Public health experts say these disparities are the consequence of decades of inequitable access to health insurance, lower quality healthcare, and reduced access to basic social and economic necessities.
Over the past several weeks, one heart-breaking report after another has highlighted COVID-19’s destructive impact on African Americans.
There’s the story of Kevin Franklin, a 56-year-old New Orleans resident who lost his mother and three older brothers to the novel coronavirus in the span of 10 days. There’s the equally tragic story of Sandy Brown, a Michigan woman whose husband and 20-year-old son died within three days of each other.
No matter where you look, you’ll find countless examples of Black Americans dying in alarming numbers.
This devastation isn’t just anecdotal, either. The latest Associated Press analysis of available state and local data (covering 24 states and five cities) shows that nearly one-third of those who have died from COVID-19 are Black, even though Black people represent only about 14% of the population in the areas covered in the analysis.
On Friday, the Centers for Disease Control and Prevention also released its first breakdown of COVID-19 case data by race, showing that 30% of patients whose race was known were Black, even though Black Americans make up only about 13% of the population in the United States. The federal data was missing racial information for 75% of all cases and did not include any demographic breakdown of deaths.
The trove of emerging data is making clear that those who have referred to the coronavirus as “the great equalizer“—implicitly arguing that the virus has affected everyone regardless of race, ethnicity, gender, sexuality, income, or zip code—are wrong. Though the virus is spreading in all parts of the country and world, the incontrovertible fact is that Black Americans are dying from coronavirus at far higher rates than their white peers.
Here’s a sampling of what that looks like at the local level:
- In Milwaukee County, Wisconsin, Black residents are only 27% of the population, but make up 41% of the county’s coronavirus cases and 53% of its deaths.
- In Chicago, Black residents represent only 30% of the population but account for 46% of all cases and 57% of all deaths. Statewide in Illinois, Black residents make up just 15% of the population, but represent 40% of deaths.
- In Louisiana, Black residents are just 33% of the state’s population, but comprise 59% of coronavirus deaths.
An earlier report from the CDC also showed that Black Americans made up 33% of hospitalized patients, despite comprising only 18% of the population studied in the report, “suggesting that black populations might be disproportionately affected by COVID-19.”
“Those numbers take your breath away. They really do,” Chicago Mayor Lori Lightfoot said of her city’s disparities during an April 6 news conference.
Public health experts say these staggering disparities are the consequence of decades of inequitable access to quality health care and basic social and economic necessities such as transportation, housing, education, and good-paying jobs.
“You Don’t Have Equal Access to Health Insurance“
Black Americans are more likely to lack health insurance than their white counterparts, and while the Affordable Care Act dramatically reduced that disparity, as of 2018, the uninsured rate among Blacks was 9.7%, while it was just 5.4% among whites. That disparity is driven in part by the refusal of Republicans in 14 states to expand Medicaid, the nation’s free or low-cost public health insurance program for low-income adults.
Eight of those states—Alabama, Georgia, Florida, Mississippi, North Carolina, South Carolina, Tennessee, and Texas—are in the South and all of them, except Texas, have a much higher percentage of Black residents than the U.S. as a whole. Not coincidentally, all eight states also have higher uninsured rates among Black residents and the overall population as a whole.
“If you’re in one of those states that did not expand Medicaid, you don’t have equal access to health insurance or access to care,” Dr. Georges C. Benjamin, executive director of the American Public Health Association, told COURIER.
These historical inequities have resulted in higher rates of chronic disease among Black people than their white counterparts. Black Americans suffer from higher rates of obesity, high blood pressure, diabetes, and heart disease, and Black children have a 500% higher death rate from asthma compared to white children.
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These chronic conditions put Black individuals at greater risk of dying from COVID-19, a disease that disproportionately kills those with pre-existing health conditions.
“We know that clearly these populations—because of the incidences of chronic disease—should they get infected, they’re going to get sick,” Benjamin said.
Black people also report higher rates of discrimination when seeking care, making them less likely to receive preventive health services and more likely to receive lower-quality care. Research has repeatedly shown that implicit bias has led many healthcare providers to dismiss Black patients’ concerns and often results in unequal treatment and unequal outcomes.
