The effects of the COVID-19 pandemic have been vast and far-reaching. In addition to generating widespread health concerns, the pandemic has left many vulnerable individuals and communities struggling to meet their needs.
From housing and food insecurity in low-income households, to gaps in the foster care system, to systemic oppression and violence against people from racial and ethnic minority groups, the pandemic disproportionately affects vulnerable and marginalized communities across the country.
How can social work serve vulnerable populations? Social services experts start by considering the social determinants of health that affect populations that social workers engage with.
Social workers can then turn to research to learn best practices for supporting the vulnerable among us during these unprecedented times. Each case is different, but experts notice patterns to the challenges faced by children in foster care, older adults, refugees and immigrants, people from racial and ethnic minority groups, and survivors of gender-based violence.
Social Determinants of Health and Social Work Populations
Crises like the pandemic drive home the reality that an individual’s health and well-being is determined by a large extent by social and environmental factors. The following five social determinants of health contribute to vulnerable populations being disproportionately affected by crises like the pandemic, according to the Centers for Disease Control and Prevention (CDC).
1. Neighborhood and Physical Environment
The environment that a person works and lives in affects their health. Communities that social workers work with may experience multiple challenges during the pandemic with respect to housing and transportation.
- People from vulnerable groups face challenges finding safe, affordable housing. Vulnerable populations often live in crowded conditions that make it easier for the virus to spread.
- Vulnerable populations may lack access to reliable transportation to work, school and health care facilities. This can delay visits to testing centers and other medical facilities.
- Lack of access to nutritious, affordable food increases the chances of contracting illness and staying sick longer. People with preexisting conditions like diabetes and obesity, which can be harder to manage in vulnerable groups, are at especially high risk of suffering adverse reactions to COVID-19.
- Long-term exposure to environmental pollutants worsens health outcomes for vulnerable populations. As with a lack of a nutrient-rich diet, environmental factors may put someone at a higher health risk, which can exacerbate COVID-19 symptoms.
- Gender-based violence has increased during lockdowns. People who experience violence at home may be spending more time in close quarters with an abuser with fewer options for support.
2. Access to Health Care and Treatment
Not everyone has the same access to health care, and not everyone receives the responsive health care treatment they deserve. Inequities in health care and treatment during the pandemic disproportionately affect certain groups of people.
Vulnerable populations are disproportionately underinsured and may lack access to quality health care. As a result, some people don’t seek care until the last minute, leading to worse health outcomes. People of color, refugees, and immigrants may lack access to culturally responsive health care. People may experience microaggressions (slights against a person based on their race, ethnicity, gender or other identity marker). Some people may need to make life-or-death treatment decisions without a translator who speaks their primary language.
Vulnerable people may put off visits to the doctor out of fear of devastating medical bills. Although much treatment for COVID-19 is subsidized by the government, families may still delay treatment, fearing out-of-pocket expenses. For some, seeking medical treatment may come with additional fears of deportation. Barriers to proper care and inequities in treatment can result in a distrust of health care systems, leading to worse health outcomes for vulnerable populations in the long term. Many people have looked to pseudoscience alternatives for treating COVID-19 at home to avoid professional medical visits.
3. Occupational Hazards and Working Conditions
Given changing social distancing guidelines, and fears and anxieties about viral spread, many people have struggled to continue to work amid adverse conditions during the pandemic.
- Vulnerable populations have been disproportionately unemployed and underemployed prior to and during the coronavirus pandemic. That means less financial security for already vulnerable populations since the start of the pandemic.
- Those who are still able to work have faced chronic stress and adverse working environments during the peak of the pandemic and its aftermath.
- Essential workers have a high degree of exposure to the coronavirus and may not be able to physical distance. These workers include those who work in farms, factories, food production and processing, grocery stores, health care facilities and public transportation.
- Many essential workers lack benefits such as paid sick days. That means some essential workers feel pressured to go to work when they are sick.
- People from racial and ethnic minority groups are disproportionately represented in essential work environments. With more people of color on the front lines, that means more health risk for communities of color at large.
4. Financial Barriers and Stressors
Vulnerable populations struggle to survive without a social safety net. Financial problems accumulate quickly, and the stress of financial burdens can be devastating.
- Vulnerable populations tend to have lower incomes and carry greater debt than the general population. These financial challenges pile on additional stress during the pandemic.
- Expenses such as child care and elder care worsen existing financial barriers to health and wellness for vulnerable people. During the pandemic, families have struggled to find child care alternatives, resulting in more women leaving the workforce to bear the burden of caring for their children.
- Barriers to wealth accumulation, including systemic racism, perpetuate social inequalities. When crises like pandemics occur, communities of color have fewer collective resources to tap into.
Unexpected job loss, child care needs and limited social safety nets are not problems unique to the pandemic; however, the pandemic has amplified existing financial stressors, putting the most strain on already vulnerable populations.
5. Education and Challenges with Schooling During A Pandemic
Vulnerable populations face inequities with respect to access to quality education. During the pandemic, this situation has been exacerbated.
