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Beyond the Case Count: The Wide-Ranging Disparities of COVID-19 in the United States

The COVID-19 pandemic’s impact in the United States has exposed long-standing inequities by race, ethnicity, and income.1

A Commonwealth Fund analysis from April showed that confirmed COVID-19 cases and deaths were disproportionately higher in communities with larger Black populations.2 Contributing to these poorer outcomes is the far greater likelihood Black and Latino Americans live in poverty and reside in neighborhoods with overcrowded households, air pollution, and inadequate access to health care.3 Beyond its toll on physical health, the pandemic has pushed the U.S. into an economic recession, which typically impacts already disadvantaged people more severely than the rest of society.4

As part of a series of Commonwealth Fund investigations into the disparate impacts of COVID-19, we analyzed the U.S. responses to the Fund’s 2020 International Health Policy COVID-19 Supplement Survey, fielded in the U.S. and nine other countries from March 30 to May 25, 2020. The survey in the U.S. was conducted among a nationally representative sample of adults age 18 and older, including oversamples of adults who identified as Black and Latino.

The analysis shows that Americans’ experience of economic hardship, their mental health concerns, and their opinion of government leaders during the pandemic varied by race, gender, and income.

Survey Highlights

  • More than half of Latino and nearly half of Black survey respondents reported experiencing an economic challenge because of the pandemic — substantially more than the 21 percent of white respondents.
  • Thirty-nine percent of women reported significant mental health concerns related to COVID-19, 13 percentage points higher than men. For people with low income, the rate of mental health concerns was nearly 20 points higher than the rate for people with high income.
  • Both Black and Latino respondents reported pandemic-related mental health concerns at a rate approximately 10 points higher than whites.
  • Compared to health care providers, state and local officials and the president received lower marks in their response to the pandemic. Black survey respondents held the least favorable views of government leaders’ actions.

Nearly one-third of all respondents faced at least one negative economic challenge associated with the pandemic (Table). The one most frequently cited was the depletion of personal savings, followed by difficulty paying for necessities such as rent or food and borrowing money or taking out a loan to make ends meet. The rate of having suffered any one of these economic hardships was more than twice as high among Latino and Black adults than it was for white adults.

Our results confirm national trends. While many people in the United States have long had issues paying for basic needs, the pandemic has exacerbated the problem. The U.S. Census Bureau’s coronavirus survey shows that as of July 2020, nearly 7 million more adults are struggling with food insecurity compared to before the pandemic, with large disparities evident between racial and ethnic groups.5

These disparities are perhaps not surprising, given that Black and Latino Americans have for generations struggled to attain levels of income, assets, and wealth on par with white Americans — even when educational levels are comparable. This persistent wealth gap has left many households of color with less of a cushion to weather the financial hardships created by the pandemic.6

The coronavirus pandemic also has spawned widespread mental health problems. Recent coronavirus survey data from the U.S. Census Bureau show that 41 percent of U.S. adults reported symptoms for anxiety and depressive disorders, compared to 11 percent in 2019. They also found that Black and Latino people, as well as women, were more likely to report symptoms.7 Financial worries and other sources of stress — such as the social isolation many have experienced — are known to contribute to poor mental health.8

Our survey finds that one-third of all respondents reported mental health concerns, such as stress and anxiety, since the beginning of the pandemic (Table). Individuals with below-average income, women, and Black and Latino people were most at risk of having anxiety and stress. People with lower income reported mental health concerns at the highest rate — 44 percent — nearly 20 points higher than people with higher income.

During a pandemic, the ability to communicate effectively and manage uncertainty is key to maintaining people’s trust and confidence.9 More than eight of 10 survey respondents reported that health care providers had done a “good” or “very good” job of handling the pandemic (Table).

Respondents overall had much less favorable views of the performance of state and local government leaders and the president (Table). Commonwealth Fund survey data from August showed Americans were much less likely to have a positive opinion of national leaders’ handling of the pandemic than were residents of other high-income countries.10

Within the U.S., Black respondents’ views stood apart from others in the survey: only 10 percent of Black people thought the president was handling the pandemic well, compared to 38 percent of whites and 41 percent of Latinos.

