Implications of the COVID-19 pandemic on social determinants of health in Texas

EHF's Shao-Chee Sim and Jennifer Meier examine the disparate impact that COVID-19 had on non-medical factors affecting Black and Hispanic Texans compared to White Texans, confirming findings from a statewide survey of Texans’ views on the pandemic, and call for state leaders to take action to confront structural racial inequities.
Shao-Chee Sim, PhD, MPA

Shao-Chee Sim
VP for Research, Innovation and Evaluation

Jennifer Meier
Research and Evaluation Associate

For many Texas residents, the full impact of COVID-19 on health reaches far beyond fatalities and hospitalizations. The social and economic downturn brought on by the Coronavirus pandemic exacerbated the non-medical factors that influence health, known as the social determinants of health (SDOH). The Census Bureau’s Household Pulse Survey collects data on various SDOH including employment, food security, and housing. The Household Pulse Survey offers near real-time data and has been conducted in phases to measure household experiences since the pandemic began in March 2020.

This blog reflects on the most pressing issues Texans faced over the course of the pandemic, including loss of employment income, food insecurity, and difficulty paying rent. We chose to focus on these SDOH measures because they capture the struggles many Texans, and others across the country, have encountered during COVID-19 and are linked to adverse health outcomes. However, both the medical and economic hardships were not felt equally among Texas residents. Non-White Texans have been disproportionately affected by COVID-19, underscoring the health disparities that persist in Texas and the U.S. The blog closely examines the disparate impact on Black and Hispanic Texans compared to White Texans, confirming findings from a statewide survey of Texans’ views on the COVID-19 pandemic, and calls state leaders to take action to confront structural racial inequities

In late April 2020, nearly half of respondents in Texas (47 percent) reported losing employment income since the COVID-19 pandemic began in March 2020. A majority of Black and Hispanic Texans (54 and 53 percent) experienced a loss of employment income at the outset of COVID-19, compared to 40 percent of their White counterparts. Figure 1 showcases the inequities between White, Black, and Hispanic Texans that have been amplified during the pandemic. Although there has been a notable improvement since mid-April of this year, the number of Black and Hispanic Texans (23 and 26 percent) reporting employment income loss is still almost double that of White Texans (14 percent).

The number of Texans who had enough of the types of food they wanted has stayed fairly consistent since the survey began, however, recently there has been a small but steady increase. In the most recent survey period, 53 percent of Texans had enough food they wanted, compared to the latter half of 2020, where only 45 percent of Texas residents were able to obtain food they wanted. The data reveals a large racial disparity in Texas that has remained relatively unchanged since the beginning of COVID-19 (see Figure 2). A larger share of White Texans (67 percent) acquired the food they wanted than the share of Black (49 percent) and Hispanic (38 percent) Texans in the latest survey, a marginal improvement starting in mid-April and continuing through June 2021. 

Texans’ ability to pay rent has been inconsistent, hitting a peak in January 2021 and then easing off slightly with the launch of the Texas Rent Relief program in February. As of June 2021, 15 percent of Texans were behind on their rent payments.  Looking across race and ethnicity in Texas from the most recent survey, Black and Hispanic Texans (21 and 14 percent) are more likely to have fallen behind on rent payments than White Texans (9 percent). These numbers are similar to what they were early on in the pandemic, once again highlighting the disproportionate struggles of non-White Texans as a result of COVID-19 (see Figure 3).

Loss of employment income, food insecurity, and difficulty paying rent are just a few of the hardships Texas residents experienced because of the COVID-19 pandemic. Many of the challenges Texans faced were echoed across the country, brought on by pandemic-related stay-at-home orders and economic shutdowns.

For much of the pandemic, the economic fallout remained stagnant, even in the wake of initial pandemic support efforts including the first round of stimulus checks and additional unemployment benefits. Only in the current survey period do we see a demonstrable improvement, due in large part to critical assistance provided by the American Rescue Plan Act to address the employment, food insecurity, and housing needs of Americans and Texans.    

However, the brunt of the pandemic has not been borne equally among Texans. We see this particularly when we look at Black and Hispanic communities, who have been disproportionately burdened by the health and economic impact of COVID-19. There are concerns that these disparities will be exacerbated as federal safety nets implemented to support families through the pandemic, including unemployment benefits and restrictions on eviction and electricity disconnection, are coming to an end in Texas.

Thus, it is important to continue collecting and analyzing data on SDOH to understand the long-term implications of COVID-19 on the health of Texas residents, especially among populations that were hit the hardest. The Census Household Pulse Survey offers reliable data for us to track the well-being of Texans over time, as rising vaccination rates and a rebounding economy moves us closer to “normal.”