- Limited access to quality job training and programs tailored to the language needs of some racial and ethnic minority groups may limit job opportunities and lead to unstable, underpaid work.
- For students from vulnerable populations, online school during the pandemic is especially challenging. Students may lack access to reliable internet, privacy to complete their school work and the oversight provided by in-person classes.
- Students previously receiving free or reduced school meals may not have access to adequate nutrition during the pandemic, making focusing on school even harder.
Even before the pandemic, education systems did not serve the needs of every student. Despite the best efforts of teachers, administrators, clinicians and parents to adapt to new modes of instruction, virtual schooling has made getting an education even harder for vulnerable populations.
The Crucial Role of Social Workers During Crisis
More than ever, social workers must advocate for vulnerable people during the COVID-19 pandemic. Specific groups face unique challenges that have been worsened in the context of social distancing, lockdowns, fears of viral spread, the disruption of routines, and personal and collective grief.
Learn about some of the challenges specifically related to the pandemic that are being faced by children and youth in foster care, older adults, refugees and immigrants, people of color and ethnic minorities, and people who endure gender-based violence.
Foster Children and Youth in the Pandemic
The coronavirus crisis disrupts children and families in foster care. Fear of spreading the virus stymies normal foster care processes.
Vaccine Transmission Stigma
At a time when children need connection and reassurance, most visits between birth parents and children in foster care have been switched to phone calls or even suspended. In the few places that permit face-to-face family time, no touching is allowed — even between parents and babies.
Across the nation, foster care parents closed their homes to new foster children after the pandemic hit. Some fear that bringing unvaccinated children into their home is a risk they are unwilling to consider — even when the children test negative for the virus.
According to the Marshall Project, some child welfare investigators have been conducting investigations from the front door or via video chat to slow the viral spread. But these measures could increase the risk that unsafe or abusive conditions may go undetected if investigations aren’t being conducted inside homes.
The result of these pandemic-driven changes? Children and youth in foster care have fewer places to go and fewer responsible adults to rely on, less physical affection and greater risk of experiencing loneliness, depression and anxiety.
Troubles in Child and Family Court
Because of social distancing requirements, court systems ground to a halt during lockdown, which in turn delayed final determinations of court-ordered foster care. This has left legal decisions in limbo as courts nationwide suspended hearings indefinitely.
Juvenile courts and dependency courts have also functioned at a much slower pace during the pandemic, delaying reunions between children or youths and their families.
Caring for Older Adults Amid the Coronavirus
Older adults face specific challenges with respect to COVID-19. The coronavirus spread especially quickly in nursing homes, skilled nursing facilities and assisted living facilities where residents are more likely to have preexisting severe chronic health conditions. Because of the inherent physical decline experienced in advanced age, older adults are at the highest risk of succumbing to the virus.
Costs of Social Isolation
To slow the spread, the Centers for Medicare and Medicaid Services (CMS) announced that medical facilities must temporarily prevent all family and nonmedical visits, leaving many residents socially isolated.
Social deprivation leads to depression and anxiety, and seniors have been especially vulnerable to loneliness during the pandemic. The AARP says that social isolation and loneliness have an adverse health effect on par with smoking 15 cigarettes a day.
Supporting Survivors of Gender-Based Violence
Lockdown orders increase risks for gender-based violence or domestic violence. Added financial and emotional strain on households during the pandemic and restrictions on movement can confine survivors of domestic abuse to their homes, where they may be forced into continual contact with an abusive person.
Underreporting and Lack of Confidentiality
Confidential reporting of domestic violence has become increasingly difficult during the pandemic, as many people have had to shelter in place with their abusers and with limited contact with the outside world.
Abusers may restrict the activity of family members, limit their access to mobile phones and monitor their internet activities. With the close quarters and limited activities imposed by the pandemic, people experiencing domestic violence face even greater challenges now than in pre-pandemic times to access support networks.
Limited Community Resources
Lockdowns have rendered some safe houses and shelters for survivors of domestic violence unavailable. People seeking help may also be unable to travel to safe houses and shelters because of public transportation restrictions caused by the pandemic.
Some safe houses and shelters that have continued to offer services addressing domestic violence during the pandemic report a backlog of people awaiting help.
Domestic Burdens and Lack of Financial Agency
UNICEF reports that women and girls are less likely than men to control household finances. As poverty levels increase during the pandemic, they may be further deprived of economic agency.
Women still shoulder the majority of unpaid housework in the U.S. (such as child care, cleaning and cooking). Pandemic-related school closures resulted in women and girls forgoing paid work to take on unpaid child care responsibilities in the home.
UNICEF also reports that women were disproportionately affected by pandemic-related job losses. According to CNBC, more than 2.3 million women have left the workforce since the start of the pandemic in spring 2020. Women have not had such low labor participation rates since 1988, according to the National Women’s Law Center.
According to the September 2020 “Women in the Workplace” report from Lean In and McKinsey & Company, 1 in 4 women are considering leaving the workforce or “downshifting” (taking a less-demanding job) in their careers in response to the pandemic.
