Hostname: page-component-76fb5796d-22dnz Total loading time: 0 Render date: 2024-04-25T20:42:22.527Z Has data issue: false hasContentIssue false
  • English
  • Français

Concepts and Terms for Addressing Disparities in Public Health Emergencies: Accounting for the COVID-19 Pandemic and the Social Determinants of Health in the United States

Published online by Cambridge University Press:  08 June 2021

Cheryl A. Levine  and
Daire R. Jansson Open the ORCID record for Daire R. Jansson [Opens in a new window]
Cheryl A. Levine*
Affiliation:
Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Washington, DC, USA
Daire R. Jansson
Affiliation:
University of Tennessee, Knoxville, Tennessee, USA
*
Corresponding author: Cheryl A. Levine, Email: cheryl.levine@hhs.gov
Get access Rights & Permissions [Opens in a new window]

Abstract

Public health emergencies, including the coronavirus disease 2019 (COVID-19) pandemic, highlight disproportionate impacts faced by populations with existing disparities. Concepts and terms used to describe populations disproportionately impacted in emergencies vary over time and across disciplines, but United States (US) federal guidance and law require equal access to our nation’s emergency resources. At all levels of emergency planning, public health and their partners must be accountable to populations with existing inequities, which requires a conceptual shift toward using the data-driven social determinants of health (SDOH). SDOH are conditions in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality of life outcomes and risks. This article reviews the historic use of concepts and terms to describe populations disproportionately impacted by emergencies. It also recommends a shift in emergency activities toward interventions that target the SDOH to adequately address long-standing systemic health disparities and socioeconomic inequities in the United States.

Keywords

social determinants of healthhealth status disparities
Type
Concepts in Disaster Medicine
Information
Disaster Medicine and Public Health Preparedness , Volume 16 , Issue 6 , December 2022 , pp. 2627 - 2633
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Haffajee, R, Parmet, WE, Mello, MM. What is a public health “emergency”? N Engl J Med. 2014;371:986-988.CrossRefGoogle ScholarPubMed
National Alliance to Impact the Social Determinants of Health. Public health’s unique role in addressing both social needs and social determinants of health. 2020. https://www.nasdoh.org/wp-content/uploads/2020/09/NASDOH_Public-Health-Social-Need_v4.pdf. Accessed January 21, 2021.Google Scholar
Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care , Board on Health Policy, Institute of Medicine. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press; 2003. https://www.nap.edu/catalog/12875/unequal-treatment-confronting-racial-and-ethnic-disparities-in-health-care. Accessed December 16, 2020.Google Scholar
US Department of Health and Human Services. Healthy people 2030: social determinants of health. https://health.gov/healthypeople/objectives-and-data/social-determinants-health. Accessed December 14, 2020.Google Scholar
Cardona, O. The need for rethinking the concepts of vulnerability and risk from a holistic perspective: a necessary review and criticism for effective risk management. In: Bankoff G, Frerks G, Hilhorst D, eds. Mapping Vulnerability. Disasters, Development and People. London: Earthscan Publishers; 2003.Google Scholar
Moore, S, Daniel, M, Linnan, L, et al. After Hurricane Floyd passed: investigating the social determinants of disaster preparedness and recovery. Fam Community Health. 2004;27(3):204-217.CrossRefGoogle ScholarPubMed
