On January 21, 2020, the first case of the novel coronavirus renamed COVID-19 was confirmed in the United States (ABCNews, n.d.). On February 26, 2020, the CDC confirmed the first case of local transmission in California. The individual infected had no known travel history to a verified outbreak area, nor did they have contact with a carrier of the virus. On March 1st, the first case of COVID-19 was confirmed in New York State, and by March 20, 2020, the state had been declared an epicenter of the virus.
What happened in New York should have been a warning to the rest of the United States – the state was, in fact, serving as the canary in the coal mine. New York saw an explosion in hospital admissions, and such a dramatic increase in its death counts that makeshift hospitals were constructed by the U.S. Army Corps of Engineers and trucks were brought in to store dead bodies until they could be buried. The question that was on the minds of many New Yorkers, the country, and in fact, the world was who were these people and how and why had they succumbed to the virus? Did their age factor into susceptibility? As it turns out, many elderly adults living in nursing homes had succumbed to COVID-19 and were dying at high rates. Did having several comorbidities make someone ripe for infection and death? Did having access to testing and hospitalization lead to fewer deaths? Did living in crowded communities cause the disease to spread more easily? As it turned out, the answers to many of these questions was yes, but they did not fully answer who was becoming infected by the disease and dying. The answer to that question could only be addressed if data on death by COVID-19 were collected for racial and ethnic groups.
Initially, only a few states like Michigan and Wisconsin collected data on COVID-19 by race. Their outcomes demonstrated that African-Americans were infected and dying at much higher rates than whites in their state (Johnson & Buford, 2020). However, while some states were collecting disaggregated data and sounding the alarm that African-Americans were disproportionately suffering from the burden of disease, the Centers for Disease Control (CDC) remained silent on the issue. Instead they continued to collect data on age and location, thereby further widening racial inequality (Johnson & Buford, 2020). In April 2020, New York released their report that included race as a demographic variable even though the state had been designated the epicenter of the virus in March. To many policymakers, the numbers were upsetting with African-Americans and Hispanics contracting and dying from COVID-19 at higher rates than any other group within the population. However, for many others, in particular, scientists and public health professionals, the numbers were not surprising. After all, many African-Americans and Hispanics could not benefit from the community mitigation strategies prescribed to slow the spread of the virus because they were included in the category of essential workers and did not and could not benefit from the stay at home work orders. They were the warriors.
Moreover, many African-Americans were in a position of double jeopardy, not only might they suffer from diabetes, hypertension, and obesity, which placed them at higher risk for contracting the virus, but if they were admitted to the hospital after contracting COVID-19, those same diseases would put them into a high-risk category limiting the possibility of them receiving a ventilator to breathe thus sentencing them to death. So, the question arises why was there such resistance to collecting data on race? After all, it was not long ago that National Academies of Medicine produced the report “Unequal Treatment: Confronting Racial and Ethnic Barriers in Healthcare” that documented the need for reporting racial and ethnic data by subcategories (Smedley, et al., 2003). So, if we knew that without the systematic collection of data at the federal level, adequate funding could not be targeted to communities in need, why would the data not be collected? The answer lies in the very policies, practices, and procedures that have led to health disparities in the United States in the first place and have plagued the nation for centuries (Williams Mohammed, 2013).
Health Inequity in the United States
Although there is no one definition for health equity, according to Braveman et al. (2017), health equity implies that everyone has a fair and just opportunity to be healthy. For health equity to occur, health disparities must be reduced. Health disparities refer to the burden of disease experienced by one group in comparison to another group. The places where people live, play, work, worship, and go to school are referred to as the social determinants of health (ODPHP,n.d.). According to this model, health is affected by the resources and opportunities available in one’s community. Communities with limited access to high quality healthcare, little or no green spaces, fewer amenities such as libraries, banks, stores, and supermarkets, as well as high levels of neighborhood violence place individuals at risk for poorer health outcomes. Thus, health disparities in the population will only decrease when individuals are provided with the social and economic opportunities they need to live a healthy life.
