Addressing Racial and Ethnic Disparities in COVID-19 Among School-Aged Children: Are We Doing Enough?

Arica White, PhD, MPH; Leandris C. Liburd, PhD; Fátima Coronado, MD, MPH

Prev Chronic Dis. 2021;18(6):e55

Abstract and Introduction

Abstract

The disproportionate impact of COVID-19 and associated disparities among Hispanic, non-Hispanic Black, and non-Hispanic American Indian/Alaska Native children and teenagers has been documented. Reducing these disparities along with overcoming unintended negative consequences of the pandemic, such as the disruption of in-person schooling, calls for broad community-based collaborations and nuanced approaches. Based on national survey data, children from some racial and ethnic minority groups have a higher prevalence of obesity, asthma, type 2 diabetes, and hypertension; were diagnosed more frequently with COVID-19; and had more severe outcomes compared with their non-Hispanic White (NHW) counterparts. Furthermore, a higher proportion of children from some racial and ethnic minority groups lived in families with incomes less than 200% of the federal poverty level or in households lacking secure employment compared with NHW children. Children from some racial and ethnic minority groups were also more likely to attend school via online learning compared with NHW counterparts. Because the root causes of these disparities are complex and multifactorial, an organized community-based approach is needed to achieve greater proactive and sustained collaborations between local health departments, local school systems, and other public and private organizations to pursue health equity. This article provides a summary of potential community-based health promotion strategies to address racial and ethnic disparities in COVID-19 outcomes and educational inequities among children and teens, specifically in the implementation of strategic partnerships, including initial collective work, outcomes-based activities, and communication. These collaborations can facilitate policy, systems, and environmental changes in school systems that support emergency preparedness, recovery, and resilience when faced with public health crises.

Introduction

The population health impact of COVID-19 has exposed decades, if not centuries, of inequities that have systematically undermined the physical, social, material, and emotional health of racial and ethnic minority groups.^[1,2] The disproportionate impact of COVID-19 and associated disparities in outcomes among some racial and ethnic minority populations is documented across age groups, including among children.^[3–5] Reducing these disparities along with the inequitable economic and social impact of the pandemic on families from racial and ethnic minority groups requires broad community-based and underused collaborations, as well as innovative approaches.

In this article, we highlight health disparities and inequities among children and teenagers from racial and ethnic minority groups. We discuss education as a major social determinant of health and the impact of restricted access to in-person school, and we describe disparities in underlying chronic medical conditions and social inequities associated with poverty and systemic disadvantage. In combination, these factors exacerbate poor health outcomes in populations disproportionately affected by social conditions beyond their control, including infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19. In light of documented disparities and the potential collateral damage inflicted by the COVID-19 pandemic, such as delays in health care, increases in social isolation, and decreases in vaccination rates,^[6] we invoke a renewed sense of urgency in attending to the population health status of children and teens from racial and ethnic minority groups.

We argue for community-based approaches that are organized to achieve greater proactive and sustained collaborations between local health departments, local school systems, and other public and private organizations. Although these approaches are not new, the impact of the COVID-19 pandemic on school-aged children experiencing systemic disadvantage reintroduces and amplifies the need for community-based collaborations and strategic partnerships. Since the causes of health disparities are complex and multifactorial, eliminating these health disparities cannot be accomplished by a single sector or entity.^[7] As trusted members of their communities, partners from the public and private sectors can play a key role in improving population health.^[8] Revitalizing old partnerships and establishing new collaborations may reduce COVID-19 disparities; improve and protect the physical and mental health of children and teens from racial and ethnic minority groups experiencing systemic disadvantage; and advance health equity, which is the opportunity for everyone to be as healthy as possible.^[2] We posit that these partnerships and collaborations can facilitate policy, systems, and environmental changes within school systems that support emergency preparedness and recovery and resilience when faced with public health crises.

