Hager ER, Quigg AM, Black MM, Coleman SM, Heeren T, Rose-Jacobs R, et al. Furthermore, the sample size differed across the locations on the basis of the proportion of families enrolled in the Brighter Bites program. Addressing the social determinants of health has been highlighted by the U.S. government’s Healthy People 2020 initiative, National Partnership for Action to End Health Disparities, and National Prevention and Health Promotion Strategy as being integral to improving health for all. Low-income racial/ethnic minority populations, predominantly Hispanic and African American populations, are struggling with an increased risk of COVID-19 infection and COVID-19–related complications and mortality (19–22). Food insecurity. Author Affiliations: 1Department of Epidemiology, Human Genetics and Environmental Sciences, Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas. I’m worried about my children’s food and about work. Hunger in America 2014: national report. Fear of going out (eg, stores) because of COVID-19. Updated July 24, 2020. I hope this is over fast. US Department of Labor. Accessed August 27, 2020. I worry that I get sick since I’m pregnant. Seligman et al posited a conceptual framework for the relationships among financial stress, food insecurity, and health (26). Food is running out for my children, I have no work, no money, I don’t even qualify for the check that Mr. Donald Trump is sending out. This variation among individuals and groups due to income is referred to as the "social gradient. Determinant One: Low Income. Dunn CG, Kenney E, Fleischhacker SE, Bleich SN. Significance was set at P <.05 for all tests. As of September 2020, the United States is the epicenter of the pandemic, with more than 6.3 million confirmed cases and more than 189,000 fatalities (2). To better understand the ongoing needs of families and provide critical services during the pandemic, Brighter Bites conducted a rapid-response survey in April 2020 in 4 locations (Houston, Dallas, Washington, DC, and Southwest Florida) among participating families. Concern about having to work with no personal protective equipment. My biggest worry is that this virus last for months since I work in a restaurant, and my savings are drying up day by day. 2Department of Health Promotion and Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center, Austin Regional Campus, Austin, Texas. All Rights Reserved. A smaller proportion of African American respondents than respondents in other racial/ethnic groups were concerned about being infected with COVID-19 themselves (38.7%) and about their child being infected (39.3%) (P < .001). A lot of people go to the supermarkets, Walmart, H.E.B, Fiesta, among others without masks, latex gloves and at the entrance of these establishments, nobody says anything to them, they also touch products and the carts without gloves and many parents take their kids to the supermarket. The Atlantic. N Engl J Med 2020;382(18):e40. ORIGINAL RESEARCH — Volume 17 — October 1, 2020. You will be subject to the destination website's privacy policy when you follow the link. Inequities exist in social and structural factors, such as access to food, employment, transportation, housing, poverty, education, and health literacy (24). Pandemic-EBT (P-EBT) due to COVID-19. Currently he is working in the areas of health inequalities, marginalization, political advocacy, health policy, and the social determinants of health… They refer to conditions that influence health outcomes, such as income, housing, food, transportation, race, and ethnicity. Similarly, concerns about disruption of employment and financial hardship identified such acute problems as inability to pay rent or bills. Planners4Health offers a... Good public health comes about through good planning, a lesson community members in Umatilla County, Oregon, have taken to heart with an initiative that combines both outlooks. When we stratified results by race/ethnicity, a significantly greater proportion of African American (64.9%) and Non-Hispanic White (63.2%) respondents, compared with Hispanic respondents or in the “other” racial/ethnic group, was concerned about affordability of food (P = .009). Social determinants of health (SDOH) external icon are conditions in the places where people live, learn, work, and play that affect a wide range of health and … g Stratified analysis showed significant differences (P < .05) in sociodemographic variables by city. A greater proportion in Houston and Washington, DC, than in the other 2 locations received Medicaid or CHIP (P < .001), whereas a smaller proportion of children in Dallas than in the other 3 locations participated in free or reduced-price meals programs (P = .04). Strategies to support meals for children, such as expanding and supporting enrollment in government assistance programs (eg, Pandemic-EBT), distribution of food for pick-up through schools, and other policy strategies should be considered (27,28). Breastfeeding is an issue of health equity. The role of housing as a social determinant of health is well-established, but the causal pathways are poorly understood beyond the direct effects of physical housing defects. Accessed August 27, 2020. Medicaid benefi-ciaries are low-income by definition, and one-half of all Medicare beneficiaries had incomes below US$26,000 in 2016.6 Both groups are, therefore, key target populations for addressing social needs. Income inequity is related to the rates of poorer health in a number of areas, from alcohol-attributable hospitalisations and deaths, to child health, to oral health. The major social determinants affecting the under 5 years' mortality and morbidity include poverty, malnutrition, inequity, lack of education, failure to implement the … Sociodemographic characteristics. 3Brighter Bites, Houston, Texas. COVID-19 and racial/ethnic disparities. Levitt L, Schwartz K, Lopez E. Estimated cost of treating the uninsured hospitalized with COVID-19. Check out the following blogs to learn more about other social determinants of health: Tags:IncomeSDHsocial determinants of health. When asked about the effect of COVID-19 on fruit and vegetable consumption, 41.4% of families reported a decrease in intake of fruits and vegetables because of COVID-19; we found no significant differences by race/ethnicity in this response (Table 2). Prev Med 2016;91:8–17. More than 80% of survey respondents were familiar with COVID-19 and were concerned about infection. Two trained coders independently coded the comments by using an open coding method in Microsoft Word to establish initial coding themes and subthemes. e Stratified analysis showed significant differences (P < .05) in sociodemographic variables by city. https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity. The survey also asked if, because of COVID-19, their consumption of fruits and vegetables had increased, decreased, or stayed the same. Government and community agencies must have a role in developing short- and long-term strategies to address the needs of our most vulnerable and underserved populations. Published April 7, 2020. At the time the survey was conducted, all 4 locations were under shelter-in-place orders, which included social distancing, school closures, and suspension of all nonessential services. Worry/fear of future financial challenges. d Fisher exact test. Response options were on a 4-point Likert-type scale ranging from strongly disagree to strongly agree. The overall survey response rate was 6.4% (1,048 of 16,436). The funder/sponsor did not participate in the work. e χ2 test. 4Department of Health Promotion and Behavioral Sciences. Four response options ranged from “nothing at all” to “a great deal.” The survey also asked about respondents’ perceived concern for themselves and their children in contracting COVID-19. Improving fruit and vegetable consumption: use of farm-to-consumer venues among US adults. Because a lot of people already have the flu. APA’s widely successful Plan4Health program will continue to promote planning for healthy communities and chronic disease prevention in 2017 with Planners4Health. Collectively, all themes stemmed from fear of contracting COVID-19. In addition, respondents were concerned about limited produce at various food stores, spiked produce prices, and the finances required to purchase food for their families. f 1-way analysis of variance. https://www.theatlantic.com/family/archive/2020/04/two-pandemics-us-coronavirus-inequality/609622. The program, which uses a school co-op concept, is disseminated in Southwest Florida and 5 US cities: Houston, Austin, Dallas, New York City, and Washington, DC. The social determinants of health in poverty describe the factors that affect impoverished populations' health and health inequality. Introduction Tobacco smoking is a leading cause of premature death and disability, and over 80% of the world's smokers live in low- or middle-income countries. I am the only financial support for my family, so if anything happened to me, I don’t know what would happen to my loved ones. Understanding the social needs of our most vulnerable families with children is critical because of the health disparities associated with COVID-19 prevention and treatment (18). Pediatrics 2010;126(1):e26–32. Quantitative data analysis. Moreover, a smaller proportion of Hispanic respondents (6.3%) than African American (23.0%), Non-Hispanic White (15.8%), or “other” (17.1%) racial ethnic groups was concerned with access to childcare (P < .001) (Table 2). HOUSING FACILITY; Provision of housing facility is a direct relationship to the determinant of health. Four themes emerged from the analysis of write-in responses to the question