Past research has shown that Black Americans’ public trust in institutions — more so than any other racial or ethnic group — is shaped by their awareness, and experience, of inequities faced as a group.11 The disproportionately negative impact of COVID-19 on Black communities may have contributed to the low satisfaction with government’s response. Our findings are also consistent with other recent polls indicating that most Black Americans do not believe the president has done a good job of responding to the pandemic.12

Conclusion and Policy Implications

During the pandemic, Black and Latino people, women, and people with lower incomes have faced significantly greater hardships than other groups in the U.S., even as they comprise a disproportionately large share of the essential workers critical to the functioning and reopening of the economy.13

Beginning in March, the federal government began passing a succession of COVID-19 relief packages to address the health and economic toll of the virus. Very little in this legislation specifically addressed disparities, however, and the few attempts to target disadvantaged people were largely unsuccessful.

For example, in reviewing the distribution of small-business loans made through the Paycheck Protection Program, the Small Business Administration's Office of the Inspector General found a lack of compliance with the program’s intent to prioritize underserved markets, such as businesses owned by women or people of color.14 Moreover, many Black-owned enterprises and businesses in low-income areas have reported difficulty accessing these federal relief funds.15

The Commonwealth Fund survey indicates that large numbers of Black and Latino adults, as well as people with low income, are struggling to pay for basic necessities and experiencing mental health concerns related to COVID-19. Such findings call for greater investments in the economic security of these disproportionately affected groups, including rent relief, nutrition assistance programs, and expanded access to behavioral health care.16

Increased oversight and accountability mechanisms might be required to ensure that any new initiatives address the disparities identified by the survey, and that these efforts reach the health care systems, providers, and people most affected by the pandemic. Outreach and educational efforts also may be necessary to increase awareness and use of new resources among Black and Latino communities. Finally, continued monitoring of the pandemic’s impact on Black, Latino, and low-income communities, as well as on women, will be important to ensure equitable access to needed resources and services.

How We Conducted This Study

The 2020 Commonwealth Fund International Health Policy COVID-19 Supplement Survey was conducted by SSRS, a survey research firm, and country contractors, from March 30 to May 25, 2020. The COVID supplement was part of larger survey that was in the field from February to June 2020, and was administered to a nationally representative sample of adults age 18 and older in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States. This study limits the analysis to the U.S. population.

The U.S. sample for the COVID-19 supplement survey was 1,266. The sample was stratified to oversample Black and Latino people to facilitate analysis by race and ethnicity. In the final sample there were 791 white (non-Latino) respondents, 146 Black (non-Latino) respondents, 199 Latino respondents, and 130 who were classified as other. Interviews were completed either online or using computer-assisted telephone interviews. The response rate in the U.S. was 14 percent. Data were weighted to ensure the final outcome was representative of the adult population. In the analysis, income levels were based on self-reported income. Respondents indicated whether their household income was either below or above the U.S. average of $62,000 per year.

We conducted bivariate analyses using Stata, version 16. Exhibits show weighted frequencies. We also conducted logistic regression analyses to estimate whether racial and ethnic differences remained after controlling for demographic characteristics and income. After controlling for these factors, findings regarding statistical significance between proportions of white respondents compared to Black or Latino respondents remained unchanged for all outcomes except for having borrowed money or taken out a loan, and for Latino respondents related to mental health impacts and having been unable to pay for basic necessities as a result of the COVID-19 pandemic.

 

Acknowledgments

The authors thank Robyn Rapoport, Sarah Glancey, Rob Manley, and Christian Kline from SSRS; and Roosa Tikkanen and Gabriella Aboulafia from the Commonwealth Fund.

Notes

1. Johns Hopkins Coronavirus Resource Center, “COVID-19 Dashboard,” Center for Systems Science and Engineering, Johns Hopkins University, accessed July 21, 2020; Richard A. Oppel Jr. et al., “The Fullest Look Yet at the Racial Inequity of Coronavirus,” New York Times, July 5, 2020; and Amy Goldstein and Emily Guskin, “Almost One-Third of Black Americans Know Someone Who Died of COVID-19, Survey Shows,” Washington Post, June 26, 2020.