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Next Section

Table 1. Estimates of Selected Chronic Conditions Among Children and Teenagers, by Race/Ethnicity, United States
Chronic Condition (Age, y)	Estimate
Current asthma (<18)^a	Age-Adjusted Prevalence, % (SE)
White, non-Hispanic	5.6 (0.40)
Black, non-Hispanic	14.2 (1.52)
Hispanic	8.0 (0.85)
Mexican American	7.0 (1.01)
Obesity (2–19)^b	Prevalence, % (SE)
White, non-Hispanic	16.1 (1.5)
Black, non-Hispanic	24.2 (2.0)
Hispanic	25.6 (1.9)
Mexican American	26.9 (2.5)
Asian, non-Hispanic	8.7 (1.1)
Type 2 diabetes (10–19)^c	Incidence Rate Per 100,000
White, non-Hispanic	4.5
Black, non-Hispanic	37.8
Hispanic	20.9
American Indian	32.8
Asian/Pacific Islander	11.9
Hypertension (12–19)^d	Prevalence, % (95% CI)
White, non-Hispanic	2.97 (1.73–4.74)
Black, non-Hispanic	6.27 (3.84–9.59)
Mexican American	4.94 (3.01–7.59)
Other	5.22 (3.65–7.20)

^a2018 data from the National Health Interview Survey (23).
^b2017–2018 data from the National Health and Nutrition Examination Survey (24).
^c2014–2015 data from the SEARCH for Diabetes in Youth Study (25).
^d2013–2016 data from the National Health and Nutrition Examination Survey (26).

Table 2. Summary of Potential Community-Based Strategies to Address Racial and Ethnic Disparities in COVID-19 Outcomes Among Children and Teens
Partnerships: public health and boards of education work together with cross-sector partners^a
• Identify and engage community partners with interest in or established relations working with K-12 schools serving minority populations • Engage women's, parents', and adolescent and youth groups to ensure there is effective peer outreach • Leverage trusted community resources, influencers, and other community leaders (eg, faith-based organizations) and businesses (eg, Adopt a School Program) • Facilitate innovative partnerships to include auxiliary services (eg, Head Start programs, YMCA, YWCA, Boys and Girls Club of America, cooperative extension services) • Include other governmental (eg, local parks and recreations departments) and nongovernmental organizations (eg, Food Bank programs) • Develop partnerships with a priority based on equity and removing systemic barriers of students experiencing disadvantage • Incorporate community oversight of activities to ensure their voice is represented and to build trust in the community • Gather, share, and use data (race, ethnicity, language, location, social factors) to focus efforts
Initial collective work: partnerships collectively define the problem and create a shared vision to solve it^b
• Plan community-based support for learning, families, and whole child development • Conduct rapid assessment of the digital literacy capacity for students and teachers • Conduct rapid assessment of barriers to virtual learning • Identify resources needed by students to receive optimal virtual learning • Conduct rapid assessment of barriers to safe (return to) in-person learning • Collaborate to identify and fill the gaps in mitigation efforts in schools • Support under-resourced schools in planning to mitigate exposure and transmission of COVID-19, as well as testing and contact tracing • Identify other health-related needs
Outcomes-based activities: partnership leads and/or facilitates activities with a focus on outcomes^c
• Address barriers to optimal virtual learning (eg, limited access to technology and eLearning materials, experience, instructor issues) • Quantify tutoring and mentoring needs and invest in rapid, remote support (eg, local volunteers tutor remotely) • Address barriers to in-person learning (eg, implementation of mitigation strategies in K-12 schools, safe transportation) • Pilot test and evaluate mitigation strategies among K-12 schools that serve a high proportion of students from racial and ethnic minority populations or from families with low incomes or limited resources • Support the capacity to identify and respond to signs of stress, isolation, or poor mental health in students • Protect students from abuse/violence • Improve adolescents' health literacy related to the COVID-19 pandemic and general health • Identify and facilitate afterschool and expanded learning opportunities
Communications: leverage existing and innovative approaches using focused messages^d
• Use existing digital platforms for small group or individual tele-tutoring (eg, 2 times per week) to strengthen learning, social engagement, and cultural affirmation • Schools identify and address inclusive delivery mechanisms for students with disabilities who are learning remotely • Develop and deliver accurate and culturally responsive information about COVID-19 and how students can protect themselves (eg, ensure language access, broad distribution through trusted sources, and relevance to students from racial or ethnic minorities) • Provide teleconsultations/telecounseling and educational sessions (webinars) to families about coping with stress and providing information on positive parenting • Provide resources and links to psychosocial and mental health support services (eg, community health centers and other health-related social needs) • Implement messages to increase awareness and resources for children and teens experiencing abuse/violence • Provide outreach activities and culturally tailored prevention messages/campaigns focused on COVID-19 • Provide outreach activities and culturally tailored prevention messages focused on preventing chronic diseases (eg, healthy eating, exercise)