College of Social Sciences, UH Mānoa

The lens of social equity

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When COVID-19 descended on the world in early 2020, it didn’t just impact people’s physical health. From the perspective of medical sociology, researchers discovered how higher rates of psychological distress were being experienced by women, racial/ethnic minorities, young people and those with lower household incomes.

Three researchers at the University of Hawaiʻi used survey data to name and explain these social challenges, and also to develop solutions to address the economic, political and environmental factors shaping health. Plus, they completed their research and published three scientific articles within a matter of only 12 months – an impressive academic accomplishment.

Common across all three papers was the finding that the pandemic was not only a medical issue but also economic and social issues, with disparate impacts due to age, gender, household income and race. Since complex challenges like COVID-19 can be eased by solutions that meet needs and build people’s capacity to adapt, the researchers’ recommendations include:

  • Working with local agencies to offer access to income, shelter, food and medical care for vulnerable social groups at higher risk of psychological distress.
  • Increasing the capacity of community nonprofits and government agencies that provide mental health peer support and clinical services.
  • Building Hawaiʻi’s capacity for local economic sustainability to protect access to jobs that pay a living wage, which will prevent high rates of psychological distress connected with the loss of household income.

“We’re very proud that our disparity analysis documented the mental health consequences of this once-in-a-generation stressor. It led to publication of papers in two internationally respected journals and a local journal featuring research on Hawaiʻi’s public health issues,” said Professor Wei Zhang, chair of the Department of Sociology. “We hope our research will help policymakers develop effective strategies to build community resilience and support the most vulnerable populations across our islands.”

The research was conducted by Zhang, sociology graduate student Margie Walkover, and Yan Yan Wu, associate professor of epidemiology in the UH Office of Public Health Studies. The trio examined regional and demographic disparities in self-reported mental health symptoms experienced during the pandemic in Hawaiʻi and on the U.S. continent.

“Our findings demonstrated that the precipitous increase in psychological distress experienced throughout 2020 was strongly associated with COVID-19 infection, and that some geographic areas and social groups were impacted more than others,” said Zhang. “For the U.S. population as a whole, younger age groups and women showed significantly higher prevalence of distress than older age groups and men. This demographic was also found in the State of Hawaiʻi.”

The three papers and their findings were:

“Trends in psychological distress and COVID-19 incidence across 15 U.S. metropolitan statistical areas in 2020” – published in Social Science & Medicine, July 2021.

  • COVID-19 and its complex ecology of social and economic stressors were associated with high levels of sustained psychological distress across all major metropolitan areas of the U.S. during 2020.
  • Higher rates of distress were identified in western and southern regions experiencing the syndemic (when two or more complex and several social stressors happen at the same time) of COVID-19 with extreme climate events, such as highly destructive wildfires and intense hurricanes.

“The challenge of COVID-19 for adult men and women in the U.S.” – published in Public Health, July 2021.

  • Younger adults and females were impacted more substantially than others during the pandemic.
  • Mitigating the high rates of psychosocial distress associated with the pandemic will require increased access to social and economic resources.

“Prevalence of Psychological Distress in Hawaiʻi” – published in the COVID-19 “Special Issue” of the Hawaiʻi Journal of Health & Social Welfare), October 2021.

  • Vulnerable social groups such as young adults, females and racial/ethnic minorities experienced high levels of psychological distress over the pandemic.
  • Asians experienced a lower prevalence of distress compared to other racial/ethnic groups.

Next research steps include supplementing the statistical findings with in-depth interviews of Hawaiʻi’s most vulnerable populations, including young females, to understand their perceptions, experiences, struggles and concerns. In addition, the researchers sent their results to the American Public Health Association, which asked the UH team to facilitate a work group. The goal: to bring together national researchers to study the impact of COVID-19 and extreme climate events on psychological distress.

“We’d also like to research diverse views toward vaccination with the aim of supporting COVID-19 prevention and containment strategies,” said Zhang. “We want to build on national findings demonstrating the impact of community resilience strategies on the psychological distress levels of residents. This research is designed to help local, state and national leadership see the need for interventions that might mitigate – not only the medical – but the economic and social conditions associated with the pandemic.”


Additional news stories from the College of Social Sciences.

Wei Zhang
Wei Zhang
Margie Walkover
Margie Walkover