Covid Reveals Health Equity Shortcomings, Exacerbates Health Disparities

The coronavirus pandemic has exacerbated health disparities in vulnerable populations, and mental health is no exception. These disparities are one example of how Covid both amplifies and is fueled by pre-existing social and economic inequities that have existed for generations in marginalized populations. Covid shines a light on the urgent need for health equity. 

Health equity exists when all people have a fair and just opportunity to be healthy, especially those who have experienced socioeconomic disadvantage, historical injustice, and other avoidable systemic inequalities that are often associated with social categories of race, gender, ethnicity, social position, sexual orientation and disability. 

~Vermont Department of Health

Health Equity Fail: Covid Rates Reveal Vermont’s Health Disparities 

In Vermont, sharp inequities exist between BIPOC (Black Indigenous/People of Color) and non-hispanic whites with regard to Covid. BIPOC are more than twice as likely as whites to test positive for coronavirus. Even though they represent a tiny sliver of the state’s population, they account for one in seven cases. BIPOC have higher rates than whites in every age group, and contract Covid at younger ages. BIPOC are also hospitalized for Covid at higher rates than whites. They have higher rates of chronic diseases such as lung disease, diabetes, and cardiovascular disease, which puts them at greater risk of severe illness. [Source: Vermont Department of Health]

What explains these gross disparities in health outcomes? The reasons are complex and multifaceted – and of course, not unique to Vermont. In its Feb. 26 Weekly Spotlight focused on health disparities in Covid, the Vermont Department of Health, addressed some of the reasons. 

“Systemic and structural racism and oppressive systems affect the conditions in which people are born, grow, live and work,” the report concluded. “People in communities that are underserved may have higher rates of underlying medical conditions; work in jobs with a higher risk of exposure and less paid leave; be more likely to live in a multigenerational household or other congregate living space, and may not have access to adequate personal protective equipment or hand sanitizer.”

Read the report here: Vermont Department of Health, Weekly Spotlight: Cases Among Black, Indigenous and People of Color (Feb. 26, 2021)

How Culture Affects Health Equity in Vermont’s New American Refugees

Cultural beliefs and customs also play a role in health disparities, for equally complex reasons. Irene “Kerubo” Webster sees this in her work with New American immigrants as a social worker at the Association for Africans Living in Vermont (AALV). Many people she talks with “seem to be more afraid of the vaccine than of the coronavirus,” she said. They come from regions that have previously experienced deadly viruses, such as ebola. They may hear disinformation from conspiratorial videos circulating on social apps that fuel false beliefs about the virus’ origins and vaccine safety. This feeds and compounds a generational mistrust of Westerners rooted in the colonization of Africa. And then there is the language barrier. 

These are not simple issues. “There are a lot of ideas to overcome and change that are really set in their minds,” Kerubo says. 

This extends to mental health challenges, she says. “Refugees and immigrants have so much that they have overcome, but you can’t see it on the surface. It’s buried somewhere. But if you sit down and engage with them you can begin to chip away and see how deep this pain is in their minds and in their hearts.”

Kerubo uses her love of music and dance to reach these communities with empowering messages. As Covid vaccination began rolling out in Vermont, for example, she released a music video countering negative messages about the vaccine and encouraging vaccination.

Advocating for Health Equity for Vermont’s Spanish-Speaking Communities

An overlapping set of barriers affect Spanish-speaking individuals in Vermont’s migrant farm worker communities. Like New American refugees, many have overcome great difficulty to establish a life in Vermont. Faced with new hardships related to the pandemic, many may not know where to turn. 

Cecilia Hayes understands this. A native of Peru whose first language is Spanish, she spoke no English when she moved to Vermont at the age of 22. Now she’s a single mom to a 10-year-old and just earned her bachelor’s in social work. She plans to start her master’s in the fall. She became a support counselor with COVID Support VT because she wanted to be a resource for help and hope to others in similar shoes. “That’s why I chose the path of social work,” Hayes says. “Because of what I’ve been through myself.”

Hayes answer calls to the 2-1-1 “warmline” and is the go-to for anyone who speaks Spanish as a first language. For the most part, callers are all dealing with similar issues, regardless of ethnicity: isolation, missing family, dealing with Covid restrictions and how that impacts their ability to work, for example. For immigrants, Hayes says, language and cultural barriers compound those stresses. These include not having grown up in the American system, not having family here, and having limited resources. Asking for help may not come naturally. Finding a therapist or clinician who speaks their language can be really hard, Hayes says, and is a formidable barrier to better healthcare. 

“People are so happy when they realize they have someone they can speak to in their native language.” 

~ Cecilia Hayes, Support Counselor for COVID Support VT

Mental Health Equity Eludes Marginalized and BIPOC Communities

Nationally, mental health challenges seem to hit marginalized communities like Vermont’s farmworker and BIPOC communities especially hard. The National Academy of Sciences, Engineering and Medicine (NASEM) recently convened a workshop to explore “how the pandemic has created, revealed, and exacerbated long-standing racial and ethnic disparities in behavioral health care.” Their report documents the extent of the disparities and presents a way forward to create health equity. 

“We have a pandemic that is dramatically influencing minority and underserved communities … to a much greater degree than the general population, and that means that those individuals in those communities are essentially doubly at risk [for mental health challenges],” said Joshua Gordon, director of the National Institute of Mental Health, in the NASEM workshop. “They are more likely to have been impacted, and they have existing risk factors that raise their risk of mental health consequences.” 

Gordon outlined a triad of practices to promote mental health recovery, centered on practical assistance for pandemic stressors such as food insecurity or economic instability, healthy coping practices, and  appropriate interventions for new or worsening mental health challenges.

Read the report here: Mental Health and Substance Use Disorders in the Era of COVID-19: The Impact of the Pandemic on Communities of Color: Proceedings of a Workshop—in Brief.

Find Multilingual Resources, Help and Connections at COVIDSupportVT.org

COVID Support VT counselor Cecilia Hayes offers services in Spanish, Monday-Friday, 8am-4pm. Each call is confidential and free. You can call or text Cecilia via WhatsApp at 1-802-304-0562.

Meet Cecilia on vimeo and find out how to connect for help in Spanish.

Find one-click translation to 100 languages of almost everything on the COVIDSupportVT.org website, plus Multilingual Resources & downloadable materials in 10 languages common to Vermont’s immigrant and refugee communities. 

Watch Chanjo, the music video by Kerubo about Covid vaccination.  Read the story here.

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Need to talk? 

Call 2-1-1 (option #2) or 866-652-4636 (option #2) for free, confidential, one-on-one counseling. Our Support Counselors are available Monday – Friday, and include a Spanish-speaking support counselor and access to interpreters for other languages.

In crisis? 

If you or someone you care for is experiencing thoughts of suicide or self-harm, you can: call the National Suicide Prevention Hotline at 1-800-273-825;  text VT to 741741 to connect with a Crisis Counselor 24/7; connect with your local community mental health agency for 24/7 support 

Find Help

Find resources and tools for coping with stress at www.COVIDSupportVT.org. Follow COVID Support VT on Twitter, Facebook and Instagram. And, to stay up-to-date, sign up for our newsletter and blog.

Learn about upcoming Wellness Workshops from COVID Support VT, and Town Halls we’re hosting in partnership with community organizations.

COVID Support VT is funded by the Substance Abuse and Mental Health Services Administration and Federal Emergency Management Agency, managed by Vermont’s Departments of Emergency Management and Mental Health, and administered by Vermont Care Partners, a statewide network of 16 non-profit community-based agencies providing mental health, substance use, and intellectual and developmental disability services and supports.