Davis, JR, Wilson, S, Brock-Martin, A, et al. The impact of disasters on populations with health and health care disparities. Disaster Med Public Health Prep. 2010;4(1):30-38.CrossRefGoogle ScholarPubMed
Braveman, P, Gottlieb, L. The social determinants of health: it’s time to consider the causes of the causes. Public Health Rep. 2014;129 Suppl 2(Suppl 2):19-31.CrossRefGoogle Scholar
Laska, S, Morrow, BH. Social vulnerabilities and Hurricane Katrina: an unnatural disaster in New Orleans. Mar Technol Soc J. 2006;40(4):16-26.CrossRefGoogle Scholar
Cybersecurity and Infrastructure Security Agency, US Department of Homeland Security. Guidance on the essential critical infrastructure workers. Washington, DC: US Department of Homeland Security; December 16, 2020. https://www.cisa.gov/publication/guidance-essential-critical-infrastructure-workforce. Accessed April 14, 2021.Google Scholar
The Lancet. Editorial: the plight of essential workers during the COVID-19 pandemic. Lancet. 2020;395(10237):1587.CrossRefGoogle Scholar
Quiñones, AR, Botoseneanu, A, Markwardt, S, et al. Racial/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults. PLoS One. 2019;14(6):e0218462.Google ScholarPubMed
Clark, A, Jit, M, Warren-Gash, C, et al. Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study. Lancet Glob Health. 2020;8(8):e1003-e1017.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. Health equity considerations and racial and ethnic minority groups. July 24, 2020; https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fracial-ethnic-minorities.html. Accessed December 14, 2020.Google Scholar
Tai, DBG, Shah, A, Doubeni, CA, et al. The disproportionate impact of COVID-19 on racial and ethnic minorities in the United States. Clin Infect Dis. 2021;72(4):703-706.CrossRefGoogle ScholarPubMed
Patel, SS, Rogers, MB, Amlôt, R, et al. What do we mean by ‘community resilience’? A systematic literature review of how it is defined in the literature. PLoS Curr Disasters. 2017;9:ecurrents.dis.db775aff25efc5ac4f0660ad9c9f7db2.Google Scholar
O’Keefe, P, Westgate, K, Wisner, B. Taking the naturalness out of natural disasters. Nature. 1976;260(5552):566-567.CrossRefGoogle Scholar
Blaikie, P, Cannon, T, Davis, I, et al. At Risk: Natural Hazards, People’s Vulnerability and Disasters. 2nd ed. London, UK: Routledge; 2004.Google Scholar
Tierney, K. The Social Roots of Risk: Producing Disasters, Promoting Resilience. Stanford: Stanford University Press; 2014.Google Scholar
Agency for Toxic Substances and Disease Registry , Centers for Disease Control and Prevention. CDC’s Social Vulnerability Index: a tool to identify socially vulnerable communities. 2018; https://www.atsdr.cdc.gov/placeandhealth/svi/index.html. Accessed December 14, 2020.Google Scholar
Nick, GA, Savoia, E, Elqura, L, et al. Emergency preparedness for vulnerable populations: people with special health-care needs. Public Health Rep. 2009;124(2):338-343.CrossRefGoogle ScholarPubMed
Crocker, AF, Smith, SN. Person-first language: are we practicing what we preach? J Multidiscip Healthc. 2019;12:125-129.Google ScholarPubMed
US Department of Justice. Federal agencies issue joint guidance to help emergency preparedness, response and recovery providers comply with Title VI of the Civil Rights Act. August 16, 2016. https://www.justice.gov/opa/pr/federal-agencies-issue-joint-guidance-help-emergency-preparedness-response-and-recovery. Accessed December 14, 2020.Google Scholar
Federal Emergency Management Agency, US Department of Homeland Security. A whole community approach to emergency management: principles, themes, and pathways for action. Washington, DC: US Department of Homeland Security; December 2011. https://www.fema.gov/media-library-data/20130726-1813-25045-0649/whole_community_dec2011__2_.pdf. Accessed December 16, 2020.Google Scholar
