Novel coronavirus doesn't discriminate, but legacy of racism creates harsher consequences for black people

2020-04-19 | The San Diego Union-Tribune

April 19--The current COVID-19 pandemic is both revealing and reminding. It's revealing that the accommodations people needed in order to do things like work from home; to receive assistance with, or deferment from, certain bills during times of financial hardship; or that valuing and respecting service workers, was possible and could be done. And then this virus is reminding us of the ways in which structural racism and inequality infect multiple areas of people's lives. For black people, the systems and institutions that have been built on and sustained by this racism, repeatedly leave us suffering greater consequences.

Early this month, numbers were being reported from a number of states that black people are contracting and dying from this virus at higher rates than white people. While black people already had higher rates of underlying chronic illnesses — which cannot be separated from environmental injustice, food deserts, employment discrimination in hiring and pay, subjection to substandard housing, and other systemic issues — this virus has magnified how that kind of sustained discrimination can make a crisis much more dangerous.

Dr. Uché Blackstock is a board-certified emergency medical physician and the founder and CEO of Advancing Health Equity, which partners with health care organizations to address the effects of structural racism on health outcomes through training, consulting and speaking engagements. She spoke with me to discuss the disparities being experienced in black communities with regard to COVID-19 and what can be done to address them. (This email interview has been edited for length and clarity.)

Q: For at least the past week, we've seen a number of reports about how black people are experiencing higher rates of infection and death from COVID-19. What are some of the reasons why black communities are being hit so much harder by this virus?

A: The reasons why black communities have been hit disproportionately harder than other communities are multifactorial. Black communities have been placed at risk for contracting coronavirus and suffering from COVID-19 due to carrying a high chronic disease burden, being more likely to be exposed as essential workers, being more likely to live in crowded housing, having less access to testing and health care, provider bias, and being more likely to live in areas with minority-serving hospitals, which deliver lower quality care.

Q: Government agencies have been under pressure to more accurately track and report the racial data around who is testing positive for this virus. What kind of insight does information about race provide in these kinds of situations?

A: We need to know the racial and ethnic demographic data for COVID-19 testing, cases and deaths to determine if there are any discriminatory practices occurring with regard to testing and care, and also to know which racial groups are being disproportionately impacted in order to allocate resources like testing, contact tracing [identifying and reaching out to all of a COVID-19 patient's recent contacts], health care workers, and ventilators in an equitable fashion.

Q: When we talk about how black communities have historically experienced higher rates of chronic illnesses — like asthma, diabetes, heart disease — what is some of the history behind this? In what ways has structural racism contributed to these issues?

A: What we are seeing now, in terms of the racialized health disparities, is deeply rooted in the history of structural racism in this country. During slavery, which occurred over centuries, black people had no access to health care or wealth. During the Black Codes and Jim Crow, there was unequal access to health care and wealth due to government policies like redlining [denial of loans or other services based on race] and the GI Bill. The higher rates of chronic disease in these communities are essentially the manifestation of disinvestment and marginalization of black communities through inequities in housing, education, employment and access to health care.

Q: How do things like race and class affect a person's health?

A: Race and class are tightly linked in this country. Black people in this country have the worst health outcomes regardless of socioeconomic and educational backgrounds. Structural racism is a key driving force in the social determinants of health: individual resources, neighborhood resources, hazards and toxic exposures and opportunity structures.

Q: What should we be doing to address the disparities we're seeing now?

A: We must act urgently and intentionally to address racialized disparities in this pandemic. In black communities, we need targeted COVID-19 testing, contact tracing, outreach to community members through community-based organizations, personal protective equipment for all essential employees, and additional health care workers, ventilators and other resources in hospitals.

Q: What is this current pandemic revealing about our health care system and how it serves the most vulnerable among us?

A: The current pandemic is exposing pre-existing inequities in the health care system and in our society. Racialized health disparities have been both persistent and profound, despite advances in health care technology. The fact that we are seeing black communities being disproportionately impacted by COVID-19 (and the fact that black women have the highest maternal mortality rate regardless of socioeconomic background or education), speaks volumes about the overarching reach of structural racism on black communities in this country.