about immediate concerns during the COVID-19 pandemic (Table 3): 1) fear of contracting COVID-19, 2) disruption of employment status, 3) financial hardship, and 4) exacerbated food insecurity. Inequalities in health stem from the conditions of people's lives, including living conditions, work environment, age, and other social factors, and how these affect people's ability to respond to illness. My worry is that my husband can lose his job due to the pandemic that we’re going through. Published April 10, 2020. My worry is that this won’t end and we won’t be able to take care of our kids. On average, 25.1% and 28.2% of families reported receiving WIC or SNAP, respectively. The survey asked families enrolled in a coordinated school-based nutrition program about their social needs, COVID-19–related concerns, food insecurity, and diet-related behaviors during the pandemic. A small proportion of respondents expressed concern about reliable transportation (6.4%) and childcare (8.2%). Brighter Bites is a nonprofit, evidence-based school health program that distributes fresh produce weekly to low-income families and provides nutrition education in school and for parents (10,11). I feel worried because I’m not giving enough vegetables and fruit to my children since my husband only works 3 days, and I’m not working because my baby was just born, so there are 4 children and 2 adults and I’m short of food and diapers for my baby, but what I need is food for the family. https://www.kff.org/coronavirus-covid-19/issue-brief/estimated-cost-of-treating-the-uninsured-hospitalized-with-covid-19. The survey provided a checklist for these 8 items, and respondents could check all that applied. My biggest worry is getting sick, or that my kids get sick, or ending up without food or money to pay the bills. In light of these concerns, Brighter Bites has partnered with other nonprofit organizations to provide masks for families at many of their food distribution locations. That we don’t have work and can’t pay the rent and bills, and that this ends up with my kids having no place to live. ICD-10-CM coding options include: Z59.5 extreme poverty; Z59.6 low income World Health Organization. Social determinants of health may influence the burden of disease on global health in many ways. b Number is the total number of survey responses received overall and in each city. Accessed September 10, 2020. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. We collated and analyzed responses to the open-ended question, “Please share your greatest concern at this time, or any other thoughts you would like to share with us.” We used thematic analysis to analyze the survey data by using an inductive approach in which we derived codes and themes on the basis of the content from the survey data (16,17). [A tabular version of this figure is also available.]. Moreover, in fall 2019 only 3.2% reported shopping at a food bank or food pantry or at other distributions at least once per week, where 13.4% reported shopping at these food outlets at least once per week in April 2020 (P < .001). Income poverty (due to unemployment, low wages, or lack of education) can lead to household food insecurity, inadequate care, “unhealthy household environment, and lack of health services.”(2) People of low socioeconomic status are most vulnerable to food insecurity since purchasing power serves as a main determinant of the ability-to-afford nutritional food sources. This general scarcity was attributed to a lack of availability and affordability and less frequent grocery shopping because of presumed store closures or fear of contracting COVID-19. The survey asked respondents how much they had seen or heard about COVID-19. Health Aff (Millwood) 2020;39(6):927–35. The parent or another adult in the family used the 2-item Hunger Vital Sign screening questionnaire developed and validated by Hager et al (13) to report household food security status during the COVID-19 pandemic. Response was voluntary. Also, the changes we observed in food insecurity, eating out, and food shopping practices could be attributed to other policy, systems, or environmental factors unrelated to COVID-19. As indicated in subthemes and comments, many respondents were concerned about contracting COVID-19 themselves or concerned about a family member contracting COVID-19. Summary of Datasets with Social Determinants of Health Indicators across New York State. Our qualitative assessment also demonstrated that although most respondents reported following safety guidelines, some expressed fear of becoming infected in public spaces. We should stay home. One subtheme was lack of personal protective equipment among family members working in a high-risk environment. The U.S. spends less than other countries on non-health social services, but much more on health Click To Tweet. Sharma