Beyond the toll of infections, hospitalizations, and deaths due directly to Covid-19, the pandemic has impacted nearly every aspect of our lives and wellbeing. Starting in April 2020, the Assessment, Policy Development and Evaluation unit of Public Health – Seattle & King County began to monitor and evaluate pandemic-related changes and disparities in social, economic, and overall health in King County, Washington. This effort leverages our team’s expertise producing and communicating data on the social determinants of health (SDOH) and health equity to measure unintended consequences of the Covid-19 response and inform planning for recovery and future emergencies.
Based on a framework developed by the CDC and informed by research from prior pandemics, we compiled local, state, and federal policies for Covid-19 mitigation and response (for example, school and business closures, stay-home orders, emergency assistance) and identified indicators likely to be affected by these strategies and related behavior changes. Indicators measured changes in unemployment; access to basic needs (food, housing, utilities); transportation; family violence; education; childcare; healthcare access; and mental, physical, and behavioral health. Traditional public health data such as vital statistics and population surveys are only available annually and after a one-year lag. Therefore, we worked with partners in public health and across other sectors to identify and access new, timely data to monitor these indicators throughout the pandemic.
Racial and ethnic health disparities and unequal distribution of resources, risks, and protective factors existed prior to the pandemic. And racism itself is a public health crisis. We disaggregated data by race/ethnicity, gender identity, sexual orientation, socioeconomic status, geography, and disability status whenever possible to identify disparities and reduce unintended consequences of Covid-19 mitigation efforts. We reported our findings in online data dashboards, brief reports, infographics, blog posts, biweekly email newsletters, peer-reviewed journal articles, and presentations to policymakers and community groups locally and nationally.
We observed large increases in unemployment claims and calls to social service, behavioral health crisis, and domestic violence hotlines in spring 2020 shortly after local strategies were implemented to slow the rapid spread of Covid-19.
We observed large increases in unemployment claims and calls to social service, behavioral health crisis, and domestic violence hotlines in spring 2020 shortly after local strategies were implemented to slow the rapid spread of Covid-19. Each of these changes disproportionately impacted communities of color. Enrollment increased for food and utility assistance programs and Medicaid. However, access to food, health care, and other basic needs remained a challenge for many. And families with children experienced major disruptions to childcare, education, and mental health. Mortality (excluding Covid-19 deaths) increased by 12% in 2020, and death rates increased by 14-38% for communities of color. Detailed findings can be found in our online dashboards and brief reports.
These findings are unfortunately not surprising and align with other research on Covid-19’s toll across the nation. Nonetheless, they help to quantify and provide a more comprehensive view of the pandemic’s impact to highlight the intersecting areas of need. We are currently conducting qualitative analyses to contextualize our findings and address gaps identified by community partners. This qualitative information will help to better understand Covid’s disproportionate impact on those whose experiences are not well captured in the quantitative data such as people living with disabilities.
Sharing timely, cross-sector data is valuable for decisionmakers to identify changes, track racial and geographic disparities, and address unintended consequences during a pandemic. These analyses have been used to inform response and recovery including the distribution of emergency food assistance funding and other pass-through federal relief funds. This framework can be replicated by other jurisdictions to identify and address racial, geographic, and other impacts of Covid-19 mitigation and recovery strategies. Collaboration between public health and across sectors to address social determinants of health is essential to reduce longstanding inequities.