In April 2024, the Harris County Commissioners Court unanimously
approved the newly developed Harris County Strategic Framework, which includes a goal focused on improving physical and mental health outcomes, with particular emphasis on addressing social determinants of health to target racial/ethnic disparities in Harris County. Among the community indicators in the County Strategic Framework’s goal on health outcomes is tracking life expectancy disparities by race/ethnicity, income, and zip code to achieve three objectives, including improving the health behaviors of community members; increasing access to quality health care; and improving children’s health outcomes. The County Strategic Framework’s health outcomes’ goal is especially relevant considering the health disparities exacerbated by the COVID-19 pandemic in Harris County. National, state, and local data show that the Hispanic/Latino community was among the most affected groups, consistently showing the highest number and percentage of cases and hospitalizations in Harris County compared to other race and ethnicity groups.
The
US Centers for Disease Control and Prevention (CDC) defines health disparities as “preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.” Disparities stem from factors such as race, ethnicity, geography, gender, education, and income. Historically, the Hispanic/Latino population has faced systemic challenges, both related to social determinants of health and health outcomes, that have contributed towards exacerbating health disparities.
In Harris County, the Hispanic/Latino community accounts for 44.6% of the population. In both Harris County and Texas, Hispanic/Latino individuals constitute a higher percentage than the national proportion of 19.1%, the second largest racial/ethnic group after non-Hispanic white individuals.
Certain social determinants of health related to employment and lack of health insurance coverage, among others, made the Hispanic/Latino community particularly vulnerable to the COVID-19 pandemic. For example, data from 2022 shows that Hispanic/Latino individuals made up the largest percentage of individuals working in sectors like natural resources, construction, maintenance, and service occupations, which increased their exposure to the virus since they could not work remotely. In addition, Hispanic/Latino individuals have significantly higher rates of uninsurance compared to other racial groups, with 32.2% of all Hispanic/Latino residents in Harris County lacking health insurance compared to 7.5% of White, non-Hispanic residents, making them more reluctant to seek and receive health care.
Health outcomes related to the COVID-19 pandemic were also consistently worse among the Hispanic/Latino community in Texas and Harris County when compared to other race/ethnicity groups. Hispanic/Latino individuals in Texas consistently had the highest number of confirmed COVID-19 cases compared to other race/ethnicity groups at 434,229 (26.8%), 578,920 (25.8%), and 716,254 (26.9%), in 2020, 2021, and 2022, respectively. Figure 1 displays confirmed COVID-19 cases by race/ethnicity in Texas from 2020 – 2023.
Figure 1: Confirmed Covid-19 Cases by Race/Ethnicity and Year in Texas, 2020-2023Furthermore, the Hispanic/Latino community had high rates of hospitalizations due to the COVID-19 pandemic. In 2020, the Hispanic/Latino community made up 43.8% of hospitalizations in Harris County, which was slightly below their share of the population in Harris County, at 44.6%. Following 2020, hospitalizations among the Hispanic/Latino community in Harris County began to decrease, though in 2021, the Hispanic/Latino community had the second highest percentage of hospitalizations in Harris County, at 29.4%, following White individuals, at 38%.
Data from a countywide assessment conducted by Harris County Public Health (HCPH) also showed that Hispanic/Latino individuals had the highest rate of COVID-19-related hospitalizations among all race/ethnicity groups in Harris County, at 38%. HCPH also found that Hispanic and non-Hispanic Black residents were more impacted by COVID-19 due to the greater likelihood of pre-existing conditions, such as obesity, diabetes, heart disease, and hypertension. Figure 2 displays COVID-19-related hospitalizations by race/ethnicity in Harris County and nationally from 2020 – 2023.
Figure 2: COVID-19 Related Hospitalizations by Race, US and Harris County, 2020-2023In response to these health disparities, Harris County Public Health utilizes the Access Coordinated Care and Empowering Self Sufficiency (ACCESS) to improve outcomes for vulnerable individuals through a Care Coordination Team. The ACCESS Harris County Latino Chronic Disease Cohort, launched in 2023, works with members of the community to enhance access to health care services. ACCESS aims to address health disparities beyond traditional preventative health approaches, focusing on providing participants with knowledge on managing chronic diseases as well as guidance on issues related to social determinants of health, such as how to access health care services. Efforts such as ACCESS Harris and other country programs that target health outcomes and social determinants of health disparities factor into Harris County’s Strategic Framework goal on health disparities, and the subsequent objective related to increasing access to quality health care.