Social Equity Amid COVID-19: Examining Health Disparities from the Perspective of Governmental and Social Responsiveness

• Published date: 01 January 2025
• DOI: http://doi.org/10.1177/02750740241284601
• Author: Jing Peng,Kaifeng Yang,Mengran Chu
• Date: 01 January 2025

Social Equity Amid COVID-19: Examining

Health Disparities from the Perspective of

Governmental and Social Responsiveness

Jing Peng

1

, Kaifeng Yang

2,3

and Mengran Chu

4

Abstract

While racial health disparities have long been studied, the literature has paid insuff‌icient attention to situations such as health

emergencies or pandemics and has generated conf‌licting results regarding some important explanatory variables. This article

considers the impact of governmental and social responsiveness on health disparities in a pandemic. The hypotheses are tested

with data from Florida’s 67 counties in COVID-19. The results indicate that minority representation on local commissions

inf‌luences local governments’responsiveness to the disparities, and local government forms moderate the impact of local

commission ideology and citizen ideology. The results also show that in counties with greater racial socioeconomic equality,

community social capital increases, rather than decreases, the racial disparities. The political participation gap between white

and black populations increases the disparities.

Keywords

health disparities, social equity, governmental responsiveness, social capital

Introduction

Social equity is at the heart of our understanding of public

administration (Frederickson, 1990) and racial disparity in

health outcomes is one of the big concerns. The persistence

of health disparities between Black and White Americans

has long been a puzzling issue in the United States: Black

Americans suffer more on almost every health index mea-

sured (Do et al., 2008; Dressler et al., 2005). As the

COVID-19 pandemic spread throughout the U.S., the fact

that racial minority groups experienced disproportionately

higher infection and mortality rates became a critical public

concern (Centers for Disease Control and Prevention, 2021;

Chowkwanyun & Reed, 2020; Hooper et al., 2020; Lopez

et al., 2021; Moore et al., 2020; Poulson et al., 2021; Van

Dorn et al., 2020; Wright & Merritt, 2020). This brings up

the old question: Why are racial minorities more vulnerable?

Health disparity is a multidisciplinary f‌ield that has attracted

attention from medical anthropology, public health, education,

environmental justice, sociology, and public policy (Warnecke

et al., 2008). Scholars have explored it at various levels. The

micro/individual level includes genetic/biological factors,

health behaviors, socioeconomic status, and psychosocial

stress from discrimination (Dressler, 1993; Dressler et al.,

2005). The meso level (groups, social networks, and com-

munities, etc.) includes interpersonal/ structural racism

(Williams & Collins, 1995) and the characteristics of neigh-

borhoods and communities such as residential segregation,

poverty, median household income, education, and social

capital (Israel et al., 1998; Uphoff et al., 2013; Williams

& Collins, 1995). The macro-level includes laws, policies,

ideologies, and political systems that produce or reproduce

structural racism (Berkman et al., 2000; Glass & McAtee,

2006; Warnecke et al., 2008).

Scholars have paid insuff‌icient attention to health dispar-

ities resulting from health emergencies or pandemics, such

as the COVID-19 pandemic. In such a pandemic, when gov-

ernments and citizens are not prepared, risks are not fully

known, human interactions are restricted, and regular govern-

mental and social functions are stopped or impaired, what

would affect health disparities? The research on COVID-19

1

Askew School of Public Administration and Policy, Florida State

University, Tallahassee, Florida, USA

2

School of Public Administration and Policy, Renmin University of

China, Beijing, China

3

School of Public Affairs and Administration, Rutgers University Newark

Campus, Newark, New Jersey, USA

4

School of Public Administration, Hubei University, Wuhan, Hubei, China

Corresponding Author:

Kaifeng Yang,School of Public Affairs and Administration, Rutgers University

Newark Campus, New Jersey, 07102.

Email: rucyang2013@outlook.com

This research is supported by Project 72342010, Theory and Institutional

Design on the Open Utilization and Authorized Operation of Public Data,

supported by the National Science Foundation of China.

Article

The American Review of Public Administration

2025, Vol. 55(1) 65–83

© The Author(s) 2024

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DOI: 10.1177/02750740241284601

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has touched on this issue and found a range of determinants,

some of which are “old culprits”in prior studies rooted in

non-pandemic settings, such as socioeconomic status (SES)

(Dalsania et al., 2022; Perry, 2021; Williams et al., 2022),

social vulnerability (Gaynor & Wilson, 2020; Kim &

Bostwick, 2020), physiological pathways, mental health

(Strully et al., 2021; Thomeer et al., 2023; Trammell et al.,

2023), and residential segregation and structural racism

(Siegel et al., 2021; Swietek et al., 2023; Tan et al., 2021).

