Cacari Stone Lisa, Boursaw Blake, Wasif Usamah, Zhu Yiliang
The University of New Mexico, Albuquerque, NM, USA.
Michigan State University, East Lansing, MI, USA.
Health Educ Behav. 2025 Aug;52(1_suppl):45S-52S. doi: 10.1177/10901981251346814. Epub 2025 Jul 23.
During the early months of the U.S. COVID-19 outbreak, the distribution of morbidity and mortality starkly reflected preexisting social determinants of health. Socially vulnerable racial and ethnic populations endured not only the highest number of cases and death rates, but the earliest age mortality. In addition, early government responses to COVID-19 pandemic varied at the state level, while the federal government failed to take immediate policy action to this public health emergency. Drawing from public-use data, we used statistical and econometric modeling techniques to investigate political, structural, and policy determinants of health outcomes during the pandemic. We also investigated the intersecting impacts of these responses on COVID-19 cases in the context of preexisting social vulnerability. Results indicate that partisanship and political ideologies significantly influenced variation in state-level responses. We also found that preexisting social vulnerabilities shaped the observed effectiveness of governmental interventions. Our findings underscore the need to tackle structural vulnerabilities as a more comprehensive policy approach to mitigating the harms of pandemics. Our results also suggest that state governments that resemble inclusive decision-making processes that prioritize the needs of the most impacted communities are more equipped to respond to pandemics. Our study underscores the complex interplay between political dynamics and social determinants of health during a public health emergency, with implications for future pandemic preparedness.
在美国新冠疫情爆发的最初几个月里，发病率和死亡率的分布鲜明地反映了先前存在的健康社会决定因素。社会弱势群体中的种族和族裔人群不仅承受了最高的病例数和死亡率，而且死亡年龄最早。此外，政府对新冠疫情的早期应对在州一级各不相同，而联邦政府未能针对这一公共卫生紧急情况立即采取政策行动。我们利用公开数据，运用统计和计量经济学建模技术，调查了疫情期间健康结果的政治、结构和政策决定因素。我们还在先前存在的社会脆弱性背景下，研究了这些应对措施对新冠病例的交叉影响。结果表明，党派之争和政治意识形态显著影响了州一级应对措施的差异。我们还发现，先前存在的社会脆弱性塑造了政府干预措施的实际效果。我们的研究结果强调，作为减轻疫情危害的更全面政策方法，需要解决结构性脆弱性问题。我们的结果还表明，那些具有类似包容性决策过程、优先考虑受影响最严重社区需求的州政府，更有能力应对疫情。我们的研究强调了公共卫生紧急情况期间政治动态与健康社会决定因素之间的复杂相互作用，对未来的疫情防范具有启示意义。
