Portal de Periódicos da CAPES

Inequities During COVID-19

2020; American Academy of Pediatrics; Volume: 146; Issue: 2 Linguagem: Inglês

10.1542/peds.2020-1501

1098-4275

Adrian Jacques H. Ambrose,

Employment and Welfare Studies

The coronavirus disease 2019 (COVID-19) pandemic has created a time of unprecedented isolation, despair, and harm. Although COVID-19 does not intrinsically discriminate on the basis of race, sex, or socioeconomic class, the effects of the pandemic seem to be more deleterious for minorities. According to some preliminary research, the pediatric population has been relatively spared the severe consequences of COVID-19.1 However, underneath the COVID-19 infections, there is a hidden pandemic that affects minority children in direct and indirect ways with potential long-term consequences.At the end of April 2020, the Centers for Disease Control and Prevention began to systematically collect ethnicity, race, and socioeconomic data at the national level. Although the compiled results are still pending, statewide data have revealed significant inequities in the rates of confirmed cases and mortality. For example, in Massachusetts, an estimated 35% to 40% of Massachusetts General Hospital's patients with COVID-19 are Hispanic, in comparison with 9% of the patient population before the outbreak.2 Furthermore, the shortage of interpreters also posed additional challenges for communications of treatments and care to minority patients and families with limited English proficiency. Because the rates of COVID-19 among people of color seem to be higher, minority children are presumably even more likely to be exposed to infection from their parents and guardians. In addition, minority children are more likely to have underlying conditions that may exacerbate the severity of COVID-19 infections; for example, minority children are more likely to have major chronic diseases, such as, asthma and obesity, in comparison with white children.3In addition to the increased direct medical risks, minority children may also face a host of unique indirect socioeconomic repercussions resulting from this pandemic. COVID-19–induced closures of many public institutions (eg, schools and libraries) disproportionately affect minority children. For many minority children, schools serve not only as the primary source of education but also as the cornerstone of their food security. In comparison with 8% of white students, ∼45% of African American and Hispanic children attended high-poverty schools, where ≥75% of the student population have free or reduced-price lunch eligibility.4 According to the US Department of Agriculture, households with children have a higher rate of food insecurity, and, especially, minority households are significantly more likely to experience food insecurity than their white counterparts.5 With each day that schools remain closed, minority children are more likely to go hungry.Yet, the ways in which minority children are disproportionately affected by school closures extend beyond issues of food security. Education is, although far from a sufficient condition, nevertheless a clearly necessary condition for socioeconomic upward mobility and poverty reduction. As teaching shifts more onto virtual platforms, that education becomes less accessible to minority children in primary and secondary schools. Schools in affluent neighborhoods, along with the families whose children attend them, are more likely to have the resources to quickly establish the infrastructures for remote learning. On the other hand, minority households, who tend to live in less-resourced neighborhoods and attend the high-poverty schools, are much less equipped to adapt to virtual instructions. In fact, Hispanic and African American families are significantly less likely to have home broadband, rendering doing remote homework, researching new knowledge, or even accessing the online educational tools essentially impossible.6 The achievement and educational gaps historically tend to be largest after school breaks because of the students' differential living conditions and ability to access learning opportunities (eg, summer science camps, tutoring). For example, minority families with limited income will likely struggle to provide their children with electronic devices (eg, iPads, Chromebooks) required by virtual learning. Moreover, online learning assumes that students will have access to a home environment that is, in addition to being quiet and safe, Internet-connected and has the appropriate adult academic support and supervisions. For many minority children, schoolgrounds may be the only available havens amid the quotidian exposure to increased rates of violence, homelessness, and crimes in their own neighborhoods.As the rates of unemployment steadily climb across the United States, this economic downturn affects everyone and has significant trickle-down effects on housing, food, and access to learning resources. However, layoffs tend to disproportionately affect African American and Hispanic households, who are already vulnerable to financial insecurities. For households fortunate enough to escape unemployment (and perhaps affording them access to some of the technology that remote learning demands), minority parents are more likely to be in industries less amenable to working from home (eg, services and transportation) in comparison with white parents, who are more likely to work in management and professional jobs.7 As a result, minority families may have to choose between working and supervising their children's new and unfamiliar home learning. In a twist of irony, for many of these families, education is one of the primary routes to escape poverty. In the context of powerful historical roots of racially inequitable education (eg, Brown v Board of Education in 1954), the inability to receive education will especially exacerbate and recreate the cycle of poverty for many minority children. With recent significant structural reforms, the achievement gaps between white students and students of color have been slowly declining. Without immediate interventions, the COVID-19 pandemic runs the risks of undoing decades of incremental progress.To fix the problems of equity, we must better understand the extent of inequities. More and more researchers and institutions are calling for research across various fields to incorporate a more holistic collection of social determinants of health data, beyond race and ethnicity. The well-being of all children depends on equitable access to health care, proper food and clean water, stable housing, proficient education, and extracurricular enrichment opportunities. To bridge the immediate inequitable gaps, pediatricians and primary care providers can be central figures in screening for the hidden challenges of minority children and referring them to the appropriate community and school resources. In addition, providers can consider advocating for innovative solutions to their local school districts and communities to better support minority families, for example, a volunteer peer-to-peer program in which more pedagogically savvy parents can virtually assist and support other parents. COVID-19 has laid bare that more children (many of them coming from minority backgrounds) will go hungry, homeless, and uneducated. Perhaps the unlikely silver lining in this pandemic is the upheaval of the current bandaging structures that covered inequities among minority children. In addressing the immediate challenges, we must balance the potential unintended consequences of proposed solutions that may further alienate children and their families. For example, to address the lack of Internet access, advocating for schools hosting free Wi-Fi hot spots in specific areas of the neighborhoods may unintentionally stigmatize the impoverished children. In addressing the structural barriers, which are likely to continue post COVID-19, pediatricians and primary care providers are key players in advocating for meaningful policy changes at the local, state, and federal levels. For example, food and housing insecurities have been insidiously persisting before COVID-19; however, during this crisis, thanks to providers and educators raising concerns, more public attention (and, subsequently, funding) emerged to address the issue. As the COVID-19 infections subside and society attempts to resume its normalcy, we will still have this pandemic to fight: we must lean into this unique opportunity to shift the inequity paradigm and advocate for the well-being of children everywhere.