Health Inequity and the Unfair Impact of the COVID-19 Pandemic on Essential Workers

The COVID-19 pandemic has laid bare our country's widespread economic and health disparities- most acutely in large, urban cities. Decades of systemic and institutional racism in policies and practices, such as redlining and biased lending policies, perpetuate inequity, leaving communities of color, specifically Black and Latino communities, vulnerable to worse health outcomes. In New York City (NYC), Black and Latino individuals are approximately twice as likely to be hospitalized and die of COVID-19 as White individuals.1 Although underlying health conditions contribute to these higher COVID-19 morbidity and mortality rates, individuals from Black and Latino communities are also more likely to be essential workers, limiting their ability to physically distance and increasing their exposure risks. Recent work supports the concept that exposure opportunity is driving racial/ethnic disparities in COVID-19 outcomes. Black and Latino individuals are overrepresented in food- and customer service-oriented occupations and must put themselves at risk for their personal job and financial security and to keep the economy going by providing critical services. In NYC during the initial months of the pandemic, data gathered by the NYC Department of Health and Mental Hygiene showed that 26% of Black and 22% of Latino adults reported exclusively working from home, compared with 44% of White New Yorkers. Black and Latino New Yorkers were also more likely to use public transportation than were Asian/Pacific Islander and White adults during the peak of the pandemic (New York City Health Opinion Poll [NYC HOP] wave 7, fielded from March 26-March 31,2020, unpublished). Furthermore, at a national level, Black and Latino individuals are more likely to live in multigenerational households. Thus, their continued exposure because of their essential work roles placed both individuals and their families and loved ones at increased risk of infection. These structural risk factors leave essential workers, and the communities of color they are part of, unfairly vulnerable to COVID-19.