During an April White House Coronavirus Task Force briefing, Dr. Anthony Fauci of the National Institute of Health (NIH) was asked about reports of health disparities and racial divides experienced during the COVID-19 outbreak. Fauci acknowledged what many public health experts unfortunately already knew. He said that “underlying medical conditions, [including] diabetes, hypertension, obesity, [and] asthma” might make it more likely for Blacks to be admitted to the Intensive Care Unit (ICU) or die due to the disease. He further stated, “We really do need to address” the country’s health disparities.
For most of the U.S.’ 15 leading causes of death, Blacks have higher death rates than whites, including deaths from heart disease, cancer, stroke, diabetes, kidney disease, hypertension, liver cirrhosis, and homicide. However, many of these disparities stem from slavery, including, Black people’s diminished access to healthy foods, safe working conditions, medical treatment and a host of other social inequities that negatively impact health.
While people of color and Indigenous communities faced very high disease burdens long before COVID-19, health disparities that have emerged in the pandemic’s wake are simply unconscionable. According to the Centers for Disease and Control and Prevention (CDC), as of June 8, there are more than 1 million (1,938,823) COVID-19 cases in the U.S. Of this number, more than 110,000 people have died. National data show that Black Americans account for nearly 25% of COVID-19 deaths, even though they comprise only 13% of the country’s population. In Chicago and Louisiana, where Blacks are 30% of the population (30% in Chicago, 32% in Louisiana), they comprise 70% of those killed by COVID-19. In New York, Black and Brown people are twice as likely to die than whites. According to data published by the New York City Health Department, neighborhoods with high concentrations of Black and Latino people, as well as low-income residents, suffered the highest death rates, while some wealthier areas, primarily in Manhattan, saw almost no deaths from COVID-19. The Navajo Nation has the highest COVID-19 infection rate in the nation, at 2,304 cases per 100,000 people.
These numbers are due, in part, to long-standing systemic inequalities including racism, inadequate access to health care, and the prevalence of low-quality health care. The federal government spent only $2,834 per person on health care provided by the Indian Health Service, for example, while spending more than $9,900 per person through other federal programs. Social determinants of health (SDOH) also play a role in heightening indigenous, Black and Brown communities’ risks from the pandemic. These economic and social conditions influence individual and group differences in health status, including access to health care and insurance; education; neighborhood and environmental conditions (including crowded housing conditions and lack of running water); social and community contexts; and economic stability.
In the midst of COVID-19, lack of access to health care continues to worsen. Communities of color (in particular, Black communities) face inequalities and SDOH like poverty that hamper access to high-quality testing and treatment services. With limited options, more Black Americans and other groups with greater needs are forced to receive care in community centers and safety net hospitals. These facilities have been disproportionately affected by lack of COVID-19 resources, and are currently coping with overburdened staff, supply shortages, and lack of ICU beds. And although Congress allocated $8 billion to assist Indigenous nations during the pandemic, it took six weeks and a lawsuit before the Navajo Nation received the funds.
Structural Factors Like Employment Status Also Predict Infection & Death Rates
To control the spread of COVID-19, jurisdictions across the U.S. have issued stay-at-home orders, except for essential activities and workers. Black and Brown people, however, are disproportionately employed as “essential workers,” including employees in grocery and drug stores, delivery people, transit services, farms, and restaurants (including fast food restaurants). They are also less likely to be employed in jobs that can be done remotely, via telework: fewer than than 20% of Black and Hispanic workers are able to do their jobs from home. These workers are at a higher risk of infection, because social distancing is simply not compatible with their jobs. Many, moreover, cannot afford to stay home and self-isolate.
The workers who are deemed to be “essential” are more likely to live either below the federal poverty line, or just above it. And those who become ill on the job may not have the option to stay home, since more than 33 million U.S. workers — many whom are “essential” workers — do not have access to paid sick leave. Health care workers are a prime example of these risks. These employees are in high demand, given the pandemic’s increasing pressure on the health care system. Health care workers make up a disproportionate share of people with COVID-19 infections, primarily due to their frequent contact with infected patients.
Policy Solutions Must Address the Needs of Overburdened Communities
Although the Families First Coronavirus Response Act provides some relief to those coping with the pandemic, we need more. Specifically, we need policies that create positive social, economic, and physical environments and promote good health for all — and especially for historically marginalized communities. We must address the underlying structural issues and inequalities that play a central role in disproportionate infection and mortality rates among Indigenous, Black, and Brown communities. Marginalized and high-risk communities must be able to access testing, health insurance and health care, sick leave, and unemployment benefits. And, essential workers need and deserve hazard pay.
In April, the House passed the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act, which would fund another stimulus check for individuals, assistance to the Indian Health Service and state and local governments, hazard pay for essential workers, coronavirus testing, and rent and mortgage assistance. It includes an extension of the $600 weekly unemployment expansion; more funds for the Supplemental Nutrition Assistance Program (SNAP) and small businesses; emergency relief for the U.S. Postal Service; and election protection measures, including facilitating voting by mail. Senate Majority Leader Mitch McConnell (R-KY) and the Senate GOP caucus panned the $3 trillion bill, however, declaring it “dead on arrival” in the Senate.
Urgent policy action is needed to aid the overwhelming number who are impacted by this crisis, including the millions who have lost their jobs. We are facing an unprecedented global health crisis. If key policy measures are not taken immediately, the pandemic will continue to disproportionately impact historically marginalized communities, to the detriment of us all.