S, Marshall A, Chow J, Ranjit N, Bounds G, Hearne K, et al. Accessed August 27, 2020. Whitby B, Fitzpatrick K. Survey shows regions of elevated food insecurity due to COVID-19 pandemic. Thousand Oaks (CA): Sage Publications, Inc; 1998. Measuring Social Determinants of Health among Low Income Populations Early Insights from State Initi This webinar, made by possible by The Commonwealth Fund, explored emerging state-level approaches to measuring SDOH among beneficiaries of publicly financed care. Frequency of grocery shopping decreased and food pantry usage increased. Coronavirus resource center COVID-19 map. My biggest concern is about my husband who is working picking tomatoes and he says that a lot of the workers aren’t being as careful as they should about coronavirus and that the bosses don’t care about them. Pinker J. We obtained further insights into the needs and concerns of survey respondents in the qualitative comments, which identified 4 themes: fear of contracting COVID-19, unemployment, financial hardship, and food insecurity. These differences, however, were small. Kaiser Family Foundation. We used the χ2 test or Fisher exact test and 1-way analysis of variance to compute differences in responses by city and race/ethnicity. Accessed August 27, 2020. We’re just worried about having a better standard of living than right now. Updated August 16, 2017. The survey was administered electronically in April 2020 to 16,436 Brighter Bites families who were enrolled in the program during the 2019–2020 school year. Qualitative assessment identified 4 main themes: 1) fear of contracting COVID-19, 2) disruption of employment status, 3) financial hardship, and 4) exacerbated food insecurity. Fear of returning to normalcy after COVID-19. Taking necessary preventive measurements for family at home to avoid contracting COVID-19. Prev Chronic Dis 2020;17:200322. No copyrighted materials were used in this article. Children growing up in more deprived areas often suffer disadvantages throughout their lives, from educational attainment through to employment prospects, which in turn affe… Moreover, we conducted the qualitative analysis to help contextualize the quantitative findings, and these analyses indicated COVID-19–related shifts in food-related practices and behaviors among respondents. There’s no work, no money and bills don’t offer forgiveness. They suggested that the combination of stress (resulting from unemployment and financial hardship) and poor nutrition can challenge disease prevention and management because these stressors strain the household budget, leaving little money for healthy foods and resulting in disordered eating (ie, consumption of unhealthy processed, nutrient-deficient foods), and increased medical care resulting in spending trade-offs (26). Little is known about the social needs of low-income households with children during the coronavirus-2019 (COVID-19) pandemic. Concern about increased prices of food in stores. We computed means, standard deviations, and frequency distributions overall and stratified by race/ethnicity. Overall, the demographic characteristics of respondents did not vary substantially by site (Table 1). Precarity is an important social determinant of health with demonstrated physical and mental health consequences, which affects people in low-income, middle-income and high-income contexts. Brighter Bites distributed the survey electronically in April 2020 in English and Spanish via Formsite (Vroman Systems, Inc) to 16,436 Brighter Bites families (56.9% in Houston, 29.2% in Dallas, 7.8% in the District of Columbia, and 6.1% in Southwest Florida) who were enrolled in the program during the 2019–2020 school year and provided their telephone number in fall 2019. Moreover, our study provides insight into these needs during the pandemic’s acute phase, when all 4 cities in the study sample were under shelter-in-place orders. That they close all the stores where you can find food. For low-income, vulnerable households there are particular challenges in creating a sense of home in a new tenancy which may have substantial effects on health and wellbeing. However, this issue has many layers. The 30-item self-report survey took approximately 10 minutes to complete. October 18, 2016 4:19 PMCategory: Health Equity, by Matt Makara - MPH, Program Manager, Affiliate Affairs, American Public Health Association, Income can influence many aspects of a person’s life, including their health, where they live and the education that they receive. Social Determinants of Health-Related Needs During COVID-19 Among Low-Income Households With Children Our study highlights the compounding effect of the COVID-19 pandemic on households with children across the spectrum of social needs. https://cancercontrol.cancer.gov/brp/hbrb/flashe.html. All changes were significant at P < .001, except for