Responding to Refugees and Immigrants
Social workers are trained in culturally responsive care so that they are prepared to support refugees and immigrants in crisis. These groups face uniquely difficult challenges during pandemics, as social distancing and seeking adequate medical care may be difficult — many refugees and immigrants work in front-line agricultural or factory jobs where social distancing to avoid virus spread is hard to maintain.
Detained Immigrants and Refugees
Incarcerated people are at a higher risk for disease spread, and that includes potential immigrants and refugees detained at the U.S. borders. Activist groups such as the Vera Institute for Justice call for the U.S. government to prevent the spread of the coronavirus in an overloaded immigration system that they say has not done enough to protect these vulnerable populations.
According to the Vera Institute, “claims of medical neglect and abuse are rampant” in U.S. detention centers. Additional problems include “[lack of] access to sanitizing products and protective equipment” and the inability to achieve social distancing “without harmful isolation.”
Investigators raise alarms about overcrowding and extended detentions, both of which pose immediate health risks. In 2020, in response to public backlash, U.S. Immigration and Customs Enforcement announced it was curtailing immigration arrests due to concerns of coronavirus spread in detention facilities. But further measures are needed.
Supporting Immigrant and Refugee Families
The National Association of Social Workers has called for taking drastic measures to support immigrant and refugee families during the pandemic. Advocates rallied for “immigration enforcement-free zones” that would allow individuals to seek out medical services without fear of deportation. This policy initiative has been supported by over 800 public health and human rights experts.
Under the February 2020 Public Charge Final Rule, U.S. government officials can deny green cards to immigrants who currently use, or may use, government benefits. That includes Medicaid and other public health programs. The U.S. Citizenship and Immigration Services stopped applying the Public Charge Final Rule in March 2021.
During a pandemic, immigration or refugee status should not be a barrier for families who need to access life-saving medical care.
Empowering People from Racial and Ethnic Minority Groups
Racial discrimination and systemic oppression negatively affect health. These social determinants of health are especially crucial to consider during public health crises.
Racial and ethnic minority groups already experience high rates of certain chronic diseases that can lead to more severe cases of COVID-19. These diseases include diabetes, high blood pressure and kidney disease.
Early data reflect a health care system that still privileges wealthy white people. Black Americans have been disproportionately exposed to COVID-19, according to the CDC. In some parts of the country, clinics and drive-through testing sites popped up quickly in historically white neighborhoods but lagged in Black neighborhoods.
Misinformation and Distrust in Government Interventions
As ProPublica reports, many communities of color were initially skeptical of shelter-in-place orders. For many, lockdown orders smacked of other oppressive governmental interventions that restricted the movement and gathering of people of color, including segregation and mass incarceration.
Misinformation has hurt people from racial and ethnic minority groups during the pandemic too. In spring 2020, as the virus spread in the U.S., rumors and conspiracy theories circulated claiming that Black people were somehow immune to or less vulnerable to the disease. False assumptions like these allowed the virus to spread rapidly in communities of color.
Asian Americans have been subjected to increasing violence during the pandemic. Advocates and activists say that racist rhetoric blaming Asian people for the spread of COVID-19 has led to a surge of hate crimes against Asian American and Pacific Islander (AAPI) people.
In late 2020, the United Nations issued a report detailing an “alarming level” of racially motivated violence against Asian Americans. The advocacy group Stop AAPI Hate reported over 2,800 hate incidents directed at Asian Americans in 2020. Social workers supporting these individuals and families during the pandemic must prepare to help with emotional support.
How Social Workers Support Vulnerable Populations
The pandemic has pushed families and social services to the brink. Social workers dedicated to serving vulnerable populations with culturally responsive care have supported people and families who experienced tremendous stress, grief, loneliness, injustice and hardship during this chaotic time.
Social workers help at all levels of health care response. On the ground, social workers can help individuals adapt and learn new coping skills, and navigate the complex medical and legal systems that so many have come into contact with during the pandemic. Social workers assist communities in creating self-sustaining systems in which everyone has access to basic needs, including food, housing, income and health care.
Social workers, from a bird’s-eye view, can also point out where systems are breaking down, and what policies need modification to improve public health and safety.
Crucially, social workers are well-positioned to help individuals, families and communities rebuild after the pandemic and reimagine better health care systems equipped to address future public health crises.
Trauma-Informed, Culturally Responsive Care
Learn how social workers support populations during unprecedented crises. Virginia Commonwealth University offers an advanced degree program in social work that equips social workers with the necessary skills to empower vulnerable populations.
Whether in clinical social work, social work administration or policy practice, Virginia Commonwealth University’s emphasis on trauma-informed, culturally responsive care prepares students for the needs of diverse communities.
If you’re interested in clinical practice, learn more about Virginia Commonwealth University’s online Master of Social Work to see how social workers can support vulnerable populations in need. This online Master of Social Work program is clinical track only, providing students with the tools they need to provide counseling as well as the medical knowledge needed to support clients in clinical settings.