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Published: July, 2020; Vol 17, Num 2

 

COVID-19’s Disproportionate Impact Across Racial Lines

The coronavirus pandemic has had a devastating impact on everyone, even people who have been fortunate enough not to have a loved one diagnosed with COVID-19 or who have been able to work safely over the past several months. However, just because COVID-19 has affected all of us in some way, it doesn’t mean it has affected all of us equally.

Public health experts have known since the early days of the virus that certain groups were at higher risk for serious health complications if they got COVID-19. We previously wrote about many of these groups – people over age 65 and people who have diabetes or chronic heart and lung conditions, for example – in our May article on vulnerable populations. Now, as health agencies gather more data on COVID-19 cases and deaths across the U.S., it’s become clear that other groups are also at higher risk.

COVID-19’s Impact on Black, Hispanic and Latino Communities

Across the U.S., black and Hispanic communities are experiencing far higher rates of COVID-19 infections and deaths than white communities. Nationally, black Americans make up 13 percent of the population, but account for 30 percent of COVID-19 cases.

A state-by-state analysis found that in 32 states and the District of Columbia, black Americans are dying at disproportionate rates from COVID-19. In some states, rates are substantially higher. For example, in Wisconsin, black Americans account for 27 percent of COVID-19 deaths, but only six percent of the state’s population; in the District of Columbia, black Americans make up 46 percent of the population, but 86 percent of COVID-19 deaths

In 42 states and the District of Columbia, Hispanics and Latinos make up a larger share of COVID-19 cases than their share of the population. In Virginia, Hispanics and Latinos only make up 10 percent of the population, but account for 49 percent of COVID-19 cases. Conversely, COVID-19 deaths among white Americans are lower than their share of the population in 37 states and the District of Columbia. 

To drill down further into COVID-19 case and death data at the state and county level, see the COVID Tracking Project.

Causes Behind Higher Impact Across Racial and Ethnic Lines

Public health experts have identified many economic and social conditions that are contributing to this disproportionate impact, and many of them are tied to systemic discrimination and structural racism.

“We know that these racial ethnic disparities in COVID-19 are the result of pre-pandemic realities,” says Dr. Marcella Nunez-Smith, director of the Equity Research and Innovation Center at Yale School of Medicine. “It’s a legacy of structural discrimination that has limited access to health and wealth for people of color.”

These economic and social factors include: 

  • Underlying health conditions: African Americans and Hispanics/Latinos experience a higher prevalence of underlying and chronic conditions such as diabetes and heart disease, which increase risk for serious complications from COVID-19. 
  • Less access to health care: African Americans and Hispanics/Latinos are less likely to have health insurance or be underinsured, leading to difficulty obtaining care if they do get sick; these groups are also more likely to live in areas without convenient access to health care facilities. 
  • Living conditions: Racial and ethnic minorities are more likely to live in densely populated areas (where COVID-19 spreads more easily) due to institutional racism in the form of housing segregation.
  • Frontline job roles: A higher percentage of African Americans and Hispanics/Latinos are frontline workers in jobs that have been declared essential during the pandemic. For example, more than half of all workers in the meatpacking and processing industry are people of color. These workers, like many in the construction industry, can’t do their job from home during the pandemic. 

Acknowledging the true root causes of these health disparities – a history of institutional racism – has to happen before we can begin changing them. We must distinguish between health disparities caused by genetics that may not be in our control (such as a family history of breast cancer) and those caused by social and economic factors that can be changed. The American Academy of Pediatrics said as much in their statement labeling racism as a social determinant of health.

“Although progress has been made toward racial equality and equity, the evidence to support the continued negative impact of racism on health and well-being through implicit and explicit biases, institutional structures and interpersonal relationships is clear. Failure to address racism will continue to undermine health equity for all children, adolescents, emerging adults, and their families.”

This statement draws a clear line between how race can affect health and how racism can affect health. We must keep that difference in mind as we move forward, identify solutions and make changes to close these health gaps. We cannot afford to have the view that health disparities are only a problem for the groups they affect, or only for those groups to solve. Public health affects all of us, and we are all in this together.

[Nick Fox]