How To Include The Social Determinants That Impact Behavioral Health In A Health Equity Tracker

Coronavirus has been called the great equalizer because no one is immune, and everyone is impacted regardless of geographic location, gender, race, ethnicity, creed, and other demographics.  Why, then do we see the disproportionate headlines describing the devastating effects of the virus in racial and ethnic communities?

While we see disparities in morbidity and mortality, we also see these same communities experiencing a disproportionate share of the economic burden of COVID-19 and the emotional toll that it has taken in all of us.

Some contributors to these disparities include the lack of tools to manage the daily stress associated with COVID-19, barriers to accessing testing and vaccines, racism, discrimination and xenophobia, lack of services that are cultural and linguistically competent, and stigma related to behavioral and mental health in communities of color. This pandemic has revealed deep-seated inequities in health care for communities of color and amplifies social and economic factors that contribute to poor health outcomes.

A recent Kaiser Family Foundation Report found the following:

• Communities of color are at increased risk for experiencing serious illness if they become infected with coronavirus due to higher rates of certain underlying health conditions compared to Whites;
• Communities of color will likely face increased challenges accessing COVID-19-related testing and treatment since they are more likely to be uninsured and to face barriers to accessing care than Whites; and
• Communities of color face increased financial and health risks associated with COVID-19 due to economic and social circumstances.

A Pew Research Center Report found that Hispanics were more likely than Americans overall to see coronavirus as a major threat to health and finances.

Financial fears, loss of employment, family stressors, working from home, virtual school, and social isolation are just some of the issues that have become the new normal over the past year.  And they are responsible for increases in anxiety, depression, excessive drinking, suicide attempts, and completions.

More than 42% of people surveyed by the US Census Bureau in December reported symptoms of anxiety or depression, an increase from 11% the previous year.  A Kaiser Family Foundation Brief found that during the pandemic, about 4 in 10 adults in the U.S. have reported symptoms of anxiety or depressive disorder, a share that has been largely consistent, up from one in ten adults who reported these symptoms from January to June 2019. And a KFF Health Tracking Poll from July 2020 also found that many adults are reporting specific negative impacts on their mental health and well-being, such as difficulty sleeping (36%) or eating (32%), increases in alcohol consumption or substance use (12%), and worsening chronic conditions (12%), due to worry and stress over the coronavirus.

The behavioral health system in the United States is vastly underfunded, fragmented, and difficult to access, especially for minorities and individuals living in rural communities. The system was not ready to meet the demand generated by COVID-19.

For a long time, power and privilege have provided those who are socially advantaged with resources to limit their exposure to and cope with, stressors caused by the pandemic. This creates great disparities in accessing services and it rewards those with privilege and leaves poor and BIPOC (Black, Indigenous, and People Of Color) communities without the opportunity to achieve their best health outcome.

So how can disparities in behavioral health services be included in a COVID-19 health tracker?

We begin by identifying the social determinants that impact behavioral health. In her manuscript Social Determinants of Mental Health: Where We Are and Where We Need to Go Drs. Alegría, M., NeMoyer, A., Falgàs Bagué, I. et al. state the following:

• Employment – Unemployment, precarious employment, and employment conditions continue to be routinely linked to increased psychological distress.

• Discrimination – whether related to race/ethnicity, immigrant status, sexual orientation, and/or occupational status, has repeatedly been associated with negative mental health outcomes in the United States.

• Income – studies have observed that poor mental health was prevalent among individuals with lower incomes and considerable financial strain.

• Housing – Longitudinal studies have suggested that persistent exposure to poor quality housing conditions (e.g., inadequate heating, overcrowding) can have negative effects on psychological health for youth and adults.

• Nutrition – Food insecurity and poor diet quality have also been linked to poorer mental health in the United States and Canada.

• Family – Familial relationships—both positive and negative—can also strongly impact mental health. Living with family, satisfaction with family relationships and family connectedness have all been associated with fewer depressive symptoms.

• Abuse – A history of abuse and neglect from a family member has been associated with symptoms of PTSD, anxiety, and aggression.

In addition to examining dynamic social determinants associated with mental health, recent research has further supported the significance of several fixed characteristics, including race/ethnicity, nationality, gender, and sexual orientation.

Therefore, multilevel interventions aimed at eliminating systemic social inequalities—such as access to educational and employment opportunities, healthy food, secure housing, and safe neighborhoods are crucial.

Including the social determinants that impact behavioral health in a health equity tracker would be able to create a simulation model to help predict which communities, defined either by demography or geography, would benefit from prevention and intervention services before they find themselves in a crisis state.

One example of this simulation could be comparing the number of people infected by COVID-19 by race and ethnicity and the unemployment rate of that geographic area. By making this correlation and understanding that both of these issues affect an individual’s mental health, we would be able to deploy cultural and linguistically appropriate prevention, intervention, and treatment resources to that particular area.

This addition to the tracker would move us closer to health equity and allow us to begin to improve health outcomes.

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About Dr. Pierluigi Mancini

With over 30 years of experience in culturally and linguistically appropriate behavioral health treatment and prevention, Dr. Pierluigi Mancini is one of the most sought-after national and international consultants and speakers on the subject of mental health and addiction, his areas of expertise are immigrant behavioral health and health disparities. His book ¡Mental! In The Trump Era – Ten Inspirational Stories About Immigrants Overcoming Addiction, Depression and Anxiety in America has recently been published to great reviews and it is available in English and in Spanish on Amazon.com. Dr. Mancini founded Georgia’s only Latino behavioral health program in 1999 to serve the immigrant population by providing cultural and linguistically appropriate mental health and addiction treatment and prevention services in English, Spanish and Portuguese. He is currently serving as the Project Director for the National Hispanic and Latino Addiction Technology Transfer Center and the National Hispanic and Latino Prevention Technology Transfer Center. Dr. Mancini recently led a project to train clinicians in Latin America who are taking care of the over 4 million displaced Venezuelans arriving in Colombia, Perú, Ecuador, Brazil, Panamá, and other countries.