By Jenifer Bratter, Ph.D.
Professor in Sociology, Rice University
Quianta Moore, J.D., M.D.
Fellow in Child Health Policy
There has been a flurry of news reports noting the increased death rates among black Americans due to Covid-19, and as demographic and other data becomes available, the reality becomes even more alarming. According to The Associated Press, African Americans account for one-third of deaths due to Covid-19, though death rates vary by state, city and county. According to AP’s analysis of death rates, the percentage of African American deaths in 25 states and five counties far exceed the population share in nearly every case. This includes Harris County, where black residents account for slightly less than 20% of the population and yet represent 40% of the Covid-19 related deaths.
Unfortunately, the disparate impact of Covid-19 on black Americans is not surprising. On nearly every health outcome, from mortality rates to rates of chronic illness, black Americans are worse off than others. For instance, the unacceptable rates of maternal morbidity and mortality in black Americans grabbed national attention earlier this year. Disparities in health, income and education have become a common narrative and while millions of dollars have been invested in health disparity research and philanthropic efforts, the aggregate statistics remain fairly unchanged. That is because the underlying policy, social and economic structures that influence access to opportunities remain fairly unchanged. Yet these structures penetrate and influence all aspects of health and wellbeing. These structures are called social determinants of health and refer to “the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economic, social policies, and politics.” The impact of social determinants of health on health outcomes is well established in the literature, and recent news articles have highlighted the role of social determinants in the Covid-19 pandemic.
The heightened risk of Covid-19 infection reflects the current social vulnerabilities that are concentrated in the lives of black Americans — that is, being more likely to work in jobs that cannot be performed remotely and more likely to work in industries that are now deemed as essential. Moreover, once black Americans contract the virus, they are more likely to die because of higher rates of pre-existing conditions, which increase the risk of mortality.
Yet knowing and understanding the root causes of health disparities in black Americans is not the same as solving the problem. The racial disparities in the United States reflect the ongoing and accumulating impact of conditions that create vulnerabilities in certain populations and put them at an increased health risk, which created a perfect storm for the pandemic to have unequal effects. Our country has a history of unequal policies and practices that lead to unequal social and economic outcomes, and unfortunately while laws have changed, many policies and practices have not. From current school segregation that now rivals 1960s levels and neighborhood segregation that is receding far too slowly, to current wealth disparities and heightened incarceration, the forces were perfectly in place for a rampant pandemic to take hold of the black community.
We have a moment in time to remake history. With the world watching, the United States has an opportunity to right historical wrongs and implement policies and practices that remove barriers to opportunities. For example, disparate banking practices have been an issue for a while, leading to barriers in home loan approval, as well as the targeting of black communities for sub-prime loans, which has resulted in a heightened rate of foreclosure. However, once it was recognized that banks were not approving minority-owned business Paycheck Protection Program loans, the federal government set aside $60 billion for small, rural and minority owned-businesses. This will help to increase opportunities for these small businesses to survive the pandemic and prevent an even greater wealth gap in America. The burden to correct historical injustice does not just fall on the federal government. This pandemic has demonstrated that anyone can become infected. It’s not just “me” anymore, but “we.” We, collectively, can do our part to improve the lives of others, as we each have likely benefited in some way from the policies and practices that have disadvantaged other communities. For example, CEOs of companies such as grocery stores that have profited from the work of low-wage employees, are now seeing a huge increase in sales. There is an opportunity to distribute some of those profits not just with shareholders, but also with the employees who put their lives on the line to make the profit possible.
Even though racial disparities are a historical and current day problem, we have an opportunity to demand more of ourselves and our country to move toward a more equal society. The benefit will be not only for black Americans, but for every resident in the United States, as the Covid-19 pandemic has taught us that a disease that affects one, affects us all.