Govinfo.gov. Executive Order 13347 - Individuals With Disabilities in Emergency Preparedness. Federal Register. July 26, 2004;69(142):44573-44574. https://www.govinfo.gov/content/pkg/FR-2004-07-26/pdf/04-17150.pdf. Accessed December 15, 2020.Google Scholar
Govinfo.gov. Executive Order 13166 - Improving Access to Services for Persons With Limited English Proficiency. Federal Register. August 16, 2000;65(159):50121-50122. https://www.govinfo.gov/content/pkg/FR-2000-08-16/pdf/00-20938.pdf. Accessed June 18, 2021.Google Scholar
Govinfo.gov. Civil Rights Act of 1964. Public Law 88-352-July 2, 1964. 78 Stat. 241.Google Scholar
Govinfo.gov. Rehabilitation Act of 1973. Public Law 93-112-September 26, 1973. 87 Stat. 355, 29 U.S.C. § 701.Google Scholar
Govinfo.gov. Americans with Disabilities Act of 1990. Public Law 101-336-July 26, 1990. 42 U.S.C. § 12101.Google Scholar
Droste, M. What are “Protected Classes”? SubscriptLaw June 22, 2020. https://subscriptlaw.com/protected-classes/. Accessed April 14, 2021.Google Scholar
Office for Civil Rights , US Department of Health and Human Services. Civil rights and COVID-19. https://www.hhs.gov/civil-rights/for-providers/civil-rights-covid19/index.html. Accessed April 14, 2021.Google Scholar
Taylor, BC. The development of emergency planning for people with disabilities though ADA litigation. Oakland, CA: Pacific ADA Center; 2018. https://www.adapacific.org/assets/documents/emergency-preparedness-litigation-legal-brief-2-2018.pdf. Accessed December 16, 2020.Google Scholar
Rutkow, L, Vernick, J, Hodge, J. The potential implications of CALIF v. City of Los Angeles for mental and behavioral health preparedness. August 22, 2011. https://www.jhsph.edu/research/centers-and-institutes/center-for-law-and-the-publics-health/research/CDC_PERRC_Project4Tool1_Los_AngelesADA.pdf. Accessed December 15, 2020.Google Scholar
Hoffman, S. Preparing for disaster: protecting the most vulnerable in emergencies. UC Davis Law Review. 2009;42:1491-1547. https://lawreview.law.ucdavis.edu/issues/42/5/articles/42-5_Hoffman.pdf.Google Scholar
Office of the Assistant Secretary for Preparedness and Response. Access and functional needs: guidance on integrating people with access and functional needs into disaster preparedness planning for states and local governments. https://www.phe.gov/Preparedness/planning/abc/Pages/afn-guidance.aspx. Accessed December 15, 2020.Google Scholar
US Department of Transportation, Federal Highway Administration. Annex 2: legislation, regulations, and policy - disaster preparedness in Federal legislation, regulations, policy. https://ops.fhwa.dot.gov/publications/fhwahop09022/sna2_legislation.htm. Accessed December 14, 2020.Google Scholar
US Department of Homeland Security. About DHS. https://www.dhs.gov/about-dhs. Accessed December 14, 2020.Google Scholar
US Department of Homeland Security. National response plan. Washington, DC: US Department of Homeland Security; December 2004. https://www.hsdl.org/?view&did=450766. Accessed December 14, 2020.Google Scholar
Kailes, J. defining functional needs – updating CMIST. 2017. https://disasterstrategies.org/blog-post/defining-functional-needs-updating-cmist-by-june-isaacson-kailes-disability-policy-consultant/. Accessed December 14, 2020.Google Scholar
Gernsbacher, MA, Raimond, AR, Balinghasay, MT, et al. “Special needs” is an ineffective euphemism. Cogn Res Princ Implic. 2016;1(1):29.Google ScholarPubMed
US Department of Homeland Security. National response framework. 1st ed. Washington, DC: US Department of Homeland Security. 2008. https://www.fema.gov/pdf/emergency/nrf/nrf-core.pdf. Accessed December 14, 2020.Google Scholar
