Am Fam Physician. 2020;102(6):326
Author disclosure: No relevant financial affiliations.
To the Editor: As family physicians, we understand how social determinants of health, such as poverty and unemployment, influence health disparities within our communities. The coronavirus disease 2019 (COVID-19) pandemic will have long-term economic impacts. After peaking at 14.7% in April, the U.S. unemployment rate is currently 10.2% higher than the 2008 recession's worst month of 10% unemployment.1 The increases in those who are unemployed and without health insurance make it harder to care for our patients, particularly patients with chronic diseases who require ongoing care that they may no longer be able to afford. Unfortunately, chronic diseases are linked to worse outcomes in patients with COVID-19. Ultimately, the economic impact of the pandemic and public health control measures will exacerbate existing disparities.
This new recession is linked to an increased risk of housing insecurity. As employers cut back work hours or lay off employees, more people are unable to pay rent or are late on their payments.2 Multiple state-sponsored eviction and mortgage protection bills are in effect, but most have expired or will soon. The federal Coronavirus Aid, Relief, and Economic Security (CARES) Act expired at the end of August.3 Patients cannot prioritize medications if they are more concerned about finding shelter.
The nonprofit organization, Feeding America, reports significantly higher levels of food insecurity and projects that food insecurity may ultimately affect one out of three adults and one out of two children within the United States.4 Food banks are seeing a 98% increase in demand, and 60% are running low on resources since the pandemic began.5 Without food and housing security, how can patients hope to control chronic health conditions?
Before COVID-19, family physicians were already well acquainted with the struggles of socioeconomically disadvantaged patients. In the short term, physicians should refer patients with social needs to appropriate assistance programs available through websites such as https://www.usa.gov/ and https://www.usda.gov/. There is now an opportunity for us to lead and partner with our communities to create long-term, comprehensive solutions to social and health inequities. Family physicians must advocate for additional resources by contacting our policymakers. Together, our collective voice can lift up our patients and increase social justice.