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COVID-19 Cases, Deaths Expose Stark Racial Divide

Reasons are complex; employers can be part of the solution

Nancy Cleeland By Nancy Cleeland August 11, 2020
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Black woman

​At first, the evidence was scant. But over the past few months, it's become undeniably clear that COVID-19 is disproportionately infecting and killing Black Americans across the country.

Black Americans are dying at two and a half times the rate of white Americans, according to the COVID Racial Data Tracker, a collaboration between the COVID Tracking Project and the new Boston University Center for Antiracist Research.

The gap is even more stark for young and middle-aged people, an analysis by the Brookings Institution found. Among those 35 to 44 years old, Black Americans are 10 times more likely to die of COVID-19 than white Americans; for those 45 to 54 years old, the multiple is seven.

Black individuals are dying from COVID-19 at roughly the same rate as white people who are more than a decade older, the Brookings analysis noted.

Racial disparities exist in cases as well as deaths, extending across all U.S. states, according to a tracker maintained by the health media nonprofit KFF.

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The tracker shows that white residents account for a smaller share of COVID-19 cases than their share of the population in every state, sometimes by more than 2 to 1. Meanwhile, Black, Hispanic and Native American residents are overrepresented. In Minnesota, for example, Black residents account for 7 percent of the population but 21 percent of known cases.

"We are all in the same storm," said Dr. David Saunders, who directs the Office of Health Equity at the Pennsylvania Department of Health. "But we are clearly not in the same boat."

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Long-Standing Problems Amplified by COVID-19

Saunders, who has worked on equity issues in public health for three decades, is unsurprised by the data but grateful for the attention it is receiving from the general public.

"These underlying health disparities that have been highlighted during COVID-19 are not new to folks in my position," he said during a recent panel discussion on COVID-19 racial inequities by the U.S. Centers for Disease Control and Prevention (CDC).

Factors highlighted by the CDC as contributing to racial inequities in COVID-19 include:

  • Racism in health care, housing, education, criminal justice and finance that "can lead to chronic and toxic stress and shapes social and economic factors that put some people at increased risk for COVID-19."
  • Limited access to and use of quality health care due to a lack of insurance, cultural differences, and "historical and current discrimination in health care systems."
  • Disproportionate representation of Black workers in front-line jobs, such as in health care facilities, public transportation and grocery stores, with limited ability to work from home. "All of us are able to sit in our homes and telework," Saunders said of his public health colleagues during the CDC discussion. "Those who cannot are more susceptible because they're exposed."
  • Inequities in access to quality education may limit future job options and lead to lower-paying or less-stable jobs "that may put [workers of color] at a higher risk of exposure to the virus that causes COVID-19. People in these situations often cannot afford to miss work, even if they're sick, because they do not have enough money saved up for essential items like food and other important living needs," the CDC noted.
  • Crowded housing, in some cases involving multiple generations. "In addition, growing and disproportionate unemployment rates for some racial and ethnic minority groups during the COVID-19 pandemic may lead to greater risk of eviction and homelessness or sharing of housing," according to the CDC.

"Race doesn't put you at higher risk. Racism puts you at higher risk," said Camara Jones, a physician and former president of the American Public Health Association, in a recent Q&A with Scientific American. "People of color are more infected because we are more exposed and less protected. Then, once infected, we are more likely to die because we carry a greater burden of chronic diseases from living in disinvested communities with poor food options [and] poisoned air and because we have less access to health care.

"We are more exposed because of the kinds of jobs that we have: the frontline jobs of home health aides, postal workers, warehouse workers, meat packers, hospital orderlies. And those frontline jobs—which, for a long time, have been invisibilized and undervalued in terms of the pay—are now being categorized as essential work."

What Can Employers Do?

The factors that have led to such stark disparities are complex and deeply rooted; solutions must also be multidimensional, these public health experts said. Employers, they suggested, can play an important role in the following ways:

  • Provide quality health care benefits, including paid sick leave, to all employees.
  • Provide adequate personal protective equipment to front-line workers.
  • Consider offering hazard pay to low-wage, front-line workers and offer flexibility to those who feel it is too dangerous to return to work.
  • Expand opportunities and pay a living wage for all employees. Take a fresh look at positions disproportionately held by people of color to root out any biases in pay and benefits.
  • Work on outreach to underserved communities to develop pathways to jobs.

James E. Bloyd, regional health officer with the Cook County Department of Public Health in Illinois, said the health care sector itself "has a wonderful opportunity to tackle health inequities because 1.7 million women of color and their children live in poverty because of the racist and sexist wage structure of the health care sector, particularly hospitals."

Momentum for Change in Public Health Equity

Bloyd, who participated in the CDC discussion, said the knowledge gained by new data on COVID-19 cases helps to make the case for change, but, like Saunders, he noted that the problem isn't new.

"We have known about existing health injustice for decades," Bloyd said. "The evidence is not enough. We need to build people power and community power based on the bedrock of social justice. … The challenge is huge, but maybe this is a turning point."

Those working in the growing field of health equity are encouraged by emerging partnerships among public health organizations, medical institutions, employers and community groups, and by the increasing willingness to regard racial disparities as a serious problem.

"So many health departments and institutions have named racism as a public health threat," said Dr. Aletha Maybank, chief health equity officer at the American Medical Association (AMA) in Chicago—a position created just a year ago. "Now we have to have action behind it."

Maybank cited a program that the AMA recently developed with Essence magazine to encourage Black women to continue getting care for hypertension despite fears about COVID-19. "Some chronic diseases weren't being managed," she noted.

The effort brought together a broad range of health organizations, including the National Medical Association—an organization created by Black physicians more than a century ago when they were excluded from the AMA.

Maybank said the partnership is serving to build bridges and address old harms. "We have to be able to look at our own history as institutions and how we may have perpetuated harm," she said. "We have to own up to that."

Saunders also saw hope in the new alliances that have formed around the COVID-19 response. "We need to capitalize on and maintain those alliances, continue looking at data in different ways, and accelerate our efforts," he said.

"I've been at this for 30 years and I've never been more excited about the future than now," Saunders added. "We have to seize this opportunity and do all we can."

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