This article is written by Matthew McCurdy, Paulah Wheeler, Mercilla Ryan-Harris, and Khadijah Ameen who are the co-founders of BLKHLTH, one of the participants in “Share the Scope.”
Racial Disparity in Healthcare
Early reporting on COVID-19 called the virus the “great equalizer”. However, as disaggregated data by race began to trickle in from cities across the country, it became quickly apparent that the impacts of COVID-19 were not being felt equally across communities. Report after report highlighted that Black people were more likely to become infected and more likely to die from the virus than our white counterparts. Why?
It is not the individual health behaviors of Black people that create COVID-19 disparities.
It is not our underlying health conditions or innate “biological” deficiencies that expose us to the virus more.
It is racism and its many manifestations at the structural, interpersonal and individual levels that create health disparities not only in COVID-19 outcomes, but in other infectious and chronic disease outcomes as well.
Renowned physician and epidemiologist Dr. Camara Jones defines racism as, “a system of structuring opportunity and assigning value based on the social interpretation of how one looks (which is what people call race), that unfairly disadvantages some individuals and communities, unfairly advantages other individuals and communities, and saps the strength of the whole society through the waste of human resources.” Racism operates in a manner that diminishes the opportunity for Black people to experience optimal health and places less inherent value on the Black body.
Structural Racism and Black Health
One example of the impact of racism on Black health is at the structural level through the differences in neighborhood residential conditions that Black people disproportionately live in. Research has shown that the resources available in a neighborhood – also known as neighborhood quality – have a direct impact on individual stress and chronic health conditions. Black people are more likely to live in low-resourced neighborhoods that lack access to healthy foods, healthcare facilities, reliable transportation, economic opportunities, quality schools, and green spaces. People living in low-resourced neighborhoods also face higher exposures to environmental toxicants, hazardous work environments, and heavily trafficked highways – all of which contribute to racial disparities in respiratory health outcomes. This absence of critical resources and services in Black communities is a result of redlining and other discriminatory policies that have segregated metropolitan areas and drained resources from Black neighborhoods. Poorer neighborhood quality and higher population density ultimately leads to reduced opportunities for social distancing and increased COVID-19 infection, hospitalization, and death rates in Black communities.
Factors affecting neighborhood quality also determine a person’s ability to manage their chronic conditions. Asthma, chronic obstructive pulmonary disease (COPD), diabetes, chronic kidney disease, heart disease, and hypertension are among the most common pre-existing conditions affecting COVID-19 patients. It is not a coincidence that these chronic conditions disproportionately impact African American communities. With limited access to affordable health care providers and few available hospitals and community health centers, Black patients are more likely to die from asthma than any other racial or ethnic group. To date, low-income families receiving housing assistance develop asthma at rates higher than the general population due to exposure to lead hazards and asbestos, inadequate ventilation and temperature control, mold, and crowded living environments. The negative impact of asthma and other chronic respiratory conditions on lungs increase the susceptibility of Black people to have negative health consequences from contracting COVID-19. The impact of disparities in respiratory health can be seen in Chicago, Illinois, one of the nation’s epicenters of asthma-related deaths and one of the first major cities to report high rates of COVID-19 prevalence among African American people.
Racism is a Public Health Crisis
Public health and healthcare decision makers must consider these poorer social determinants of health when creating policies and practices that reach Black communities. Decision makers must acknowledge and address the role of structural racism in creating differences in the living conditions of Black people that negatively impact our health. BLKHLTH believes that racism is and has been a public health crisis, and our organization has been dedicated to addressing it as such. We hope our colleagues across public health and healthcare institutions can join us.
BLKHLTH is a non-profit organization that critically engages and challenges racism and its impact on Black health through workshops and trainings, practice-based consulting, community health events, and digital media. Our vision is to live in a world where racism and other intersecting forms of oppression do not determine a person’s ability to achieve optimal health. You can follow us on social media @blkhlth (Twitter, Instagram, Facebook, and LinkedIn) and on our website at blkhlth.com.
Outcome Health is committed to amplifying Black voices in healthcare. Learn more about our #SharetheScope campaign.