Social determinants of health, kidney disease and COVID-19

The COVID-19 pandemic is having a disproportionate impact on black and brown Americans — the same communities hit the hardest by kidney disease and kidney failure. The unprecedented global pandemic has brought to light what nephrologists, nephrology nurses, dialysis patients and we at the American Kidney Fund (AKF) have known for decades: People who are low-income experience food insecurity, face barriers to higher education, live in areas with higher pollution and/or live in areas with higher crime rates are more likely to have chronic diseases and illnesses. These non-medical conditions are called social determinants of health (SDOH) because they contribute to decreased health outcomes and greatly influence a person's overall well-being.

Many Centers for Disease Control and Prevention (CDC) programs collect and provide information about SDOH to the public. In its Healthy People 2020 plan, the CDC defines SDOH as "conditions in the environments in which people live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks."

The correlation between communities of color and health disparities is clear. These non-medical components must be addressed to better ensure the health and life of communities of color.

Know the stats

Due to high rates of diabetes and high blood pressure — the two leading causes of kidney disease — communities of color have disproportionately high rates of kidney disease.

• African Americans make up just 13% of the U.S. population, but they account for 35% of Americans with kidney failure.
• About 14% of Hispanic Americans have kidney disease.
• For every 3 non-Hispanics who develop kidney failure, 4 Hispanics do.
• African Americans are 3 times more likely than white Americans to develop kidney failure.
• Hispanic Americans are 1.6 times more likely than non-Hispanics to develop kidney failure.
• Native Americans are 1.2 times more likely than white Americans to develop kidney failure.

We are also seeing these negative health disparities between racial and ethnic communities during the COVID-19 pandemic:

• African Americans have experienced the highest rates of mortality due to COVID-19 — 92.3 deaths per 100,000 people.
• Hispanic Americans have experienced a mortality rate of 74.3 deaths per 100,000 people.
• White Americans have experienced a mortality rate of 45.2 deaths per 100,000.
• Asian Americans have experienced a mortality rate of 34.5 deaths per 100,000 people.

What is AKF doing about this?

AKF has long been focused on fighting health disparities that shorten the lives of too many Americans, especially the disproportionate number of African Americans and Hispanic Americans who have kidney disease. We know these communities cannot have good health outcomes until the systemic racism that contributes to their SDOH is addressed. 

Our vision is a world without kidney disease. Until that day comes, we believe that every kidney patient should have access to health care, and every person at risk for kidney disease should be empowered to prevent it. We know that when people have safe housing, nutritious food, a livable income and access to quality education and continuous learning, they have lower rates of chronic kidney disease and lower rates of kidney failure. We know there needs to be a holistic approach to health care in low-income communities that addresses the non-medical SDOH, and we are calling on our nation's leaders to take on the systemic racism African Americans and Hispanic Americans endure.

We have been working with communities of color for decades and we are the only kidney organization that provides direct financial assistance to low-income, financially struggling dialysis and recent kidney transplant patients — the majority of whom are people of color. Of the patients we help with financial assistance, 35% are African American, 20% are Hispanic/Latinos and 6% are Native American or Asian/Pacific Islanders.

We regularly sign on to letters to Congress urging them to pass or take up legislation to protect kidney patients, including legislation that would particularly benefit people of color who have kidney disease, such as the Health Equity and Accountability Act of 2020 and funding for CDC's Racial and Ethnic Approaches to Community Health. Our recent letters encourage collecting data on the impact of COVID-19 on minority populations, increasing federal funds for Medicaid coverage, ending surprise billing and protecting patients through the Affordable Care Act, and more.

You can see all the letters we've signed on to and read more about our public policy priorities here.

How can you help right now?

In April, Congresswoman Nanette Diaz Barragan (D-CA) introduced legislation — H.R. 6561, the Improving Social Determinants of Health Act of 2020 — that would require the CDC to address SDOH and work to improve health outcomes for communities that have been impacted. The bill would establish the first federal program to provide money to states, municipalities and cities specifically to address the SDOH faced by low-income Americans by ensuring access to nutrition, housing, transportation, education and employment. In just two minutes, you can contact your representative here and ask them to cosponsor Rep. Diaz Barragan's important piece of legislation.

UPDATE 8/19/20: A companion bill to H.R. 6561 was introduced in the Senate on August 5 by Sens. Tina Smith (D-MN) and Chris Murphy (D-CT).