Racism: The Root Cause of COVID-19 Disparities in Washtenaw County
Intermediate Analyst, University of Michigan Kidney Epidemiology and Cost Center
July 8, 2020, Epidemiology, Staff, Advocacy, Chronic Disease, Coronavirus, Epidemiology, Health Care Access, Health Care Management, Health Disparities, Infectious Disease, Racism, Social Epidemiology
In the fight to make Black lives matter, it is critical that we examine how racism contributes to health inequities right here in our backyard. Black residents of Washtenaw County, like elsewhere in Michigan, have been disproportionately affected by COVID-19. Despite being only 12 percent of the county population, Black residents currently account for 30 percent of deaths and 41 percent of county hospitalizations. This data mirrors health data prior to the pandemic that showed that Black county residents had a life expectancy ten years lower than white residents with Black newborns in the county being twice as likely to be born at a low birth weight compared to white newborns. When Washtenaw County ranks as one of the top five healthiest counties in Michigan, what accounts for these stark inequities?
Social determinants of health—the conditions in which you grew up, live, learn, work, and play—are much more important and influential than individual behaviors or genetics.
There is a tendency in this country to blame poor health outcomes on individual behavior. For example, it must be differences in diet, exercise, or substance use that accounts for these differences. But public health experts have identified that “social determinants of health”—the conditions in which you grew up, live, learn, work, and play—are much more important and influential than individual behaviors or genetics.
In this context, historical racism and unjust policies leading to race-based differences in opportunity, resources, and experiences of discrimination are key drivers of the COVID-19 disparities through the conditions they’ve created in Washtenaw County. In short, exposure to racism is the key risk factor.
A 2017 county assessment found that “a history of racism, segregation, and exclusion still has a negative impact on neighborhoods with high-concentrations of people of color, primarily located on the east side of the county.” Ypsilanti and Ypsilanti Township are noted as experiencing significant inequities compared to Ann Arbor in quality of life measures, public schools, and housing equity. Further, the county also ranks 81 out of 83 Michigan counties in inequality, with Black children 6 times more likely to grow up in poverty than white children. This segregation—caused by historical redlining policies and lax industry regulations—have placed many industrial polluters in communities of color and concentrated environmental justice concerns in the eastern part of the county. We see the highest percentage of COVID-19 cases and deaths in the eastern zip codes of the county, where more Black residents live.
These structural disadvantages faced by communities of color in Ypsilanti make them more susceptible to COVID-19 than residents elsewhere in the county through reduced access to things like preventative health care, quality housing, a clean environment, educational and employment opportunities, and a living wage. This lack of access strongly contributes to a higher prevalence of underlying medical conditions such as diabetes, asthma, hypertension, and obesity.
How can local health officials address these inequities in their COVID-19 response?
The State and local health departments can explicitly address forms of racism and discrimination. Ongoing reporting in the county of COVID-19 data must continue and not only include race/ethnicity, but also information about socioeconomic status and other important social factors. Further, this data will need to be put in context and presented with information about health equity.
For our local public health response to be most effective, communities most impacted need to have a seat at the table and be involved in decisions that affect their lives.
Strategies must be developed to ensure testing, treatment, supporting services, and community engagement are present in the most impacted communities by the pandemic, like has been done in Los Angeles County, California. Washtenaw County's racial equity officer took the important step of creating a task force led by people of color, and the county’s health department has been partnering with community members from areas hardest hit by COVID-19. For our local public health response to be most effective, communities most impacted need to have a seat at the table and be involved in decisions that affect their lives.
Given that the criminal justice system disproportionately targets people of color and that law enforcement violence is a significant public health issue, health officials in our county and state should lend support to efforts to decrease police enforcement of social distancing and release people from overcrowded jails and prisons—particularly those who are older or who have chronic health conditions. The county jail has taken important steps in reducing the jail population and this must continue further because all incarcerated people are at high risk. Finally, local health officials must be proactive in tracking recommendations from the state's Task Force on Racial Disparities and crafting local strategies to implement them.
Members of our community can have an impact as well. People can support local mutual aid efforts to help our neighbors meet their basic needs, support friends and family as they return home, help provide support to our friends and family experiencing homelessness at a time when we are being asked to shelter in place, and more. By supporting these local efforts and equitable policies such as affordable housing, making it easier to vote, support for the unemployed, a living wage, education funding, and divesting from police and prisons to invest in our communities, we can create a healthier and more equitable Washtenaw County.
About the Author
Jeremiah Simon, MPH, is a public health trained data analyst at the University of Michigan Kidney Epidemiology and Cost Center and an organizing member of the Michigan Chapter of Public Health Awakened, a group formed to take action on local, regional, and state social justice issues that impact health and equity.
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