Frieda Wiley, YES Magazine (originally posted May 5, 2020)
As the coronavirus exacerbates longstanding racial health disparities, researchers, local governments, and philanthropists are looking to data to understand and mitigate its impact.
As the COVID-19 pandemic continues to unveil the deficiencies in all of our systems, racial disparities—particularly the disproportionate number of Black people dying—top the list. The staggering statistics keep pouring in, dispelling an earlier rumor among some in Black communities that Black people are somehow immune to contracting the disease. But more importantly, the high numbers highlight the health care inequities in the United States.
“Inequities have existed for generations, and it’s something we cannot ignore,” Michigan Lt. Gov. Garlin Gilchrist says. “The disparity and mortality rate with COVID-19 are more urgent because people [can] die within a month of contracting the virus.”
In Michigan, Gilchrist’s home state, the African American population is 14%. Yet, as of mid-April, Black Michiganders make up 33% of the coronavirus cases and 41% of COVID-19 deaths.
For the former engineer, these numbers are intensely personal. Fifteen people in Gilchrist’s life have succumbed to the disease, and several more of his family members and friends are in the hospital fighting for their lives.
Sadly, the statistics in Michigan echo trends across the country.
African Americans make up 14.6% of the U.S. population. Yet they are up to 2.6 times more likely to die from COVID-19-related complications than other groups, according to a report by APM Research Labs. In some areas, that death risk is significantly higher. For example, Black people in Milwaukee County make up 26% of the population but 81% of the COVID-19-related deaths.
Why Are Black people Dying at Higher Rates?
Dr. Uché Blackstock, founder and CEO of Advancing Health Equity in New York, cites racial discrimination as the underlying issue to the high number of poor health conditions in Black communities. Advancing Health Equity works with various health care organizations to address factors that contribute to unequal treatment in the health care field.
The simple answer, some doctors say, is racial inequity, and its No. 1 symptom: poverty.
“The biggest factor in health disparities in the Black community is racism—redlining and other processes put into place that have left Black communities disenfranchised and marginalized socioeconomically,” Blackstock says. “As a result, the health status of these communities is quite poor.”
In March, Blackstock was one of the first in the field to point out the discrimination in the criteria for COVID-19 testing. Initial tests were to be performed only on those presenting symptoms who’d traveled abroad, or had come in contact with someone who’d already been diagnosed. Because most Black people presenting symptoms at the time did not meet this criteria, they were turned away.
Overall, while the country is seeing a shortage in testing and personal protection equipment, and a lack of comprehensive data coverage, the effect in Black, Brown and Indigenous communities has shown that exposure does not equal impact. What was initially thought of as the great equalizer, COVID-19 is devastating BBI communities.
There’s an African American saying that when America catches a cold, Black people get the flu. Well, America has a virus and disease epidemic, and Black people have caught the plague.
Downstream, the poverty in many African American communities means a lack of access to quality health care, the scarcity of healthy food, and living in dangerous areas with high crime rates and high pollution. All these factors harm the body. Compounded with the high numbers of people cohabitating in close living quarters, which creates extra hurdles when it comes to sanitization and isolation, Black communities are a hotbed for crises.
None of this is new information, but add the deadly coronavirus disease to an already ticking bomb, and we have ourselves an explosion. Dragging our feet by simply acknowledging the problems is no longer satisfactory, if it ever was. Black communities need real solutions now, health experts say.
Local and State Governments Lead
During the early stages of the outbreak, local and state governments sought input and resources from the federal government to help contain the virus and mitigate its risk. Inefficiencies in federal support and leadership prompted many local and state officials to craft their own solutions.
In early April, Michigan Gov. Gretchen Whitmer announced that she was assembling a task force to develop strategies that would help address the health disparities among Black communities in her state. The task force will pool the insights of educators, epidemiologists, infectious disease experts, and other appropriate parties to brainstorm and enact solutions to help the Black communities in Michigan.
Among these efforts are increased testing. The state’s chief medical executive and chief deputy director for health, Dr. Joneigh S. Khaldun, launched enhanced screening initiatives. Doing so not only helps identify new cases of the virus, but it also serves as a source of collecting more data, Khaldun says.
“We’re going to be working with the local health departments and hospitals to do everything we can to track cases based on race and ethnicity,” Khaldun adds.
The Michigan task force will also evaluate particular issues affecting the predominantly African American city of Detroit. For example, the task force is charged with investigating the root causes of racial disparities and then crafting recommendations to counter these disparities. Members are also searching for ways to fund efforts to thwart the impact of racial disparities resulting from the outbreak. Other initiatives include recommending changes to existing state laws to address racial disparities and how they are handled during pandemics and pinpointing any outstanding issues that may remain regarding the response to pandemics.
This task force is not Michigan’s first attempt to improve public health equality. In February, the state launched a healthy babies initiative in response to data indicating that Black women are three times more likely to die of pregnancy-related complications than White women.
“This task force is building upon the work we’ve already done to address racial disparity,” says Lt. Gov. Gilchrist, who leads the task force. “There are things we’ll learn from this that will relate to other social determinants of health.”
But what is it going to take to flatten the COVID-19 curve for Black communities? We won’t know that until we have more comprehensive data, some say.