shopping at a farmers market/food co-op/farm stand ≥1 time per week (P= .31). CDC twenty four seven. We obtained informed consent from all respondents, and one parent or adult per family completed the survey. Program options were the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Supplemental Nutrition Assistance Program (SNAP), Double Dollars, Medicaid/Texas Health Steps, Medicare, national school lunch and/or breakfast programs (free or reduced-price meals), and Children’s Health Insurance Program (CHIP). DOI: http://dx.doi.org/10.5888/pcd17.200322external icon. Percentages may not add to 100 because of rounding. Accessed September 8, 2020. The American Planning Association’s Planning and Community Health Center has partnered with the American Public Health Association at the national level. Published April 23, 2020. Chowkwanyun M, Reed AL Jr. Accessed April 20, 20182020. Income: Lower Wages Come at Cost to Public Health, Housing is a Social Determinant of Health, Education is a Social Determinants of Health, Get to Know Social Determinants of Health, Planners4Health: A new approach to advancing practice at the intersection of planning and public health, Plan4Health connects people to nutrition, recreation in rural Oregon. These increases in risk are likely due to health inequities, which result in a disproportionately greater prevalence of obesity, diabetes, respiratory disorders and other predisposing conditions among Hispanic and African American populations (23). Prev Chronic Dis 2011;8(2):A49. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html. The Healthy People 2020 Social Determinants of Health topic area is organized into 5 place-based domains: Economic Stability; Education; Health and Health Care; Neighborhood and Built Environment; Social and Community Context; Poverty is a key issue in the Economic Stability domain. A secondary effect of school closures is the lack of access to national school lunch and/or breakfast programs (free or reduced-price meals) for children, thus increasing the risk of food insecurity among low-income families. Our results highlight the compounding effect of the COVID-19 pandemic across the spectrum of basic social needs among low-income households with children. The concerns were due to various reasons, such as lack of personal protective equipment and working in frontline jobs. There’s no help with bills, and the food is very limited. Income can influence many aspects of a person’s life, including their health, where they live and the education that they receive. Within countries, the evidence shows that in general the lower an individual’s socioeconomic position the worse their health. Your research has connected housing with cardiovascular health, depression, sleep disorders, asthma, and obesity. The COVID-19 pandemic is occurring in the context of a global economic crisis, both of which highlight health and social challenges for the most vulnerable people in our communities. Webb Hooper M, Nápoles AM, Pérez-Stable EJ. Boyatzis RE. Dietary habits. the economic spectrum, low-income individuals are particularly likely to face challenges related to housing, food, and transportation. The objective of our study was to quantitatively and qualitatively describe the data obtained from this rapid-response survey. SDOH refer to economic and social conditions and their distribution among the population thus influencing individual and group differences in health status. The broad social and economic circumstances that together influence health throughout the life course are known as the ‘social determinants of health’. Going back to be in a store, park, schools and being with the family, without any worry of some infection. 1. That we don’t have masks, gloves, or disinfectant wipes because you can’t find them at the stores. If the respondent indicated “often true” or “sometimes true” to either of the 2 questions, we considered the household food insecure. The social gradient not only represents the effects of income on health but also the importance … The survey also invited respondents to write in any other concerns by using this statement: “Please share your greatest concern at this time, or any other thoughts you would like to share with us.”. Employment and unemployment. Email: Shreela.V.Sharma@uth.tmc.edu. Accessed August 27, 2020. All values are number (percentage) unless otherwise indicated. c Significance set at P < .05 for all tests. JAMA 2020;323(19):1891. Qualitative comments provided additional insight, with many respondents expressing a concern about a general scarcity of food. Finally, our cross-sectional descriptive study does not allow us to draw conclusions on cause and effect; our study is a snapshot at an early moment in the pandemic and serves as a baseline for examining patterns of change and causal associations in future studies.