How limitations in energy access, poverty, and socioeconomic disparities compromise health interventions for outbreaks in urban settings

Abstract

Low-income households (LIHs) have experienced increased poverty and inaccess to healthcare services during the COVID-19 pandemic, limiting their ability to adhere to health-protective behaviors. We use an epidemiological model to show how a households' inability to adopt social distancing, owing to constraints in utility and healthcare expenditure, can drastically impact the course of disease outbreaks in five urban U.S. counties. LIHs suffer greater burdens of disease and death than higher income households, while functioning as a consistent source of virus exposure for the entire community due to socioeconomic barriers to following public health guidelines. These impacts worsened when social distancing policy could not be imposed. Health interventions combining social distancing and LIH resource protection strategies (e.g., utility and healthcare access) were the most effective in limiting virus spread for all income levels. Policies need to address the multidimensionality of energy, housing, and healthcare access for future disaster management.

Keywords: Energy policy; Energy sustainability; Social sciences; Sociology.

Graphical abstract

Figure 1

County cases and deaths for novel COVID-19 infection Differences in un-fitted model outcomes across counties due solely to differences in demographic and socioeconomic make-up over the first 120 days after the first identified case.

Figure 2

Outbreak curves over time in the un-fitted, “do nothing” scenario The left column shows symptomatic infectious cases overtime in each socioeconomic category of households in each county. The right column shows cumulative deaths over time in each socioeconomic category of households and as an all-households total in each county. Panels A and B show the Allegheny un-fitted cases and deaths, panels C and D show the Hidalgo cases and deaths, panels E and F show the Los Angeles cases and deaths, panels G and H show the Oakland cases and deaths, and panels I and J show the Philadelphia cases and deaths.

Figure 3

Effect of interventions on symptomatic cases in the different counties for un-fitted outbreak Delta labels indicate the percentage improvement from the combined strategy above that achieved by social distancing alone.

Figure 4

Effect of interventions on symptomatic cases in the different counties for a COVID-19 fitted outbreak Delta labels indicate the percentage improvement from the combined strategy above that achieved by social distancing alone.