The coronavirus pandemic is cracking open many of the fissures that structural violence generates in our society. Structural violence refers to the economic, political, medical, social and legal systems that perpetuate inequity and negatively affect communities. It is not a term we often hear outside the public health realm. However, with the global pandemic we are now fighting, it is an important issue to explore and address going forward.
Structural violence creates social structures that manifest in racism and poverty, as well as housing, education and gender inequality, which results in complex and overlapping factors that influence health outcomes. With COVID-19, the unfortunate reality is that recent statistics show poor U.S. citizens of color have higher than expected death rates from infection.
People affected by structural violence, whose health and well-being are influenced by adverse social determinants, are more likely to:
- live in crowded homes they do not own
- be homeless
- not own a car and be dependent on crowded public transportation
- work low wage jobs in the food or manufacturing sectors
- lack health insurance
- lack access to healthy foods and regular physical activity
- be unable to afford missing a single paycheck
All of these factors put them at greater risk for COVID-19 infection. Frequent hand washing and social distancing become distinctly more challenging in many of these circumstances.
According to the 2019 Connecticut Children’s Community Health Needs Assessment, more than 30% of Hartford residents live in poverty. In addition, the Assessment notes that residents and community leaders identified poverty, food insecurity, a lack of transportation, housing affordability, and housing quality as issues of highest concern.
Read additional blogs from Connecticut Children’s Office for Community Child Health related to COVID-19.
Let’s take a closer look at one of these identified needs and how it exacerbates COVID-19 – food insecurity. Good food is critical for good health, and access and affordability of adequate healthy foods and beverages has been a significant issue for Hartford residents. According to Foodshare, one in seven children in Hartford live in food insecure households. People living in poverty have higher rates of obesity, as well as heart disease, hypertension, poorly controlled asthma, and diabetes, all of which are underlying risk factors for worse outcomes from a COVID-19 infection. Recent studies from the University of Connecticut show that approximately 16% of Hartford preschoolers and 27% of Hartford adults have obesity and that diagnosis predisposes them to the above co-morbidities and to worse overall health.
In Hartford County, as of this writing, 3,351 patients have been diagnosed with COVID-19, and 295 of them have died, a death rate of 8.8%, which is higher than the average death rate from this infection. Early COVID-19 data emerging from New York City shows that along with advanced age, obesity with its associated chronic inflammatory state is a significant “chronic” risk factor for severe illness, hospitalization, and poor outcomes from the disease. Recently published predictive models show that by 2030, half of all adults in the U.S. will have obesity, and nearly a quarter will have severe obesity, with large disparities across states and demographic groups. Non-Hispanic black and low-income adults were among the groups with the highest predicted rates.
The current coronavirus pandemic will end, and in its wake, we must seize the opportunity to make major structural societal changes. Among those changes should be improvements to the food system that eliminates disparities in access to and affordability of healthy food choices for all families. The Kohl’s Start Childhood Off Right program at Connecticut Children’s is working in collaboration with the Hartford Childhood Wellness Alliance toward that goal. We must all work together to end the structural violence that leads to chronic conditions such as obesity and puts residents at greater risk for infection and death with COVID-19.
Read additional blogs from Dr. Nancy Trout here.
Nancy Trout, MD, MPH is a primary care pediatrician and co-director of Kohl’s Start Childhood Off Right, which is a childhood obesity prevention initiative of Connecticut Children’s Office for Community Child Health.
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