In the United States, the coronavirus pandemic has been racialised since its emergence. Leading political figures, including the President, have referred to Covid-19 as the “Chinese virus”. With the growth of positive cases, media attention has focused on emergent health disparities in rates of infection and mortality among different racial groups.
Discussing health disparities is crucial. However, this still runs the risk of further racialising and sensationalising the impacts of the current public health crisis, rather than addressing the root causes of these inequalities. Experts continue to vigorously debate how these issues can be best measured and appraised. Accurate data on racial and ethnic disparities in the pandemic are vital, but there is also a need to contextualise information from public health authorities about which populations are the most vulnerable and why.
We must be cautious because race is often used as a justification for unequal outcomes, thus potentially feeding into the perception that there are essential differences between humans when that is clearly not the case. Uncontextualised claims about racial health disparities can be misinterpreted as evidence of genetic differences among groups and can lead to the unfair blaming of minorities. In a recent piece in The Atlantic, historian Ibram X. Kendi poses the question: why are Black Americans blamed for their increased exposure to the virus and for their higher death rates, when inequalities such as racism, exploitation, and lack of resources all contribute to these health disparities? We need to account for all of the factors that lead to health disparities instead of blaming vulnerable and excluded groups.
A dire picture: Black Americans and Covid-19
The first academic peer-reviewed article that addresses racial and ethnic health disparities related to the coronavirus outbreak in the United States was published in April this year. Using data from the Connecticut State Department of Public Health, scholars Cato T. Laurencin and Aneesah McClinton address the implications of higher infection and death rates for Black Americans in Connecticut.
They highlight that, of the 3,141 cases recorded in that state at the time of their research, 50% had missing racial and ethnic data. The available data as of 1 April 2020 shows that Black Americans constituted 17.2% of Covid-19 cases, and 14.4% of Covid-19 deaths, but only 12% of the Connecticut general population.
Black Americans in Washington, D.C. are also overrepresented among deaths from complications due to Covid-19. As of 10 June, the District of Columbia government reports that the Black American community constitutes 46% of positive cases and approximately 74% of deaths in the region, while they constitute 46.4% of the district’s population.
When we look at the entire US, a recent report by the Centers for Disease Control and Prevention (CDC) states that 33% of hospitalised cases were Black Americans, while this group is only 18% of the national population.
As of 10 June, the New York City Health Department reports that 222 deaths of every 100,000 people are Black Americans. In comparison, the white and Asian/Pacific Islander death rates are 111 and 102 per 100,000 people, respectively.
For hundreds of years, institutions have maintained racial hierarchies that are responsible for the vast majority of health disparities in the US. Therefore, it is possible that Black Americans are exposed to the virus more often as a result of institutionalised racism that places less value on minority lives. Perhaps they contracted the virus before other racial groups, and experienced its impacts in its early spread.
Not everyone has been exposed to the virus yet, so it is too early in the pandemic to know the final extent of racial health disparities, and the differences in the burden of diseases from Covid-19. Nevertheless, the early numbers in New York City mentioned earlier show a very troubling trend.
Early on, some believed that Black Americans were immune to the coronavirus. Some of the advocates for an early reopening of the economy seemed to believe that white and “patriotic” Americans were also immune.
Clearly, neither of these ideas are true – individuals across racial and class lines can and will be affected by the pandemic. So, why are Black Americans contracting the virus, and dying from it, more often than their white counterparts?
Native Americans and communities of colour face many structural inequalities, including everyday racism, poverty, residential segregation, and limited access to quality health care, that affect their propensity to infection. The US also has a history of inadequately addressing the needs of underserved communities during times of crisis. For all of these reasons, we can expect that communities of colour will have an especially difficult time recovering from this pandemic.
Latinos and Black Americans compared
The public conversation on racial inequalities thus far has centred primarily on Black Americans. In contrast, the impact of Covid-19 on Latin people has received less attention. An important question then is if the emerging picture for Black American communities applies to Latin communities – who also face high levels of structural racism and everyday discrimination. A recent analysis by historian José Moya suggests that “Latinos have both the highest infection rates and the lowest mortality rates”. Moya’s numbers are compiled from data updated to 15 May from the Covid Racial Data Tracker.
It is too early to provide a substantial analysis of why the mortality rates are lower so far – given the high proportion of undocumented immigrants in this population and the often incomplete death statistics that experience constant lags. If consolidated statistics in the future were to confirm this trend, it could have to do with what is known in the epidemiological literature as the “Hispanic Health Paradox”, which refers to the fact that, despite the discrimination and disadvantage they face, Latinos tend to have better health outcomes and behaviours than their white counterparts.
