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Much of the research on the mental health impacts of the COVID-19 response have been focused on frontline healthcare workers (FHCW). However, other essential workers (OEW) have also faced many mental health challenges due to exposures associated with their employment status, which may be compounded by higher levels of social vulnerability. This chapter describes disparities among FHCW, OEW, and the general public regarding mental health outcomes associated with the pandemic. In addition, it considers the role that structural racism (e.g., historical redlining of neighborhoods and biased lending practices) plays in the higher vulnerability of OEW to the mental health impacts of the COVID-19 pandemic response. Mental health inequities overall, and among essential workers, must be addressed as part of the recovery from COVID-19 to build resilience to future public health emergencies. The model used by New York City to more equitably distribute mental health resources and support services is shared.

Since the development of the COVID-19 vaccinations, questions surrounding race have been prominent in the literature on vaccine uptake. Early in the vaccine rollout, public health officials were concerned with the relatively lower rates of uptake among certain racial/ethnic minority groups. We suggest that this may also be patterned by racial/ethnic residential segregation, which previous work has demonstrated to be an important factor for both health and access to health care.

In this study, we examine county-level vaccination rates, racial/ethnic composition, and residential segregation across the U.S. We compile data from several sources, including the American Community Survey (ACS) and Centers for Disease Control (CDC) measured at the county level.

We find that just looking at the associations between racial/ethnic composition and vaccination rates, both percent Black and percent White are significant and negative, meaning that higher percentages of these groups in a county are associated with lower vaccination rates, whereas the opposite is the case for percent Latino. When we factor in segregation, as measured by the index of dissimilarity, the patterns change somewhat. Dissimilarity itself was not significant in the models across all groups, but when interacted with race/ethnic composition, it moderates the association. For both percent Black and percent White, the interaction with the Black-White dissimilarity index is significant and negative, meaning that it deepens the negative association between composition and the vaccination rate.

The analysis is only limited to county-level measures of racial/ethnic composition and vaccination rates, so we are unable to see at the individual-level who is getting vaccinated.

We find that segregation moderates the association between racial/ethnic composition and vaccination rates, suggesting that local race relations in a county helps contextualize the compositional effects of race/ethnicity.