Most workers experience multiple, interconnected vulnerabilities to COVID-19

COVID-19 has had a devastating impact on people's physical and mental health and has caused economic hardship. However, this adversity has disproportionately hurt certain populations—including essential workers and women—deepening existing disparities.

One reason behind these disparities? The same people have been affected by clusters of interrelated factors, according to new research published in PLOS Global Public Health.

"Most research on COVID-19 disparities focuses on individual factors, but few have explored the complex relationships between the multiple factors that leave people more vulnerable to the pandemic and the conditions it has created," said Ariadna Capasso, a doctoral student at NYU School of Global Public Health and the study's lead author. "A systems-thinking approach, which considers these multiple factors at the same time, helps us to understand these interrelations, which can inform effective policies."

The researchers applied a systems-thinking approach to analyzing responses to a survey of 2,800 workers in the United States collected via social media in April 2020. Workers were asked questions about their employment, income, mental health, access to health care, and where they lived.

The study identified three clusters of vulnerabilities:

• financial (e.g., not salaried, loss of income, unable to work from home, food insecure)
• mental health (e.g., depression, anxiety, traumatic stress)
• healthcare access barriers (e.g., no health insurance, no paid sick leave)

Nine out of 10 workers experienced at least one vulnerability cluster. Notably, 41 percent had two vulnerabilities and 15 percent reported all three. The clusters disproportionately affected certain groups of people: essential workers, women and rural residents.

Essential workers experienced more financial vulnerability than other workers; this may be due to working in less stable or hourly jobs, which may not provide sick leave.

When it came to mental health, women experienced worse mental health than men. Essential workers reported better mental health, as did people living in rural areas. In contrast, rural residents experienced more healthcare access barriers and greater financial vulnerability than those living in urban areas.

"Each of these factors does not occur on its own," said Yesim Tozan, assistant professor of global health at NYU School of Global Public Health and the study's senior author. "Our findings highlight how financial, mental health, and healthcare access vulnerabilities are interrelated and contribute to COVID-19-related disparities that workers experience."

The researchers urge policymakers to consider how different factors may overlap when creating or strengthening policies to mitigate the social and economic disparities related to the pandemic.

Additional study authors are Sooyoung Kim, Shahmir Ali, Abbey Jones, and Ralph DiClemente of NYU School of Global Public Health.