The Path Forward: Recognizing Strong Connections between COVID-19, Racism, and Health Inequities
DIRECTOR’S MESSAGE
Welcome to the Summer 2020 edition of Health Equity Happenings, the Center for Health Equity’s digital news publication.
The events of the first half of 2020 have made the importance and timeliness of the Center for Health Equity’s work clearer than ever. Both the COVID 19 pandemic and the epidemic of violent police misconduct that has reached a tipping point this spring have disproportionately affected African Americans and other communities of color. These outsized impacts share a common root cause in the persistent legacy of racism and segregation in the United States. I discussed this in a recent Bloomberg School of Public Health COVID-19 Real-Time Response Story.
The COVID-19 crisis has cast a bright light on how systemic racism, manifested in gross inequalities with respect to access to care and ability to socially isolate for minority populations, has been the major factor in the disproportionate effects the illness has had on minority communities. Black and other minority communities across the country have suffered the most from the pandemic
According to new data published by the New York Times on July 5, 2020, “Latino and African-American residents of the United States have been approximately three times as likely to become infected as their white neighbors”. These statistics came from detailed characteristics of 640,000 infections detected in nearly 1,000 U.S. counties. Across the US, the COVID-19 infection rate per 10,000 people was 38 – 23 for White people, 62 for Black people, and 78 for Latino people. The data also shows that through the end of May, Black and Latino people were nearly twice as likely to die from the virus as white people. Disparities involving Native American people also exist. In much of Arizona and in several other counties, they were far more likely to become infected than white people. For people who are Asian, the disparities were generally not as large, though they were 1.3 times as likely as their white neighbors to become infected. Reports from APM Research Labs, and the US CDC, show similar findings.
The disproportionate impact of the pandemic on disadvantaged populations exists across the world, and it is telling and disturbing.
This disproportionate burden is also seen in the law enforcement system, where blacks and other minority groups are stopped more often, arrested more often, and sadly, killed more often, by police officers. Blacks in America make up only about 14% of the US population, but represent 34% of total incarcerations. As with the pandemic, the epidemic of social injustice in the US hits people of color the hardest.
The failures of American society to provide the needed care to communities of color during the pandemic, and the killings of African Americans by police are the most visible examples of a broader pattern of failure with respect to minorities of this moment in history. However, the social circumstances of many minority communities have been defined by the early 20th century legacy of racism and residential segregation, which enforced racial separation and then denied those communities access to opportunities for education, business development, home ownership, or the kind of “placemaking” (i.e., creating quality places where people want to live, work, play, and learn) that white communities have always enjoyed. The practice of redlining--a practice perhaps most clearly seen in how banks defined credit risks in certain neighborhoods during the first part of the 20th century--continues to shape the character of many black neighborhoods across the US. Keeping African Americans and other people of color in neighborhoods characterized by poverty, crime, lack of access to quality food, lack of opportunity, and lack of social services has perpetuated and deepened the racial divide in this country--and it has had clear public health implications.
Dr. Lisa A. Cooper, MD, MPH. Director of the Johns Hopkins Center for Health Equity and the Urban Health Institute, June 2020. Photo Credit: Johns Hopkins University.
Well before the COVID-19 pandemic raised questions about the racial aspects of the disease’s effects, public health professionals had recognized that systemic, cultural and personal racism made minorities more susceptible to chronic disease, and more likely to have worse outcomes from those conditions, than their white counterparts. Obesity, hypertension, diabetes are all prevalent in minority communities, and a constellation of social and community factors that begin with residential segregation are in large measure to blame. Being Black and regularly subjected to racism, even unconsciously articulated in interpersonal exchanges, has been shown to increase stress and correlates with suboptimal health outcomes. In the US, public health professionals know that race can be a predictor of health status, and racism is always a health risk for the victims experiencing it. Racism itself, in short, is a public health problem.
These realities are what the Center for Health Equity exists to address. The latest Health Equity Happenings provides updates on the work the Center’s team of talented and committed researchers, doctors and clinicians have been doing to improve the health of people in the US and around the world who have been marginalized, oppressed, and denied the benefits of modern health care and opportunity.
I am grateful for how the Center for Health Equity’s research and education programs, implemented in partnership with communities, continue to address disparities in health related to social factors such as systemic racism. The Center for Health Equity will continue to fight for more equitable health outcomes for disadvantaged people, as we did before the pandemic made these inequities more visible to mainstream America.
And if changes to the health care system, as well as to the broader cultural context within which it exists, occur as a result of more people seeing the stark differences between white, black, and brown health outcomes, perhaps the suffering that people of color and the poor have endured through--and before--this pandemic, will have had some redemptive aspects for the future and be a silver lining in the dark clouds of COVID-19.
Lisa Cooper, MD, MPH
Director, Johns Hopkins Center for Health Equity
Director, Johns Hopkins Urban Health Institute
Bloomberg Distinguished Professor, Equity in Health and Healthcare, Johns Hopkins University Schools of Medicine, Nursing, and Public Health
James F. Fries Professor of Medicine, Johns Hopkins School of Medicine
OTHER LEARNING RESOURCES
COVID-19, RACISM + HEALTH INEQUITIES