It should also be noted that there are also significant differences in terms of demographics of Latino communities across the US, such as whether they are immigrants, and if so, which country they come from. This means that the Covid-19 outcomes, as the data compiled by Moya also shows, can be highly uneven. For instance, the same dataset from New York City we mentioned before shows that Latinos have a higher death rate than Black Americans: 237 deaths per 100,000 people are among Latin communities, while the Black American rate is 222 per 100,000 people.
While an analysis of mortality rates will need more data and time, it is worth focusing on the convergent trend that sees both Black Americans and Latinos experiencing higher infection rates than the rest of the population. One prominent explanation that might account for the increased exposure to coronavirus of both groups is the higher presence of members of these communities in essential jobs. At this stage, this is a hypothesis that will need to be further developed as more data becomes available.
The Latin and Black American communities are an integral part of the labour force. According to data from the Current Population Survey, in 2018 17% of the national labour force was comprised of Latin workers, and 13% of Black workers. The CDC reports that, in 2020, around a quarter of the Latin and Black American workers in the US is employed within the service industry, including hospitality, transportation and travel, delivery, food, healthcare, and education services. By comparison, only 16% of white workers are in the service industry.
Latin workers are significantly overrepresented in agricultural labour (53% of the total agricultural workforce), and Black workers are overrepresented among nursing, psychiatric, and home health aides (36%) and nurses (30%). Another dataset also shows the key role played by immigrants (many of whom are Latinos) in the food supply chain: they constitute 35% of crop production workers and 37% of meat processing industry workers.
This means that workers from these communities are far more likely to be in essential jobs that require continued work throughout the public health crisis, and put workers at increased risk of exposure to the coronavirus. Are working class folks, specifically women and men of colour, being sacrificed, so others may continue to receive deliveries and go to grocery stores?
Essential workers have also been more exposed to the virus since the beginning of the epidemic. Those who got sick earlier faced a higher risk of dying because of the novelty of the disease, and because health systems in certain cities were overwhelmed by the number of new cases. As time passes, scientists learn more about how to treat the disease more effectively and might get closer to developing a vaccine or a cure.
What can be done?
It is challenging to draw definite conclusions because the pandemic is still ongoing, and because of the limited data that is currently available on race and ethnicity. We will not know the true extent of disparities in mortality rates among racial, ethnic, and religious lines until a greater proportion of the overall population is exposed and tested for the virus, and all of the new data has been gathered, checked, and analysed. If health disparities persist, we must ensure that racial minorities’ behaviors or genomes are not blamed for this extra burden.
Rather, explanations should focus on structural inequalities. What is clear is that cities and towns with higher numbers of working class Black Americans and Latin people should be prepared to conduct extensive community-based health education and outreach, as well as provide referrals to critical medical care for these populations at higher risk. We also have to be honest about who is put most at risk by the partial reopening of the economy: it is low-income workers, often Black American or Latin workers.
Universal policies can work to reduce health disparities during the current pandemic, but also in anticipation of future ones. These could include increasing the minimum wage, a universal basic income, expanding coverage under Medicare (the national health insurance programme), placing the elderly with family members, releasing those with immigration and non-violent offences from prison and detention centres, and reopening the borders to nurses and healthcare workers, professionals, and agricultural workers.
Providing amnesty to DACA (Deferred Action for Childhood Arrivals) recipients and all undocumented workers doing frontline work during the pandemic, would go a long way to support the individuals that we have finally come to recognise as essential for our society to function.
By increasing labour protections, recognising the undocumented as people, and reducing the costs of healthcare, we can help the working and middle classes increase their incomes. That would not only improve their individual health and reduce health disparities, but also increase the health of the whole population, making us all more resilient to Covid-19 and other health threats.
Ernesto Castañeda is a professor in the Department of Sociology at the American University in Washington, DC, where he is a faculty fellow with the Center for Health, Risk, and Society, and affiliated with the Center for Latin American and Latino Studies, and the Metropolitan Policy Center.
Carina Cione, Abby Ferdinando, Jhamiel Prince, Deziree Jackson, Emma Vetter, and Sarah McCarthy are students in the Sociology Research and Practice Master’s Program at the American University.
The views expressed in this article are those of the authors and do not necessarily reflect Corona Times' editorial stance, or the position of any institution or association.