In summary

A study in Orange County reveals a higher prevalence of COVID-19 in minority communities and shows the disparities in health care.

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By Bernadette Boden-Albala, Special to CalMatters

Bernadette Boden-Albala is director and founding dean of the Program in Public Health at UC Irvine,

 Lea este artículo en español.

A new study from UC Irvine and the Orange County Health Care Agency shows COVID-19’s true prevalence in the community, and it paints a shocking picture. This study, called the actOC project, is the first of its kind in California and presents data that shows striking health disparities revealed in higher rates of COVID-19 antibodies among minority communities in Orange County.

The actOC project found an overall prevalence of exposure to SARS-CoV-2 is 11.5% in adults; previous estimates were less than 2%. Not only is this statistic shocking because it is seven times greater than case counts closest to the date of the study, but more shocking is the demographics most impacted by infection rate. 

In Orange County, the greatest prevalence of exposure is maintained by the Latino community and persons of lower income. Latinx and low-income residents had the highest prevalence of antibodies with prevalence rates of 17% and 15%, respectively.

The COVID-19 pandemic has shown itself to be a pandemic of disparities across the country as well as in Orange County. As the disease continues to spread nationwide, data shows that the virus disproportionately impacts Black, indigenous people, Latinx and other people of color. 

The Center for Disease Control and Prevention found significant race gaps in COVID-19 deaths. At the national level, Blacks are dying at a rate 2.5 times higher than whites, and non-whites under 65 are dying at a much higher rate of COVID-19 than white people of the same age group. 

The increased mortality rate for COVID-19 faced by racial minorities in our county confirms an unfortunate truth that public health experts have known all along – your race can determine your health outcome.  Public health experts often refer to “social determinants of health,” the conditions in which people live and work to explain population health outcomes. 

In the case of COVID-19, we can directly see that social determinants like socioeconomic status, housing, employment and access to health care lead to higher risk of infection or death. Disadvantaged communities with less capital and fewer resources are more vulnerable to exposure of COVID-19, due to any one or combination of lack of testing, poor quality health care systems or harsh working conditions that make social distancing impossible. 

The good news is that public health experts and agencies can now use the information provided in studies such as actOC to design measures to decrease the exposure to COVID-19 in targeted communities experiencing adverse social determinants of health, such as Orange County’s Latino population and lower socio-economic population. Programs should focus more testing in these communities and provide a greater investment in access to quality health care in these communities. 

Public policy strategies can be developed and implemented to reduce social injustices by promoting equity in social resources, city planning, education, health care and economic impact investment and all other factors which can contribute to social determinants of health. Studies such as the actOC provide the ammunition needed to address real problems in our community, which inevitably will impact public health. 

Health disparities are a symptom of parallel systematic and institutional biases. The persistence of health disparities over time, across generations and in the context of dramatic changes in population composition can be attributed to structural racism. 

Intervention strategies for COVID-19 mitigation and risk reduction are purposeful in how we aim to target social determinants. To reduce disparities, interventions should not just improve overall health – they must also decrease or eliminate gaps in disease risk and outcomes by race-ethnicity.  

The COVID-19 pandemic has highlighted the devastating impact that social determinants of health continue to have on creating health disparities across the country and within Orange County. The pandemic has also made crystal clear the fact that disparities can be easily targeted in our county, and that with the right information and policy initiatives, public health vulnerabilities can be eliminated, and health equality and access to care for all can be achieved. 

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