The federal government has stalled on releasing complete data stratifying COVID cases and deaths by race and ethnicity. Their delay prompted organizations such as APM, along with state and local governments, to conduct their own research, and most recently the COVID Racial Data Tracker, a new collaboration of The Atlantic’s COVID Tracking Project and The Antiracist Research & Policy Center.
The COVID Racial Tracker launched April 15, with the sole purpose of collecting, publishing, and analyzing comprehensive COVID-19-related data by race in the U.S. Information is gathered from state, district, and territory public health authorities, as well as trusted news sources. In late April, The Antiracist Research & Policy Center was awarded a $300,000 grant by the Marguerite Casey Foundation to continue their work.
“By collecting this data, for us, we’re shining a light on the ways in which there are a number of systems that people of color interact with that have predetermined whether or not they will survive this crisis,” Carmen Rojas, incoming Marguerite Casey Foundation president and CEO, tells YES! “This is model setting, and for all intents and purposes should be the job of the federal government. Because it’s not doing its job, we decided to resource an organization to empower our communities and the families in our communities to actually have a voice and be able to advocate for themselves.”
Without projects such as the COVID Racial Data Tracker, it would be hard to focus on the history of decisions that caused the vast majority of people affected by this crisis to be people of color, Rojas says. The tracker includes and also extends beyond Black communities because immigrant families, low-wage workers, people with disabilities, and other communities are all potentially more vulnerable to COVID-19 than the general population.
This work, she says, is critical in addressing structural racism in America’s health care systems.
In Florida, where the death rate from the coronavirus among Black people is nearing the 90th percentile, the data lags behind other states because residents were not tested in the outbreak’s early phases, according to Dr. Cheryl Holder, program director of Panther College of Medicine communities and associate professor at the Herbert Wertheim College of Medicine at Florida International University.
“The data tells me that the vulnerable population has to be protected,” Holder says, referring to the Black and 60-and-over populations. “The equity lens requires more resources to make sure these people do not get exposed.”
Black physicians in Florida, including Holder, are engaging the media to increase awareness among its Black residents. Holder has gone on radio shows, written opinion pieces for local newspapers such as the Miami Herald, and, as president of the Florida State Medical Association, she, with her colleagues, crafted a letter to the Florida Gov. Ron DeSantis asking for a meeting to discuss solutions.
Meanwhile, the Florida association has been “very successful,” Holder says, in its efforts to acquire necessary personal protection equipment, which has been another challenge around the country. In late April, they received “a delivery of 100K surgical gloves, 20K gloves, 1,695 N95 masks, 1,000 face shields, booties and gowns.”
“Most importantly,” Holder adds, “our advocacy resulted in walk-up test sites opening throughout the state in more [African American] communities and testing guidelines for all adults regardless of symptoms.” They’re awaiting decisions on additional test sites, she says, including more homeless testing and “care kits” with hand sanitizers, household cleaning products and surgical masks for the community.
To date, Orlando, Tampa Bay, Pensacola, West Palm Beach, Tallahassee, and Broward County have received shipments of nitrile gloves, masks, and face shields.
Gilchrist says improvement is going to come from working with local health departments and hospitals “to do what we can to track cases based on race and ethnicity.” And this is part of the task force’s work.
Improvements will also come from greater representation of BBI people as decision makers in our local, state, and federal governments and in in the medical field, according to Karen Lincoln, associate professor of social work and senior scientist at the University of Southern California.
“If we really want to address disparities based on race, we need more representation at the local and federal levels of government as well as at the higher levels of health care,” Lincoln says. Having a strong Black presence in these areas increases the likelihood that decisions made will bring about a more positive outcome for Black Americans. However, an uptick in African American involvement in the health care system cannot completely eliminate the risk of biases and discrimination that Black people seeking treatment routinely face. Lincoln points out that it is impossible for all Black patients to have access to Black physicians because there are not enough Black doctors to meet those needs.
Considering the historical disparities, Lincoln questions proposed solutions.
“The COVID-19 pandemic highlights some very persistent systemic issues that help us understand the disproportionality, so we must ask ourselves: Are the solutions we propose for COVID really enough?” For African Americans whose current experiences are byproducts of socioeconomic and geopolitical systems heavily entrenched in centuries of racism, she’s not so sure.
Meanwhile, Rojas believes what she calls a tethering—of sectors (community, government, philanthropy) and issues (health, housing, employment, water)—is necessary to forge ahead and offers real opportunities.
“We need leaders and organizations imagining a cross-sector approach to power-building,” she says. It’s going to take governments, which should be held accountable to the people, in addition to community organizations that are out here doing the work, and the philanthropic community shoring up resources and access.
“A lot of the philanthropic dollars in California [and in Washington state] come as a result of health care conversions,” Rojas explains. “You have a bunch of MDs running philanthropies who have a hard time saying things like ‘white supremacy,’ or ‘systems of power.’ They’re wanting a deeply logical or medical approach or understanding to what is happening.”
But, she says, medical health professionals must be situated in a context of racial justice to be able to meet people’s needs.
YES! Executive Editor Zenobia Jeffries Warfield contributed to this article.
FRIEDA WILEY , PharmD, is a licensed pharmacist-turned-full-time freelance medical writer who has written for O The Oprah Magazine, The Costco Connection, AARP, and the National Institutes of Health. During the COVID-19 lockdown, she can be found breaking into a scorpion pose on her yoga mat or watching spring bloom from the safety of her window.