US Department of Homeland Security. National response framework. 2nd ed. Washington, DC: US Department of Homeland Security. May 2013. https://www.hsdl.org/?view&did=735934. Accessed December 14, 2020.Google Scholar
Office of the Assistant Secretary for Preparedness and Response. HHS/ASPR: access and functional needs web-based training. 2019. https://www.train.org/illinois/admin/course/1083869/. Accessed December 14, 2020.Google Scholar
US Department of Homeland Security. Instruction manual 262-12-001-01. DHS lexicon terms and definitions. Revision 2. Washington, DC: US Department of Homeland Security; October 16, 2017. https://www.dhs.gov/sites/default/files/publications/18_0116_MGMT_DHS-Lexicon.pdf. Accessed December 16, 2020.Google Scholar
US Department of Homeland Security. National response framework. 3rd ed. Washington, DC: US Department of Homeland Security. June 2016. https://www.hsdl.org/?view&did=793551. Accessed December 14, 2020.Google Scholar
US Department of Homeland Security. National response framework. 4th ed. Washington, DC: US Department of Homeland Security. October 28, 2019. https://www.fema.gov/media-library-data/1582825590194-2f000855d442fc3c9f18547d1468990d/NRF_FINALApproved_508_2011028v1040.pdf. Accessed December 14, 2020.Google Scholar
US Department of Homeland Security. National disaster recovery framework. 2nd ed. Washington, DC: US Department of Homeland Security. June 2016. https://www.fema.gov/media-library-data/1466014998123-4bec8550930f774269e0c5968b120ba2/National_Disaster_Recovery_Framework2nd.pdf. Accessed December 14, 2020.Google Scholar
US Department of Health and Human Services. Emergency preparedness and response. https://www.hhs.gov/programs/emergency-preparedness/index.html. Accessed December 14, 2020.Google Scholar
Office of the Assistant Secretary for Preparedness and Response. Pandemic and all hazards preparedness act. https://www.phe.gov/Preparedness/legal/pahpa/Pages/default.aspx. Accessed December 16, 2020.Google Scholar
Pandemic and All-Hazards Preparedness Act. Public Law No: 109-417, STAT. 2831 (2006). https://www.congress.gov/bill/109th-congress/senate-bill/3678/text.Google Scholar
Office of the Assistant Secretary for Preparedness and Response. Progress report on the implementation of provisions addressing at-risk individuals. Washington DC: Office of the Assistant Secretary for Preparedness and Response. August 2008. https://www.phe.gov/Preparedness/legal/pahpa/Documents/PAHPAat-risk-reportcongress090108.pdf. Accessed December 14, 2020.Google Scholar
Govinfo.gov. Pandemic and All-Hazards Preparedness Reauthorization Act (PAHPRA). 127 STAT. 161 (2013). https://www.govinfo.gov/content/pkg/PLAW-113publ5/pdf/PLAW-113publ5.pdf.Google Scholar
Congress.gov. Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAIA). 133 STAT. 905 (2019). https://www.congress.gov/116/plaws/publ22/PLAW-116publ22.pdf.Google Scholar
Kailes, JI, Enders, A. Moving beyond “special needs”: a function-based framework for emergency management and planning. J Disabil Policy Stud. 2007;17(4):230-237.CrossRefGoogle Scholar
Office of the Assistant Secretary for Preparedness and Response. At-risk individuals with access and functional needs. https://www.phe.gov/Preparedness/planning/abc/Pages/at-risk.aspx. Accessed December 16, 2020.Google Scholar
National Association of County and City Health Officials, Association of State and Territorial Health Officials. Capacity-building toolkit for including aging & disability networks in emergency planning. Washington, DC. 2019. https://www.naccho.org/uploads/downloadable-resources/NACCHO_Aging-and-Functional-Needs-Planning-FINAL.pdf. Accessed December 16, 2020.Google Scholar
