COVID-19 and Access to Healthcare at the Crossing of Race, Poverty, and Rurality

ABSTRACT: Black Americans make up 7.7 percent of the rural population in the United States.1 During the COVID-19 pandemic many in this population found themselves at a unique intersection of inequity - being Black, poor, and residing in a rural area. Poverty is a known contributor to negative health outcomes and is a risk factor for death from coronavirus infection.2 The association between race and poverty, when examining infectivity and mortality rates of COVID-19, have disproportionately devastated Black Americans and other minorities.3 Further, research indicates the presence of a general “rural mortality penalty” wherein rural Black communities have higher death rates than similar communities in urban areas.4 How does someone at the crossroads of these statuses fare when struggling with health care accessibility? The pandemic underscored a need for health equity discourse to continue exploring nuances within marginalized communities. This article argues that the COVID-19 public health crisis highlighted important omissions in public health discussions of healthcare access and health equity, notably that traditional ways of defining healthcare access falls short of capturing the lived experiences of Black, impoverished people living in rural communities. Instead law and policy responses, targeting healthcare access, must expand the definition of “access” to include “Healthcare Access+” factors that acknowledge the history, culture, and unique circumstances of rural Black communities.