Examining the Pandemic’s Disproportionate Impact on Black Americans

Neblett: This is a very specific type of racial injustice. The epidemic is racism, right? It's a public health concern, a public health problem. In terms of balancing the action against the racism epidemic and measures to control the coronavirus, I think the easy answer is to say, We have to do it carefully. So if we're going to be out protesting, wear a mask, socially distance, be smart, making wise choices. But there are a number of problems with the easy answer. For one, if you've been to any of these protests, it's not often practical to follow the guidelines that have been recommended, and I think larger, big picture, it's important to realize that for many people, this is not a choice that they feel they have the luxury to make. Unfortunately, for some, it's a death by COVID or death by the police, and I'm going to take my chances in terms of going out and taking a stand.

Speaker 1: Hello and welcome to Population Healthy, a podcast from the University of Michigan School of Public Health. This episode as part of a series of special editions of our podcast focusing on the ongoing coronavirus pandemic. Enrique Neblett is a professor of Health Behavior and Health Education at the University of Michigan School of Public Health, and is the Associate Director of the Detroit Community Academic Urban Research Center. Much of his work deals with racism and its effects on the mental and physical health of Black Americans and systems that create health inequity in the US. We asked him about the disproportionate impact of the coronavirus on the Black population. It's a big topic. So let's begin with some startling statistics.

Neblett: I think there are a couple of different ways in which people have talked about how Black Americans have been affected by the pandemic. One of them has to do with higher rates of hospitalizations, infection and mortality rates. From very early on in the pandemic, we were kind of astounded by some of the numbers that showed African-Americans disproportionately represented for all of those outcomes. Milwaukee, Chicago, are a couple of places that come to mind, where African Americans are about a third of the population, but represented over 70% of the deaths. We saw similar data at a state level where in Georgia, I think African-Americans are about a third of the population, but represented 80% of the hospitalizations.

Unfortunately, we see the same things here in Michigan. African-Americans are roughly 14% of the population, but 33% of the cases and 41% of deaths, and those numbers haven't changed much over the last couple months. Here in Washtenaw County African-Americans are 12%, but 50% of the hospitalizations.

The second area that I think is really important is thinking about the psychological impact of the pandemic. About a month ago, David Williams at Harvard wrote an interesting piece on the stress pandemic and said Coronavirus has really exacerbated the kinds of stress that African- Americans are experiencing. They’re disproportionately represented among essential workers and have to make tough decisions often with regard to staying home if they get sick or risking lost wages or even unemployment. It was an ABC news poll that said African-Americans are three times as likely to personally know someone who has died from the virus than white Americans. So you couple kind of the emotional toll of having to make tough decisions, with premature loss of close family members, the unemployment rate has gone up as high as it's been in I think 10 years.

Speaker 1: Let's step back and examine why Black Americans are being infected with and dying from COVID-19 at higher rates than other populations.

Neblett: A really complex set of factors account for why the pandemic is disproportionately affecting Black Americans. Folks are more likely to succumb to COVID when they have diabetes or other underlying conditions. And so we know that Black Americans are unfortunately more likely to have high rates of cardiovascular disease, asthma, etcetera. So that's one factor.

A second is that Black Americans are more likely to hold jobs that are essential to the function of critical infrastructure. Things like food production, healthcare workers, delivery drivers, cooks and so on and so forth, and these are jobs that require continuous interaction with the public, and they’re also jobs that are less likely to offer critical benefits - things like paid vacation or sick time. And so folks may not have the luxury of being able to stay home.

Another factor is poverty. Poverty is a social determinant of health and has played a role in coronavirus. Access to affordable health care. If my co-pays are really high, I may not be able to go seek treatment, or I may not even have quality health insurance. Access to affordable housing. There may be issues around food security, being able to stockpile food - those sorts of things. There's a long list of things. People have also talked about implicit bias. The New York Times reported that doctors might refer African-Americans less for testing. People may not trust medical providers or medical mistrust. They may delay treatment seeking because they don't think they're gonna be taken seriously. Access to good information about social distancing and best practices. There's a lot of inaccurate information, unfortunately. People's access to information is limited by digital devices and things of that nature.

