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 

In This Article

Education is a Major Social Determinant of Health

Education is a major social determinant of health and is essential to achieving health equity.[9] Educational attainment and disparities in health are closely linked.[10] Moreover, education is highly correlated with income and occupation, and "less education predicts earlier death".[11] Furthermore, through occupational attainment, education most often determines access to health care and health-related benefits, including paid time off and paid sick leave.[12] Adults with less education report worse general health, more chronic conditions, and more functional limitations than those with higher levels of education.[13,14]

School closures (during the spring of 2020) in response to the COVID-19 pandemic, including in-person kindergarten through grade 12 (K-12) schools, and the safe reopening of schools and institutions of higher education have been at the center of public health decision making to ensure guidelines protect students, teachers, faculty, and staff. According to Fay et al, along with the economy and the health care system, schools are "a third pillar of a pandemic-resilient society".[15] Besides education, schools provide facility-based services on which many students and families rely, including academic intervention supports, food and nutrition programs, childcare, after-school support, and social, physical, and mental health services. Schools can also serve as an extension of the home environment and offer a protective social environment for some students.[16] As enduring community institutions, services provided by schools to "communities made vulnerable by systemic racism, inadequate insurance, family instability, environmental toxicity, and poorly paid jobs"[17] are essential to the overall well-being and psychosocial health of students experiencing poverty and systemic disadvantage.[12] In this article, students experiencing systemic disadvantage include those who are disproportionately from racial and ethnic minority groups, with disabilities, experiencing homelessness, in foster care, and for whom English is a second language.[18]

Children who experience poverty and systemic disadvantage, who are more likely to be from racial or ethnic minority groups, may be at higher risk of infection, severe illness, and death from COVID-19.[4] Because of school closures, children already experiencing disadvantage may have limited access to the facility-based services, academic supports (eg, private instructors, learning pods), virtual learning options, and digital technologies needed to successfully complete their grade-level academic requirements.[18] Parents' lives are also impacted by school closures. Some parents may not be able to return to work or may not have paid leave, flexible schedules, or options to work remotely and may have to balance how they provide supervision to several children at home with different academic schedules.[17,18] Parents' comfort with their own educational attainment and confidence to help their children academically is also a factor in how well students perform.[19,20] These challenges may widen the gap in academic performance for students experiencing disadvantage compared with their more privileged counterparts. Conversely, in-person learning during the pandemic may pose challenges for these children and their families. Schools that serve communities with a disproportionate number of people experiencing poverty are often under-resourced, overcrowded, and understaffed, which increases risk for COVID-19 transmission in schools and adds to the challenges associated with safe reopening.[17] Furthermore, some students may live with others who, for various reasons, are at increased risk for COVID-19 infection or live in intergenerational or crowded housing, which may influence their parent's or guardian's decision to send them to in-person school. Under-resourced schools may also have reduced capacity to offer high-quality virtual learning or be able to provide the supports needed for students with disabilities or other special needs. To mitigate the impacts of COVID-19 on the scope and quality of educational resources available to these students, decision makers, programs, and interventions must consider health disparities and social inequities and act on the unique conditions that could increase students' risk of infection and severe illness from COVID-19.