The impact of COVID-19 on healthcare coverage and access in racial and ethnic minority populations in the United States.

This study described spatiotemporal changes in health insurance coverage, healthcare access, and reasons for non-insurance among racial/ethnic minority populations in the United States during the COVID-19 pandemic using four national survey datasets. Getis-Ord Gi* statistic and scan statistics were used to analyze geospatial clusters of health insurance coverage by race/ethnicity. Logistic regression was used to estimate odds of reporting inability to access healthcare across two pandemic time periods by race/ethnicity. Racial/ethnic differences in insurance were observed from 2010 through 2019, with the lowest rates being among Hispanic/Latino, African American, American Indian/Alaska Native, and Native Hawaiian/Pacific Islander populations. Pre-pandemic insurance coverage rates were geographically clustered. The percentage of adults citing change in employment status as the reason for non-insurance increased by about 7% after the start of the pandemic, with a small decrease observed among African American adults. Almost half of adults reported reduced healthcare access in June 2020, with 38.7% attributing reduced access to the pandemic; however, by May 2021, the percent of respondents reporting reduced access for any reason and due to the pandemic fell to 26.9% and 12.7%, respectively. In general, racial/ethnic disparities in health insurance coverage and healthcare access worsened during the pandemic. Although coverage and access improved over time, pre-COVID disparities persisted with African American and Hispanic/Latino populations being the most affected by insurance loss and reduced healthcare access. Cost, unemployment, and eligibility drove non-insurance before and during the pandemic.

Quantifying the Distribution of Environmental Health Threats and Hazards in Washington State Using a Cumulative Environmental Inequality Index.

Background: Environmental racism, community stressors, and age-related susceptibility play a significant role in environmental inequality. The goal of this article was to use an inequality index (II) to assess the level of equality in environmental threats and hazards based on race, poverty, and age in Washington State. Methods: Using the Washington Environmental Health Disparities Map, we quantified the level of disproportionate burdens on communities with greater populations of people of color, people in poverty, children younger than 5, and people older than 65 using 3 cumulative environmental indices and 10 individual environmental indicators. Results: Census tracts with a higher proportion of people of color and those with people living below 185% federal poverty levels were found to be disproportionately burdened by environmental threats (II = -0.175 and II = -0.167, respectively, p < 0.001). Individual environmental indicators were found to disproportionately burden communities of color and low-income communities. Children younger than 5 were also disproportionately burdened by cumulative environmental indices (II = -0.076, p < 0.001) and individual indicators. Our analysis did not show disproportionate burden of environmental health threats based on the proportion of people older than 65 (II = 0.124, p < 0.001). Discussion: The disproportionate burden of the cumulative environmental threats on communities of color and low-income communities in this study corroborates similar analyses. These findings can be applied in policy and regulatory actions to correct the distributive environmental disparities. Conclusion: We found much higher burdens among historically marginalized communities and children who are more susceptible to environmental threats and hazards.

The Washington State Environmental Health Disparities Map: Development of a Community-Responsive Cumulative Impacts Assessment Tool.

Communities across Washington State have expressed the need for neighborhood-level information on the cumulative impact of environmental hazards and social conditions to illuminate disparities and address environmental justice issues. Many existing mapping tools have not explicitly integrated community voice and lived experience as an integral part of their development. The goals of this project were to create a new community-academic-government partnership to collect and summarize community concerns and to develop a publicly available mapping tool that ranks relative environmental health disparities for populations across Washington State. Using a community-driven framework, we developed the Washington Environmental Health Disparities Map, a cumulative environmental health impacts assessment tool. Nineteen regularly updated environmental and population indicators were integrated into the geospatial tool that allows for comparisons of the cumulative impacts between census tracts. This interactive map provides critical information for the public, agencies, policymakers, and community-based organizations to make informed decisions. The unique community-academic-government partnership and the community-driven framework can be used as a template for other environmental and social justice mapping endeavors.