Office of the Assistant Secretary for Preparedness and Response. Community resilience. https://www.phe.gov/Preparedness/planning/abc/Pages/community-resilience.aspx. Accessed April 14, 2021.Google Scholar
Wulff, K, Donato, D, Lurie, N. What is health resilience and how can we build it? Annu Rev Public Health. 2015;36:361-374.CrossRefGoogle ScholarPubMed
Sherrieb, K, Norris, FH, Galea, S. Measuring capacities for community resilience. Soc Indic Res. 2010;99(2):227-247.CrossRefGoogle Scholar
Cohen, O, Leykin, D, Lahad, M, et al. The conjoint community resiliency assessment measure as a baseline for profiling and predicting community resilience for emergencies. Technol Forecast Soc Change. 2013;80(9):1732-1741.CrossRefGoogle Scholar
Leykin, D, Lahad, M, Cohen, O, et al. Conjoint Community Resiliency Assessment Measure-28/10 Items (CCRAM28 and CCRAM10): a self-report tool for assessing community resilience. Am J Community Psychol. 2013;52(3-4):313-323.CrossRefGoogle ScholarPubMed
Rapaport, C, Hornik-Lurie, T, Cohen, O, et al. The relationship between community type and community resilience. Int J Disaster Risk Reduct. 2018;31:470-477.CrossRefGoogle Scholar
National Academies of Sciences, Engineering, and Medicine. Building and measuring community resilience: actions for communities and the Gulf Research Program. Washington, DC: The National Academies Press. 2019. https://www.nap.edu/catalog/25383/building-and-measuring-community-resilience-actions-for-communities-and-the. Accessed April 14, 2021.Google Scholar
Clark-Ginsberg, A, McCaul, B, Bremaud, I, et al. Practitioner approaches to measuring community resilience: the analysis of the resilience of communities to disasters toolkit. Int J Disaster Risk Reduct. 2020;50:101714.CrossRefGoogle ScholarPubMed
Bolin, B. Race, class, ethnicity, and disaster vulnerability. In: Rodríguez H, Quarantelli EL, Dynes RR, eds. Handbook of Disaster Research. Handbooks of Sociology and Social Research. New York, NY: Springer; 2007:113-129.Google Scholar
Collins, TW, Jimenez, AM, Grineski, SE. Hispanic health disparities after a flood disaster: results of a population-based survey of individuals experiencing home site damage in El Paso (Texas, USA). J Immigr Minor Health. 2013;15(2):415-426.CrossRefGoogle Scholar
Davidson, TM, Price, M, McCauley, JL, et al. Disaster impact across cultural groups: comparison of Whites, African Americans, and Latinos. Am J Community Psychol. 2013;52(1-2):97-105.CrossRefGoogle ScholarPubMed
Lichtveld, M. Disasters through the lens of disparities: elevate community resilience as an essential public health service. Am J Public Health. 2018;108(1):28-30.CrossRefGoogle ScholarPubMed
Braveman, P, Egerter, S, Williams, DR. The social determinants of health: coming of age. Annu Rev Public Health. 2011;32(1):381-398.CrossRefGoogle ScholarPubMed
Delahoy, MJ, Whitaker, M, O’Halloran, A, et al. Characteristics and maternal and birth outcomes of hospitalized pregnant women with laboratory-confirmed COVID-19 - COVID-NET, 13 States, March 1-August 22, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(38):1347-1354.Google ScholarPubMed
Centers for Disease Control and Prevention. CDC Research on SDOH. https://www.cdc.gov/socialdeterminants/research.html?Sort=Article%20Date%3A%3Adesc. Accessed December 14, 2020.Google Scholar
Phibbs, S, Kenney, C, Severinsen, C, et al. Synergising public health concepts with the Sendai Framework for Disaster Risk Reduction: a conceptual glossary. Int J Environ Res Public Health. 2016;13(12):1241.CrossRefGoogle ScholarPubMed
United States Census Bureau. Community resilience estimates. 2020. https://www.census.gov/data/experimental-data-products/community-resilience-estimates.html. Accessed January 21, 2021.Google Scholar