I think people have often not discussed the root cause of many of these factors. When I think about what causes underlying conditions or poverty or inadequate testing, we have the name structural and systemic racism. In terms of what that means, for folks who aren't familiar with structural systemic racism, these are historical and also contemporary practices that operate sort of person-to-person at an interpersonal level, but also at institutional and cultural levels to maintain the superiority of one group over another. In the US that happens to be white folks, relatives of people of color.

Through things like Jim Crow segregation and disparities and sentencing laws, over time those things have created wealth inequality and lack of affordable housing and inadequate healthcare. If you don't have access to the same education and employment opportunities, that has implications for the types of jobs that you're going to have, right? Segregation laws have contributed to neighborhood and housing conditions, so if there isn't quality housing, that's gonna have implications for some of the factors I mentioned in terms of overcrowding and living in crowded spaces. We also know that segregation impacts who lives were. So if I live near the freeways or neighborhoods where there's more environmental contaminants or drilling or whatever, those things I link to asthma, diabetes, cardiovascular disease. Again, there are lots of factors. I think at the root of many of these is systemic racism, is probably what I would point to as a key factor in understanding the disparities.

Speaker 1: It may feel overwhelming to tackle systemic racism head on and dismantle systems and organizations that have been in place for decades. But if systemic racism is the root cause of COVID related and other health disparities, we need to work together to end it. So what are some specific things individuals or communities can do to address these issues and work toward health equity?

Neblett: There are a lot of different strategies that can be used to mobilize in working against systemic racism. I think that the strategy has to be multi-pronged, so individuals and communities are important. We all have different but important roles to play.

There are things like just listening to one another, self-educating, reading and learning about what is systemic racism and how does it operate. At an individual level, one strategy for mobilizing is engaging in protest, rebellion and resistance, attending rallies and protests is a way of making voices heard. I've also seen at the individual level, people using their voices and privilege to get the message out. So writing op-eds, for example. Writing letters and making phone calls to lawmakers and representatives.

At the community level, I've been really privileged in my role as Associate Director of the Detroit Community Academic Urban Research Center, to be thinking with community organizations about how to mobilize. And some of the factors center around sharing information about things that are happening. So, what is everyone doing? What are the available resources and information that can be shared with community organizations and residents? Other strategies for mobilizing include investing in capacity building so that community organizations have the capability with the expertise they already have to build their infrastructure and be able to respond to a disaster of the nature that we faced.

And then I think there are other broad strategies. So things like demanding action. We've seen workers come together and have job actions to demand safety supplies, masks, PPE, those sorts of things. It's important that as part of the mobilization efforts, we identify specific concrete actions that can focus our efforts and that will lead to sustained systemic change. There's been a lot of emphasis recently on writing statements and some of the things I mentioned at the initial level, but those things in and of themselves can’t be the end game. If we don't specify actions that will enable us to move forward, then I fear we won't unfortunately address these issues in unique ways.

I think that many Black Americans feel that the people they've seen murdered are their family members, it's their brother, it's their father, it's their son, it's their mother, their daughter, etcetera. And it seems that every day you wake up, there's a new name. Tony McDade, Breonna Taylor, Ahmaud Arbery, Manuel Ellis, George Floyd. I do think that people are fighting for their humanity. The question we have to ask is not how we balance the epidemic of racism against measures to control the pandemic per se, although I certainly appreciate where that's coming from. But instead, how do we eradicate racism to alleviate the suffering of Black people and promote health equity for Black people in the United States? Black Lives Matter.

Speaker 1: This has been a special edition of Population Healthy, a podcast from the University of Michigan School of Public Health. During the ongoing coronavirus pandemic, we’ll work to bring you analysis from our community of experts to help you understand what this public health crisis means for you. To stay up-to-date in between special edition episodes, be sure to check out our website publichealth.umich.edu, subscribe to our Population Healthy newsletter at publichealth.umich.edu/news/newsletter and follow us on Twitter, Instagram, and Facebook @umichsph