Most notably, a 2003 Institute of Medicine report on racial and ethnic disparities in health care found that “stereotyping, biases and uncertainty on the part of healthcare providers can all contribute to unequal treatment.” The study found that even white clinicians who don’t believe they are prejudiced “typically demonstrate unconscious implicit negative racial attitudes and stereotypes.”
“We see this with other diseases,” said Usama Bilal, an assistant professor of epidemiology at Drexel University in Philadelphia. “People of color, when they go to the hospital, they tend to have their symptoms dismissed. They tend to be sent home.”
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This implicit bias already appears to be playing out in the case of COVID-19. According to at least one analysis, doctors are less likely to refer Black Americans for testing when they show up at a clinic with symptoms of COVID-19. This can create a disparity in testing that leads to worse outcomes for Black people.
“People Need to Eat”
But access to quality health care is not the only factor. Black Americans disproportionately work the sorts of service jobs now classified as “essential,” such as public transportation workers, food service workers, postal service employees. As BuzzFeed reported earlier this month, data from the Bureau of Labor Statistics also shows that a disproportionate number of Black individuals work in the healthcare and personal care fields, which lead to exposure to potentially sick people.
“In many of these communities, the people most impacted, particularly minorities, are public-facing,” Benjamin said. “They’re the ones that are working in skilled nursing homes, they’re bus drivers, they’re in the grocery stores. There are many people in the service industry that are still working today and then you have the challenge, for many of these folks, they’re having to use public transportation, so they’re still out in the public domain going to work.”
While nearly 30% of white Americans are able to work remotely from the comfort of their living rooms, less than 20% of Black Americans and only 16% of Latinos are able to work from home, making it harder for them to follow social distancing guidelines.
“People have to continue going out to work,” Bilal said. “People need to eat. That’s the most basic human need … If you don’t have food, you won’t survive, and in our society, the way it is structured, you need money to buy food and therefore, you need to go to work.”
Many white Americans can count on savings or inherited wealth to get by, but Black Americans have far less wealth than their white counterparts. In 2016, the median wealth of white households was $171,000. That is 10 times the wealth of Black households ($17,100). This crushing disparity is the result of hundreds of years of racist U.S. government policy. While whites have been building generational wealth for centuries, Black Americans lived through slavery, Reconstruction, and Jim Crow era economic repression.
Black communities have also been disproportionately harmed by the crack cocaine epidemic, the “war on drugs,” the HIV/AIDS epidemic, and decades of mass incarceration, all of which have further fueled the wealth gap. These disparities have left Black Americans far less likely than their white counterparts to attain a Bachelor’s degree, which is a key driver of the black-white pay gap.
As a result, Black Americans are more than twice as likely as white Americans to live in poverty, which makes them particularly vulnerable to economic downturns like the one being caused by the coronavirus. So, as Bilal noted, in order to eat, they have to continue working.
Black Americans, as well as other communities of color, also disproportionately reside in densely populated metropolitan areas, have suffered from segregation and redlining, and endure more exposure to air pollution from automobiles and refineries. All of these factors make them uniquely vulnerable to suffering the worst impacts of COVID-19.
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The Trump administration’s failure to manage the outbreak decisively also impacted the African-American community in a unique way. The early days of the outbreak saw rampant misinformation and confusing, inconsistent communication from the federal government, which created a void that was quickly filled by rumors and conspiracy theories positing that Black people were immune to the coronavirus.
“Initially, this whole issue that African Americans in particular were immune to the virus probably delayed people in social distancing initially,” Benjamin said. “People are getting the message now, but not fast enough.”
So all that talk of the virus being an equalizer among all people? It’s just that, Benjamin said: Talk.
What this pandemic does highlight, according to Bilal, is the legacy of structural racism. “What we’re seeing now is the long-term consequences of centuries of racism,” he said. Rather than equalize things, Bilal believes the coronavirus is “actually widening disparities.”
Not only are Black Americans dying in shocking numbers, but they’re also being economically devastated by the coronavirus. Nearly 22 million Americans have filed for unemployment benefits in the past three weeks, but the crush of job layoffs that have rippled across American society has disproportionately harmed communities of color. A recent survey by Data for Progress found that nearly half (45%) of Black Americans have lost jobs, hours, or been put on leave, compared to only 31% of white Americans.
