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Across the US, people of color are more likely to contract a dangerous case of the coronavirus, ending up in critical care, or dying from COVID-19.
Much has been made of the pre-existing conditions that undergird this racial disparity, such as higher rates of diabetes, asthma, lung disease, hypertension, and obesity in communities of color.
But the truth is that people of color are not naturally more likely to develop these conditions, or the coronavirus, but they are far more often subjected to health-affecting hardships than whites.
A government report in the UK found “historic racism and poorer experiences of healthcare or at work” put people of color at a higher risk of dying from the coronavirus. Experts told Business Insider the same is true in the US.
The coronavirus is killing a disproportionate share of Black and brown Americans, especially young ones.
As of June 6, the US Centers for Disease Control and Prevention has estimated that Black Americans aged 35-44 years old are 10 times more likely to die from COVID-19 (the illness caused by the coronavirus) than their white counterparts. Latinx people in the same age bracket are eight times more likely to die than whites.
Much of the discussion to date about why people of color are at a higher risk of contracting deadly cases of COVID-19, or ending up in the hospital with some of the most severe illnesses, has hinged on underlying medical conditions.
“Health disparities have always existed for the African-American community,” Dr. Anthony Fauci, the US’s leading infectious disease expert, said in an April White House press briefing.
Fauci said the racial gap in COVID-19 disease and death is a result of “underlying medical conditions — the diabetes, the hypertension, the obesity, the asthma,” which are all more prevalent in communities of color.
But all of this talk of pre-existing conditions obscures a hidden truth: race is not what is making Black people more vulnerable to those illnesses, or to COVID-19. Racism is.
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“Opportunity and exposure are not equally distributed, especially by race, in this country,” Dr. Camara Jones, an epidemiologist and physician with affiliations at Morehouse, Emory, and Harvard universities, told Business Insider.
“COVID-19 has unmasked the structural racism in this country.”
“Race” is not what makes people sick
What is different is how we are treated, which has a dramatic impact on our access to care, fresh food, and exposure to dangerous environments.
That means the rate of Americans of color with heart conditions, diabetes, asthma, and obesity is high, but Jones warns there is still a deep misunderstanding about why that is the case.
“We have to make sure that people understand that race is not biology,” Jones said. “This false narrative of biologically-based differences in the races? It has been debunked.”
Wizdom Powell, Director of the Health Disparities Institute at UConn Health, told Business Insider there are serious ramifications of this misunderstanding.
“If you promote an idea that biology or genetics are solely driving a problem, and if that problem is located in the bodies of stigmatized or other populations, then, really, the empathy disappears. And when empathy disappears policies to address and bridge those disparities also disappear.”
One recent study found that “structural factors including health care access, density of households, unemployment, pervasive discrimination, and others,” are what is driving COVID-19 disparities, and “not intrinsic characteristics of Black communities or individual-level factors.”
It’s not unique to the US. In the UK, a government report this week found that “historic racism” was the “root cause” of the pandemic’s outsized impact on people of color. Anyone who wasn’t “White British” was at higher risk of death from COVID-19, the report said.
Public health messaging has fanned the idea that personal choices can change the odds for people of color
The problem is perpetuated, Jones said, in public health messaging, where “race” often becomes a “rough proxy” for class and opportunity, and puts the onus on people of color to change their own circumstances.
Even US Surgeon General Jerome Adams (who is Black himself, and has spoken about facing racism on a daily basis) has suggested that personal choices could shift the needle.
“We do not think people of color are biologically or genetically predisposed to get COVID-19,” Adams said, during a White House press briefing in April. “But they are socially predisposed to coronavirus exposure, and have a higher incidence of the very diseases that put you at risk for severe complications of coronavirus.”
Adams told Black and Latinx communities to “avoid alcohol, tobacco and drugs,” saying “we need you to do this, if not for yourself, then for your abuela, do it for your granddaddy, do it for your Big Mama, do it for your pop pop.”
Historian and author Ibram X Kendi says this sort of individual blame is not doled out in the same way to whites.
“We say ‘oh all those Black folk and their soul food. That’s why they’re unhealthy,’ as if you don’t have white people who gathered this weekend and had hamburgers and hot dogs only on their barbecue menu,” Kendi said on “Unlocking Us with Brene Brown.”
“So, I think that it’s critically important for us when we think of groups, and group inequality, to recognize that what changes communities, what changes groups, it’s not their individual behaviors, it’s policy change.”
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In the US, many Black, Latinx, and indigenous populations are at a higher risk of contracting COVID-19 simply because they have to leave home to do their work.
People of color make up a disproportionate number of essential workers. According to the Economic Policy Institute, there are 55.2 million essential workers in the US. Half of those in food and agriculture, and 53% in industrial, commercial, residential facilities and services, are people of color.
People of color are also over-represented in professions that might readily expose them to the virus: immigrants and Black Americans together account for half of home health care workers.
Where we live plays a big role in who gets sick
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Housing disparities play a key role in spreading the virus unfairly to communities of color.
And people of color are far more likely to live in a crowded house. According to the Pew Research Center, in 2009, 24% of Black Americans live in multi-generational households, versus 13% of whites.