So why are these disparities so persistent? To adequately answer that question, we would have to examine the history of the United States and the racism and structural racism that is a part of the American fabric. However, given the scope of this paper, I will only provide a brief description. Racism is the prejudicial treatment of an individual based on race to devalue, disempower, and treat them in an inferior manner (Williams & Mohammed, 2013). Structural racism, which is a form of racism, is the unfair treatment that has been built into institutions, policies, and practices that have historically disadvantaged specific communities (Williams & Mohammed, 2013; Braveman et al., 2017). For example, the racial wealth gap is the product of centuries of racial discrimination that has denied families of color, particularly African-American families, the opportunity to build wealth by obtaining mortgages to purchase homes. Less homeownership in the African-American community forces many African-Americans to live in substandard housing located in under-resourced communities. Over time living in unhealthy homes and communities has harmful consequences for one’s health over the life course leading to cardiovascular disease, diabetes, hypertension, and obesity. Moreover, perceived discrimination can lead to depression, anxiety, and maladjustment (Prelow et al., 2004). Now that we have identified the problem, the question arises as to what can be done to reduce health disparities and increase health equity in the African-American community.
The Way Forward: Health Equity as a Human Right
One way to move forward is to define health equity as a human right. Human rights, enshrined in the Universal Declaration of Human Rights through a global consensus, are the rights we all share because of our shared humanity. The document, though aspirational and non-binding, calls on all nations to respect, promote, and protect everyone’s human rights. Article 25 in particular, states that “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control,” (pp. 52). Furthermore, Article 12.1 of the International Covenant on Economic, Social and Cultural Rights, which is binding, asserts that “the States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.” Moreover, Article 12.2 states that “the steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for… (b) the improvement of all aspects of environmental and industrial hygiene;(c) the prevention, treatment and control of epidemic, endemic, occupational and other diseases; (d) the creation of conditions which would assure to all medical service and medical attention in the event of sickness,” (OHCHR,n.d.).
In short, if the United States treats health as a human right and not as a commodity, then collecting data on race to help eradicate COVID-19 or any disease and providing access to high-quality healthcare for all, will no longer be seen as a threat to economy, but rather as the mechanism for ensuring health equity for all Americans regardless of their race, class, or gender.
Roseanne L. Flores is a Professor in the Department of Psychology at Hunter College and the Graduate Center of the City University of New York. She received her PhD from the Graduate Center of the City University of New York, and more recently an Advanced Certificate in Public Administration and Public Policy as well as a Certificate in Health Care Policy and Administration both from the CUNY School of Professional Studies. She is also a Faculty Associate of the Roosevelt House Public Policy Institute at Hunter College as well as a member of the Human Rights faculty. She is a Developmental Psychologist by training and was a National Head Start Fellow in the Office of Head Start in Washington, DC in 2009-2010 where some of her work focused on research, practices, and policies that influenced children, families, and communities. In addition to her work at the Office of Head Start, she worked at the Institute of Education Science in the National Center for Education Research on the development of a template for the dissemination of assessment instruments developed from research in the field. Prior to her work in the Office of Head Start she was a Visiting Scholar at the Educational Testing Service in Princeton, NJ during the summer of 2009 where she worked in the areas of assessment, research and policy. In 2011 she served as a reviewer for the Race to the Top — Early Learning Challenge Grant, and in 2014 as a reviewer for the Preschool Development Grants.
Roseanne was a member of the 2011-2012 class of the American Psychological Association Leadership Institute for Women in Psychology, and the 2013 co-chair of the Committee on Children, Youth and Families. She is currently serving as an ECOSOC Representative to the United Nations for the APA as well as the chair and member of the Coalition for Psychology in Schools and Education also at the APA. In addition, she is a member of the NGO Committee on Children’s Rights, New York. Roseanne served as the 2016 co-chair of Psychology Day at the United Nations which addressed psychological perspectives on the global migration crisis.
In 2013 she participated in the National Institute of Minority Health and Health Disparities Translational Health Disparities course which provided her with a foundation for much of her current research and scholarship which focuses on environmental risk factors such as community violence, poverty, and poor nutrition and their relationship to the health and educational outcomes of minority children and families.
Roseanne has published several articles and book chapters addressing the physical and mental well-being of children, youth and families and presented her research at numerous conferences. In addition, she has served as a reviewer for National Institutes of Health (NIH), Agency for Healthcare Research and Quality (AHRQ), and the Health Resources and Services Administration (HRSA).