As of Aug. 29, Hispanic Ohioans were also over-represented in COVID-19 cases (6.3%) and hospitalizations (5.9%) relative to the percent of the state population (4%) but underrepresented in deaths (2.2%).
Health care providers and researchers interviewed by the Dayton Daily News said the pandemic exacerbates inequality and racism already in the community before coronavirus spread started, and it mirrors disparities consistently found in other aspects of health from infant mortality rates, to breast cancer survival rates to access to health care and more.
“We were starting from an unequal baseline when COVID hit,” Dr. Mamle Anim, chief medical officer at Dayton-based Five Rivers Health Centers. “We were already at unequal levels and one population was already groaning under the weight of health effects and lack of access and not the right medications and then we added COVID on top of that.”
Disparities vary at the county level.
In Montgomery County, 35.5% of people with cases as of Aug. 24 identified as Black, which make up 21.5% of the population.
In Clark County, Hispanic residents made up 25.3% of coronavirus cases but 3.6% of the population.
Greene and Miami counties had a higher percent of Black residents with cases than overall population, but the difference was within a percentage point. 3.2% of cases in Miami County were Black residents compared to 2.4% of the population; 8.1% of Greene County COVID-19 cases were Black residents compared to 7.3% of the county population.
In Champaign County, Hispanic residents were 16.7% of cases but 1.7% of the county population and in Butler County, Hispanic residents were 11.7% of COVID-19 cases but 5% of the population. However, both of these counties had significant numbers of coronavirus cases where the person’s ethnicity was not known, including 30.6% of cases in Butler and 53% of Champaign cases.
A major limitation for fully assessing the impact of racial and ethnic disparities across the state is the high percentage of coronavirus cases with unknown race and ethnicity data. In Ohio, on average, 13% of cases in each county are listed as “unknown” for race. Without complete counts of race and ethnicity for those who test positive for COVID-19, it is difficult to measure the full impact of racial and ethnic disparities.
“Strengthened data collection and reporting will be critical to eliminating COVID-19 disparities and advancing the health and wellbeing of all Ohioans,” said Health Policy Institute of Ohio President Amy Rohling McGee.
There are many layers of factors to why there are racial disparities in local and statewide COVID-19 case data.
Essential workers that work in high exposure roles are disproportionately minorities. Skilled nursing facility workers, for example, are about 28% Black and 13% Hispanic. Home health workers are about 31% Black and 18% Hispanic.
People of color are more likely to have multiple generations of families living together for both socioeconomic and cultural reasons, said Anim, which can mean more vulnerable generations of families having higher exposure risk from there being many people in the household. About 29% of Asian households, 27% of Hispanic households and 26% of Black households reported in 2017 living in multi-generational family households, compared to 16% of white households, Pew Research reported.
Access to health care is also part of the challenge, said Anim, and there are racial disparities in who gets access to testing and insurance coverage and the ability to afford needed health care. After initial data came out showing disparities, community health centers like Five Rivers and Community Health Centers of Greater Dayton have been holding pop-up testing sites to increase access.
Anim said the pandemic shows how urgent it is for those in health care to eliminate health disparities as much as possible.
There are also racial disparities in rates of pre-existing conditions that are risk factors for more serious complications from COVID-19.
Dr. Patrick Lytle, VP of clinical outcomes at Kettering Health Network, said with COVID-19 and other health conditions, people are affected by the social determinants of health — conditions in the places where people live that affect a wide range of health risks and outcomes.
“We do know that African Americans do have a higher risk with diabetes, hypertension and heart disease. Those three things are what I would call co-morbid conditions ... if you do contract the virus, those individuals tend to get sicker faster and have more difficulty combating the virus,” Lytle said.
State task force
To reduce COVID-19 disparities, a series of action steps was recently published by the COVID-19 Minority Health Strike Force, formed by Gov. Mike DeWine and chaired by Director of RecoveryOhio Alisha Nelson and Director of the Ohio Department of Aging, Ursel McElroy.
The task force’s blueprint said the COVID-19 exposed and amplified inequities facing Ohioans of color and so their recommendations for action went beyond the current crisis to establish a vision of Ohio as “a model of justice, equity, opportunity, and resilience to withstand future challenges.”
Dr. Roberto Colón, associate chief medical officer at Miami Valley Hospital, said Ohio took an important first step in creating a comprehensive plan to respond.
“The next step is actually changing and to continue to try and change. And that’s really going to be a challenge we all have to bear ... Otherwise, we’re going to keep repeating this exercise over and over again without trying to really make a difference,” Colón said.
The 33-page framework identified three policy categories that contribute to health outcomes and disparities: health care and public health, the social and economic environment, and the physical environment.
Researcher Hope Lane, with Cleveland-based Center for Community Solutions, who authored a report on the task force’s blueprint, said the recommendations, if consistently adopted on the state level, will have a trickle-down effect to public health and human service organizations statewide including nonprofits and the private sector.
“We are incredibly pleased with the blueprint as it not just shows that minority health matters to the administration, but that mattering is the minimum,” Lane said.
Ohio COVID-19 Minority Health Strike Force recommendations
- Acknowledge racism as a public health crisis and commit to swift action to dismantle racism. This includes government and private partners reviewing policies and procedures through this lens such as administrative policies; leadership appointments; hiring and other human resource practices; vendor selection and contracting; and grant management, funding and other resource allocations.
- Apply a health equity lens to policy. This could include prioritizing equitable outcomes in policy agendas for communities of color, conducting impact assessments of proposed policy to ensure equitable outcomes for communities of color, tailoring policies to meet the needs of communities of color, and strategically allocating resources and funds to advance equity.
- Ensure equitable representation of Ohioans of color in government and private sector leadership. State and local government and private sector leadership should develop and implement plans to ensure equitable representation of Ohioans of color in leadership positions across all branches of government as well as for-profit and nonprofit organizations, including governing and advisory boards and C-suites.
- Require cross-sector cultural and linguistic competency and implicit bias trainings. State and local government leadership and Ohio’s professional licensing boards should require trainings for policymakers and licensed professionals on cultural and linguistic competency, cultural humility, and implicit bias.
- Develop cultural competency and language access plans. State government leadership should work closely with partners to develop and implement cultural competency and language access plans to deliver multilingual and community-tailored delivery of programs, services, and resources.
- Develop a plan for future emergency response efforts. The plan should ensure the rapid mobilization of communities of color during emergency responses to mitigate the adverse and disparate impact on Ohioans of color.
Ohio by the numbers
13%: Black population
22.8%: COVID-19 cases involving Black people
82%: White population
53.1% COVID-19 cases involving white people
4% Hispanic population
6.3% COVID-19 cases in involving Hispanic people
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