“Discrimination in housing, which relegates Black and brown people to unaffordable, severely damaged and inferior houses with mold and pest infestation, and allergens, and structural inefficiency has to do with health,” Dayna Matthew, a professor of law, public health, and director of the Equity Center at the University of Virginia School of Law, told Business Insider.
“Who can safely shelter in place?” Jones said. “Who has a [second] home in the mountains?”
The answer is: more white Americans than Black ones. According to 2020 data from the Brookings Institution, white families in the US have an average net worth of $171,000, nearly ten times greater than Black families ($17,150).
These disparities extend out of the house and into the street, as people head off to work.
Black people make up 14% of the population, but about 25% of public transit users, according to the American Public Transportation Association. This number is higher in high density cities like New York, Chicago, and Los Angeles. Public transit can be crowded and lack good airflow, making it a perfect place for COVID-19 to spread.
The stress of dealing with racism increases risks of heart conditions, a risk factor for COVID-19
Constantly feeling unsafe as a Black or brown person in America increases risks of depression, anxiety, as well as hypertension and cardiovascular disease — two of the factors that most increase the risk of suffering worse outcomes from COVID-19.
“It’s not just that Black lives matter. Black lives are precious,” Jones said. “Racism is sapping the strength of the whole society.”
What can be done?
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The following seven big ideas, culled from the handful of experts Business Insider spoke with for this story, barely make a dent, but they are a start.
1. Clean water and clean air
There is a mind-numbing pile of evidence that clean drinking water in America falls all too predictably along white housing pipelines, not just in Flint, Michigan, but from North Carolina to New Orleans, and California.
Similarly, many of the breathing problems (such as asthma) and other health issues so prevalent among people of color are largely attributable to the toxic air wafting through the neighborhoods where non-white people live.
As Kendi said at his “Antiracist Baby“ book talk Wednesday night, the US Environmental Protection Agency, whose core mission is to “protect human health” — and the environment — should be “one of the most well funded agencies in the federal government, and one of the most empowered as well, particularly to fight environmental racism.”
2. Universal healthcare
“We need universal healthcare, not universal health insurance,” Dr. Rhea Boyd, a California pediatrician who testified before the US House Committee on Energy and Commerce on health care inequality this week, told Business Insider.
Doctors, too, have a role to play to make more equitable healthcare decisions.
“Doctors need to know what questions to ask about how racism may have shaped your living conditions,” she said. “It’s not that you come in and you’re Black. It’s ‘hey, tell me about your living situation? How many folks are living in your house? What kind of housing do you live in?'”
In the privatized care environment, it’s tough for doctors to execute this kind of time-intensive patient care.
“The more patients you see in a day, the more money your organization makes, the more they pay people. That doesn’t have to be the way healthcare runs.”
3. Equal schooling
The US Supreme Court ruled 66 years ago that “separate educational facilities are inherently unequal” in the landmark Brown v. Board of Education schools desegregation case.
The US’s taxpayer-funded public school system remains largely reliant on local property taxes for school budgets, and as a result, many Black children are left behind their white peers, in underfunded schools that don’t have enough cash, because the property taxes where they live are lower by design.
4. Desegregated housing
Segregated housing unfairly divvies up everything from education to public safety between communities rich and poor.
“We have been structurally separated so that our racism flourishes,” Matthew said. “We do not have any way of encountering one another. At home, at school, at work, at play, in the supermarket … I don’t know, you don’t know me. We don’t think of people as humans.”
5. No voter registration
Kendi also suggested, at his book talk on Wednesday, that Americans should “not have to register to vote” in the US, since every American citizen over the age of 18 (with very few exceptions) has the right to cast a ballot.
“That would then prevent Black people from being disenfranchised, thereby preventing them from electing people who will look after their interest, or the interest of antiracism,” Kendi said.
6. A living wage for essential workers
“Enslaved descendants of African people were considered essential as well,” Jones said.
7. Better access to fresh food
A study published last week found one in 10 Americans did not have enough food — including 20.4% of African Americans, 15.4% of Latinx households, and 6.4% of whites. People of color more often live in “food deserts,” too, where food is expensive and of lower quality.
The pandemic, and the Black Lives Matter movement, have shone a light on race and health
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This month there has been a global push to support the Black Lives Matter movement, and confront police brutality, following the deaths of George Floyd, Ahmaud Arbery, Breonna Taylor, and Rayshard Brooks.
But in the middle of the coronavirus pandemic, it has also drawn attention to the systemic disparities in healthcare that are widening the racial gap in COVID-19 deaths.
Confronting structural inequities across housing, food insecurity, proper education, neighborhood, and environmental safety “requires a deep, almost psychoanalytic approach,” Wizdom Powell told Business Insider.
“We need to analyze all of the decisions and biases” in our society and “interrogate … long-standing beliefs about the value of Black and brown bodies and lives.”
“I invite us as a nation to really take this opportunity that has been created by this pandemic and the shadow pandemic of racism that’s still operating,” Powell said. “To have the bold and courageous conversations required to reduce and eliminate disparities once and for all. And I think that given what we know about our collective power, we can do that.”
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