Economic Stress

Los Angeles County has been a national leader in providing access to healthcare for all residents, regardless of socioeconomic status. Serving an incredibly diverse population experiencing inequality, the Department of Health Services and the Department of Public Health—along with many private and non-profit service providers—strive to serve all Angelenos without regard to documentation status, income, race or ethnicity, language, or health status. However, COVID-19 and the effects of the global pandemic threaten this progress. Both the virus and the related shutdowns run the risk of entrenching inequities resulting from the social determinants of health, creating challenges and undoing the gains made by expansive public policy in recent years.

California has been particularly hard hit by COVID-19, with an estimated $1.5 billion in lost revenue, around 21,000 lost community health center jobs, and nearly 7 million lost patient visits. This loss made it harder to provide healthcare, increased the likelihood of negative health outcomes in patients, and, barring intervention, could result in the closure of community health centers. While health outcomes were racialized prior to the onset of COVID-19, the pandemic exacerbated health inequities in Los Angeles County. The death count for Native Americans is about 1.5 times that of whites, while it is two times as high for African Americans, 2.7 times for Latinos, and over 3 times for Pacific Islanders. Though some primary care providers have been able to pivot rather seamlessly to telehealth visits, prohibitive Medicare and Medicaid reimbursement rules, combined with the difficulty of navigating prescribing laws and regulations at the federal and state levels, created burdens for the FQHCs that provide healthcare to lower-income communities in Los Angeles. Chronic non-communicable diseases such as cardiovascular disease, diabetes, and sickle cell disease all increase the risk of severe illness from COVID-19.

While cardiovascular disease is the leading cause of death for Black, Native American, Latino and white men, other comorbidities tend to disproportionately impact communities of color. For example, approximately 9.7 percent of Black and Latino adults in California have Type 2 diabetes, compared to 6.8 percent of white Californians. According to the American Diabetes Association and the Centers for Disease Control and Prevention, diabetics face a higher chance of serious complications from COVID-19. Current evidence suggests that individuals living with HIV/AIDs who are on an effective treatment regimen are no more susceptible to COVID-19 than individuals who do not have HIV/AIDS. However, among the many knock-on effects of COVID-19 is the disruption in healthcare and social service provision.