2. Laurie Zephyrin et. al., "COVID-19 More Prevalent, Deadlier in U.S. Counties with Higher Black Populations," To the Point (blog), Commonwealth Fund, Apr. 23, 2020.

3. Linda M Burton et al., “State of the Union 2017: Poverty,” Pathways Special Issue (Stanford Center on Poverty and Inequality, 2017); Jacob M. Izenberg, Mahasin Mujahid, and Irene Yen, “Health in Changing Neighborhoods: A Study of the Relationship Between Gentrification and Self-Rated Health in the State of California,” Health & Place 52 (July 2018): 188–95; U.S. Department of Housing and Urban Development, Measuring Overcrowding in Housing (U.S. Census Bureau, Sept. 2007); Jesse C. Baumgartner et al., How the Affordable Care Act Has Narrowed Racial and Ethnic Disparities in Access to Health Care (Commonwealth Fund, Jan. 2020); Christina A. Nguyen et al., “Comparison of Healthcare Delivery Systems in Low- and High-Income Communities,” American Journal of Accountable Care, published online Dec. 23, 2019; Elizabeth J. Brown et al., “Racial Disparities in Geographic Access to Primary Care in Philadelphia,” Health Affairs 35, no. 8 (Aug. 2016); and Shivani A. Shah, Michael E. Chernew, and Nancy Beaulieu, “Supporting Health Care Delivery in Low-Income Areas During COVID-19,” Health Affairs Blog, July 17, 2020.

4. National Bureau of Economic Research, Determination of the February 2020 Peak in U.S. Economic Activity (NBER, June 8, 2020); and Robert I. Lerman and Sisi Zhang, Coping with the Great Recession: Disparate Impacts on Economic Well-Being in Poor Neighborhoods (Urban Institute, Jan. 2013).

5. U.S. Census Bureau, “Week 12 Household Pulse Survey: July 16–July 21,” July 29, 2020.

6. Urban Institute, “Nine Charts About Wealth Inequality in America (Updated),” Oct. 5, 2017; Jeanna Smialek and Jim Tankersley, “Black Workers, Already Lagging, Face Big Economic Risks,” New York Times, June 1, 2020; Thomas M. Shapiro, Toxic Inequality: How America’s Wealth Gap Destroys Mobility, Deepens the Racial Divide, and Threatens Our Future (Basic Books, 2017); Tatiana Meschede et al., “‘Family Achievements?’: How a College Degree Accumulates Wealth for Whites and Not for Blacks,” Federal Reserve Bank of St. Louis Review 99, no. 1 (Jan.–Mar. 2017); William R. Emmons and Lowell R. Ricketts, “Unequal Degrees of Affluence: Racial and Ethnic Wealth Differences Across Education Levels,” Regional Economist (blog), Federal Reserve Bank of St. Louis, Oct. 12, 2016; and Angela Hanks, Danyelle Solomon, and Christian E. Weller, Systemic Inequality: How America’s Structural Racism Helped Create the Black-White Wealth Gap (Center for American Progress, Feb. 2018).

7. National Center for Health Statistics, Mental Health Household Pulse Survey (Centers for Disease Control and Prevention, July 2020); and Alyssa Fowers and William Wan, “A Third of Americans Now Show Signs of Clinical Anxiety or Depression, Census Bureau Finds amid Coronavirus Pandemic,” Washington Post, May 26, 2020.

8. Corinne Lewis et al., “How the COVID-19 Pandemic Could Increase Social Isolation, and How Providers and Policymakers Can Keep Us Connected,” To the Point (blog), Commonwealth Fund, April 8, 2020; Scott Keeter, “People Financially Affected by COVID-19 Outbreak Are Experiencing More Psychological Distress Than Others,” Fact Tank: News in the Numbers, Pew Research Center, March 30, 2020; Nirmita Panchal et al., The Implications of COVID-19 for Mental Health and Substance Use (Henry J. Kaiser Family Foundation, Aug. 2020); and Catherine K. Ettman et al., "Prevalence of Depression Symptoms in U.S. Adults Before and During the COVID-19 Pandemic," JAMA Network Open 3, no. 9 (Sept. 2020): e2019686.