The COVID-19 research also identif‌ied some new factors,

such as accessibility to internet and telehealth services

(Menon & Belcher, 2021; Press et al., 2021, March), and

living conditions related to housing size, work arrangements,

and adherence to social distancing measures (Carrión et al.,

2020; Chang et al., 2021; Kim et al., 2020a).

Nevertheless, existing studies have neglected some impor-

tant political and administrative factors salient in public

administration scholarship. Some factors have been used to

explain health disparities in normal settings but not in pan-

demics, such as policymakers’ideology and citizens’ideol-

ogy (Purtle et al., 2017; Rodriguez, 2019; Zhu & Clark,

2015). Some factors have been utilized in analyzing other

types of social equity gaps rather than health disparities,

such as representative bureaucracy (Liang et al., 2020;

Meier et al., 2005; Riccucci & Van Ryzin, 2017; Sowa &

Selden, 2003), political participation (Clark, 2018), and non-

prof‌it organizations (Cheng et al., 2022). Some factors have

yielded conf‌licting results in explaining health and racial dis-

parities, such as social capital (Hawes & Rocha, 2011;

Hawes, 2017; Hero, 2003). Overall, the health disparity liter-

ature on COVID-19 has not been well-integrated with the

social equity literature in public administration.

This article considers some “missing”variables to explain

the racial disparities amid COVID-19. From a governance

perspective, the outcomes of an emergency depend on the

responses from the government, society, and the market, par-

ticularly the former two. In a pandemic, especially in its early

stage, what contributes to the varying levels of responsive-

ness of government and society to the demands or needs of

racial minorities? This article considers the characteristics

of two main governance actors (elected off‌icials and citizens)

and the main institution arrangement connecting them (form

of government). Integrating political and social contexts of

local governance, this framework contributes to our under-

standing of health disparities in emergencies and our knowl-

edge about social equity in general.

Our empirical strategy addresses two potential pitfalls in

existing studies regarding health disparities in COVID-19.

Most existing studies do not compare models across different

waves of the pandemic or different health-related indicators.

People may be more cognizant and prepared during later waves

than in the f‌irst wave. Racial disparities may manifest distinct

patterns across various health outcomes, such as infection, hos-

pitalization, mortality, and vaccine rate. Investigating a range of

health outcomes across different pandemic waves, this article

offers a more complete understanding of the multifaceted

nature of racial disparities.

Theory and Hypotheses

While structural factors continue to play a role in explaining

health disparities amid COVID-19, disparities in a pandemic

are directly inf‌luenced by how different groups respond to the

situation. Individual exposure and behavioral adjustments are

shaped by how government and society cater to their needs,

with responses varying based on ethnicity. The public admin-

istration literature has highlighted the role of government and

society in preventing and responding to emergencies. On the

role of government, Stivers (2007) and Craemer (2010) are

skeptical about unfair governmental responsiveness based

on race, and a growing literature emphasizes the responsibil-

ity of local governments in grappling with rooted disparities

(Deslatte et al., 2020; Dzigbede et al., 2020; Gooden &

Rissler, 2017). Gooden et al. (2009) argue that it is the gov-

ernment’s responsibility to alter power imbalance and

provide additional assistance for disadvantaged groups. On

the role of society, the literature has emphasized the mecha-

nism of social resilience and responsiveness in effective

emergency management (Dzigbede et al., 2020; Johnson

et al., 2015; Mizrahi et al., 2021; Shi et al., 2020). Thus,

we propose a responsiveness framework to study the

factors that inf‌luence government responsiveness and social.

Governmental Responsiveness

Governmental responsiveness refers to the willingness and

ability of government off‌icials and institutions to address

the needs, concerns, and preferences of the public (Fossett

& Thompson, 2006; Yang & Callahan, 2007). In the

context of rooted disparities, local governments are the

“f‌irst responders”and their responsiveness to the needs of

vulnerable populations inf‌luences health disparities

(Deslatte et al., 2020; Dzigbede et al., 2020; Gooden &

Rissler, 2017). According to the public administration litera-

ture, the factors that incentivize elected off‌icials or county

councils to improve their responsiveness to racial disparities

include minority representation and the political ideology of

county commissioners, as well as the local institutional struc-

ture (Clark, 2018; Lewis & Hamilton, 2011; Matsubayashi &

Rocha, 2012; Yang & Callahan, 2007).

Minority Representation on the Commission. As key

decision-makers in a county, commissioners shape govern-

mental responsiveness and prioritize specif‌ic groups in

policy adoption and implementation. Scholars have linked

descriptive representation, to the representation of groups

by individuals who share their characteristics or experiences

(Hero, 1998; Pitkin, 1967; Preuhs, 2006), and substantive

policy representation (Phillips, 1998). It suggests that since

minority representatives share backgrounds with minority

constituents, they are strong advocates for reducing racial

66 The American Review of Public Administration 55(1)