The federal government passed a $2 trillion coronavirus emergency relief bill that expanded unemployment benefits and will direct one-time $1,200 payments to every American earning under $99,000, but Bilal said those decisions, as “extreme” as they might seem, won’t level the playing field. Instead, Black Americans and other marginalized communities will bear the brunt of the devastation caused by the coronavirus.
There’s ample precedent for Bilal’s argument. During and after the 2008 great recession, Blacks, Latinos, Native Americans, and other communities of color were hit the hardest. The median wealth of middle-class Black Americans plunged to $33,600 in 2013, a 47% decrease from pre-recession levels. For Hispanics, median wealth fell to $38,900, a 55% decline from 2007. White families, in contrast, only saw their median wealth decline by 31% to $131,900, according to the Pew Research Center.
This doesn’t have to happen again, of course. “The economic aspect depends on how we react as a society and what the government does. The government could use this opportunity to implement a lot of wonderful measures,” Bilal said. “Is it doing that? I think we’ve seen the answer to all of that.”
“Without Racial Data, We Can’t See Racism“
As for addressing the racial disparities in COVID-19 mortality rates in the short term, both Benjamin and Bilal said more data is essential.
“The biggest issue is we just don’t have the data, we don’t have enough racial and ethnic data,” Benjamin said. “It’s very important, because you can’t target resources if you don’t know where the problem is.”
Once more data becomes available, Benjamin said efforts can be made to “aggressively engage” the hardest-hit communities through radio and social media ads, faith leaders, and other mediums to increase awareness. He also said data was critical to do what he described as “shoe-leather epidemiology,” or identifying cases and working proactively to slow the spread of the virus.
Bilal also added that more data would direct officials to administer tests more strategically to identify cases and isolate them. (This assumes, of course, that there are enough tests for everyone who needs one, which so far, there haven’t been.)
Perhaps no one has better made the case for the importance of data than Ibram X. Kendi, director of the Antiracist Research and Policy Center at American University.
“Without racial data, we can’t see whether there are disparities between the races in coronavirus testing, infection, and death rates,” Kendi wrote in the Atlantic. “If we can’t see racial disparities, then we can’t see the racist policies behind any disparities and deaths. If we can’t see racist policies, we can’t eliminate racist policies, or replace them with anti-racist policies that protect equity and life. Without racial data, we can’t see racism, and racism becomes like asymptomatic carriers — spreading the virus, and no one knows it.”
Many agree that more robust data is needed, including Democratic lawmakers and the presumptive Democratic presidential nominee Joe Biden. Four hundred health professionals also wrote Department of Health and Human Services Secretary Alex Azar a letter on April 6, pressuring him to release data on minority access to coronavirus tests.
Beyond better data, Benjamin also said the government needs to step up and increase funding, expand access to testing, invest in communications and outreach to Black communities, and perhaps most importantly, increase funding for Medicaid and push states that haven’t expanded Medicaid to do so.
“They’re going to have to put more money on the table,” he said.
In the long run, however, Benjamin argued that if the U.S. is to truly address racial health disparities, then the government will need to both dramatically increase its investment in public health and in social programs that ensure the well-being of all Americans.
“Eighty percent of what makes you healthy occurs outside the doctor’s office. After this, for our whole society, we’re going to have to think about what are the social structures that we have in place that put more people at risk,” Benjamin said. “As a nation we spend far less on social services compared to healthcare costs than all the other industrialized nations … If you gave me the $4 trillion we’re probably going to spend on this, I could have found a much more efficient way to prevent a lot of this stuff on the front end.”
“Eighty percent of what makes you healthy occurs outside the doctor’s office.”
Creating a stronger social safety net is critical to stamping out the next pandemic before it arises, Bilal said.
“Even if we have the testing and contact tracing and isolation, that doesn’t work unless we have a social system that allows people to stay at home if they are sick. That’s fundamental for the control of infectious diseases,” Bilal said. “If people cannot stay at home and survive because they won’t have money to buy food, then they won’t stay at home and we won’t stop the spread of infectious diseases.”
The Associated Press contributed to this report.
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