are really important issues right now. Issues of hesitancy are really delivery issues, and those are barriers to getting vaccines into those communities, just like challenges around translation and access. But they don't speak really to the fundamental issues related to why communities of color are more vulnerable to COVID-19 or what's really driving those enormous disparities that we see not only in our state, but across the U.S.

You know, the national guidelines attempted to prioritize structural racism over race for these very reasons, and there's been a shift away from that guidance not only in the state of Vermont, but in many other states, out of a desire, I think, for expediency or simplicity. And so the question then becomes: Well, if we are not going to prioritize people on the basis of structural risk factors, then, you know, what else do we have in place to do that? And so I'm not sure what the state's approach will be, but it's really important to think about prioritization as the first step in achieving equity and vaccination.

More from Vermont Edition: Is Vermont Doing Enough To Address Racial Inequities In Its Vaccine Program?

I think the state has been really effective in thinking about how to deliver resources into communities on the basis of equity, and many of the strategies that it's employed around testing, around support to communities that have seen outbreaks will be really important to harness as it is in the process of delivery.

See Anne Sosin's full COVID-19 and rural health equity report below. 

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