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

Community-based Approaches to Reducing COVID-19 Disparities

Understanding the social context of populations with high rates of COVID-19 infection and severe illness is critical to the development, implementation, and evaluation of public health prevention strategies. Although structural long-term solutions to eliminating racial and ethnic health disparities are optimal and preferred,[41] evidence suggests that immediate relief and support during the COVID-19 pandemic can be achieved when local public health departments, school leaders, and community partners join forces. For example, the Coordinated Approach to Child Health: Curriculum & Training (CATCH) program consists of comprehensive and coordinated programs, policies, and services that involve partnerships between families, schools, and the community.[42] This school health program focuses on coordinating the efforts of teachers, school staff, and the community to promote healthy behaviors to prevent childhood obesity. Through this approach, programs had greater impact in reducing overweight and obesity when schools worked with community-based partners.[42] Using a coordinated approach can impact the way communities conceptualize and address problems and can enhance implementation of strategies.[8] This approach may help address the unique challenges some children face throughout the pandemic and support transitions into early pandemic recovery and beyond.

Another way to inform focused prevention strategies is for school districts to develop plans that can be tailored at the individual school level to address gaps in learning and well-being for the students. According to a study by researchers at Johns Hopkins University, most state and territorial boards of education (89%, 48 of 54) have individual plans with provisions to narrow gaps in learning and well-being that may have been exacerbated by school closures for children experiencing poverty and systemic disadvantage.[43] Some of these provisions include providing access to digital technologies and corresponding training and support for students and parents; special virtual instructional support (eg, tutoring); prioritization of children experiencing disadvantage for in-class instruction; and accommodation of schedule-related or childcare needs of parents with lower income, people of color, or essential workers. Because states and school districts may have implemented their reopening plans differently, partnerships and collaboration with public health departments and community-based organizations could help with monitoring the execution and reach of those plans as well as assessing critical needs to ensure that equity considerations are implemented. Examining these provisions can inform models and standards to use during the COVID-19 pandemic and for emergency preparedness planning.

Plans should be comprehensive and consider disparities in conditions that could affect educational achievement, including mental health and emotional well-being, within the context of the COVID-19 pandemic. For example, compared with 2019, the proportion of mental health–related visits for children aged 5–11 and 12–17 years increased approximately 24% and 31%, respectively; these increases began in April 2020, corresponding to the time in which many schools were required to close.[44] Younger adults (aged 18–24 y), Hispanic people, NHB people, essential workers, and unpaid caregivers for adults reported having experienced disproportionately more adverse mental health outcomes.[45]

Zimmerman et al found what they describe as "nuanced contextual covariables in our society that provide a fuller back story" to the complex association between educational attainment and health outcomes.[46] Namely, they identified social skills, emotional dysregulation, trauma, abuse, and neglect, among other variables that should be addressed when the goal is to increase educational attainment. Moreover, Hahn and Truman argue that another essential element in the pathway from educational attainment to health outcomes is the "psychosocial environment," which includes sense of control (eg, work-related factors, health-related behaviors, stress), social standing (social and economic resources, stress), and social support (social and economic resources, health behaviors, family stability, stress).[10] If these variables require attention absent a global pandemic, then they cannot be ignored during this public health crisis. Partnerships can facilitate obtaining resources to promote coping and resilience, reduce health and mental health disparities, and expand access to services to support children's and teens' mental health. For example, schools could help link children and their families to community health centers for affordable mental health support services.