9. Sandra Crouse Quinn et al., “Exploring Communication, Trust in Government, and Vaccination Intention Later in the 2009 H1N1 Pandemic: Results of a National Survey,” Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science 11, no. 2 (June 2013): 96–106.

10. Reginald D. Williams II et al., Do Americans Face Greater Mental Health and Economic Consequences from COVID-19? Comparing the U.S. with Other High-Income Countries (Commonwealth Fund, Aug. 2020).

11. James M. Avery, “Political Mistrust Among African Americans and Support for the Political System,” Political Research Quarterly 62, no. 1 (Mar. 2009): 132–45; Gabriel R. Sanchez and Edward D. Vargas, “Taking a Closer Look at Group Identity: The Link Between Theory and Measurement of Group Consciousness and Linked Fate,” Political Research Quarterly 69, no. 1 (Mar. 2016): 160–74; and Sirry Alang, Donna D. McAlpine, and Rachel Hardeman, “Police Brutality and Mistrust in Medical Institutions,” Journal of Racial and Ethnic Racial Disparities 7 (2020): 760–68.

12. African American Research Collaborative, “2020 COVID-19 Poll of African American Voters,” May 19 2020; and Sara R. Collins et al., An Early Look at the Potential Implications of the COVID-19 Pandemic for Health Insurance Coverage (Commonwealth Fund, June 2020).

13. Celine McNicholas and Margaret Poydock, “Who Are Essential Workers? A Comprehensive Look at Their Wages, Demographics, and Unionization Rates,” Working Economics Blog, Economic Policy Institute, May 19, 2020; Ryan Nunn, Jimmy O’Donnell, and Jay Shambaugh, “Examining Options to Boost Essential Worker Wages During the Pandemic,” Up Front (blog), Brookings Institution, June 4, 2020; and Kristi L. Kirschner, Lisa I. Iezzoni, and Tanya Shah, “The Invisible COVID Workforce: Direct Care Workers for Those with Disabilities,” To the Point (blog), Commonwealth Fund, May 21, 2020.

14. Office of the Inspector General, Flash Report: Small Business Administration’s Implementation of the Paycheck Protection Program Requirements (U.S. Small Business Administration, May 2020).

15. Alana Abramson, “As Minority-Owned Businesses Fall Further Behind During the Pandemic, Efforts Are Underway to Help. It May Not Be Enough.,” Time, June 5, 2020; and Timothy L. O’Brien, “PPP Isn’t Enough for Black-Owned Businesses,” Bloomberg Opinion, June 15, 2020.

16. Lauren Bauer and Diane Whitmore Schanzenbach, “Food Security Is Economic Security Is Economic Stimulus,” blog post, The Hamilton Project, Brookings Institution, Mar. 9, 2020.

Publication Details

Publication Date: September 10, 2020
Contact: Yaphet Getachew, Program Associate, Delivery System Reform, The Commonwealth Fund
Citation:

Yaphet Getachew et al., Beyond the Case Count: The Wide-Ranging Disparities of COVID-19 in the United States (Commonwealth Fund, Sept. 2020). https://doi.org/10.26099/gjcn-1z31

Experts

Yaphet Getachew
Program Associate, Delivery System Reform, The Commonwealth Fund
Laurie Zephyrin, M.D.
Vice President, Delivery System Reform, The Commonwealth Fund
Melinda K. Abrams
Senior Vice President, Delivery System Reform and International Innovations, The Commonwealth Fund
Arnav Shah
Research Associate, Research and Policy, The Commonwealth Fund
Corinne Lewis
Program Officer, Delivery System Reform, The Commonwealth Fund
Michelle M. Doty
Vice President, Organizational Effectiveness, Survey Research and Evaluation, The Commonwealth Fund