COVID-19’s arrival in the United States has made it impossible to ignore that Black Americans are disproportionately burdened by disease and death. Yet, there is still a lack of understanding regarding the complexity of the issues that result in such a significant disparity.
During a press conference on April 7th, President Donald Trump and Dr. Anthony Fauci briefly discussed the coronavirus’ disproportionate impact on the Black population in the United States. At that point, only a few states and major cities had published data on coronavirus rates by race and ethnicity. As of April 27th, 36 states are tracking coronavirus-related deaths by race.
The available data highlight the presence of emerging racial disparities. New York reports the highest number of deaths in the nation, with more than 17,600 fatalities. Even though Blacks make up only 9% of New York’s population, they account for 18% of deaths. Similarly, New Jersey’s population is 13% Black, but 22% of those who died were Black. In Michigan, 41% of those who passed away were Black, which is almost triple their 15% share of the population. Lastly, Blacks comprise almost 60% of fatalities in Louisiana; however, this demographic group makes up only 32% of the state’s population. Data reported by many other states show similar trends.
The big question that should be forming in people’s minds is “why are Black Americans experiencing significantly higher death rates for coronavirus than any other racial/ethnic group? A frequently used answer is: Black Americans suffer more from preexisting health conditions.
It is true that Black Americans are more likely to be diagnosed with preexisting health conditions that are also associated with a higher risk for severe illness from COVID-19. According to the Centers for Disease Control and Prevention, people are more likely to be severely ill with the coronavirus if they have chronic respiratory diseases, serious heart conditions, severe obesity, or diabetes. Non-Hispanic Black adults are 20% more likely than non-Hispanic White adults to be diagnosed with asthma. Non-Hispanic Blacks adults are also 60% more likely to be diagnosed with diabetes, 40% more likely to be diagnosed with high blood pressure, and 30% more likely to be obese than non-Hispanic White adults.
Data shows that 60% of people in Louisiana and 57% people in New York who died from coronavirus were previously diagnosed hypertension. Hypertension increases risk for death in coronavirus patients because it puts additional stress on the heart. Also, 38% of people who died in either state had diabetes. Diabetes increases risk for death in coronavirus patients because it can cause severe dehydration and respiratory distress. So, preexisting health conditions can increase risk for death from coronavirus and, thus make Black Americans more susceptible.
That being said, solely blaming preexisting health conditions puts the fault on Black Americans and directs attention away from the social factors that play a role in these disproportionate coronavirus death rates. Inadequate access to healthcare, racial bias in healthcare, and employment in “essential jobs” are examples of the contributing social factors.
Black Americans have higher rates for preexisting health conditions because they have limited access to health insurance and medical services. In the United States, 1 in 10 Blacks are uninsured compared to 1 in 20 Whites. Uninsured individuals are solely responsible for any medical bills they receive; for this reason, the uninsured often avoid receiving medical care because simple tests can be costly. In fact, Black Americans are more likely to avoid primary care services that can help to prevent or manage preventable diseases because of financial costs. Black Americans are also more likely to live in medically underserved areas, or regions that are experiencing a primary care shortage. According to a study, predominantly Black zip codes were 67% more likely than predominantly White zip codes to be categorized as primary care shortage areas. This geographic disadvantage limits Black Americans’ access to preventative care services, which also increases their risk for unmanaged asthma, diabetes, hypertension, and obesity. The likelihood of Black Americans to be uninsured and live in neighborhoods with primary care shortages increases their risk for severe illness from the coronavirus.
Racial bias in treatment also contributes these disproportionate coronavirus death rates. Over the years, stories have emerged about health professionals discrediting pain levels reported by Black individuals. Six days ago, on April 27th, a Black teacher named Rana Zoe Mungin died from coronavirus in New York City after her symptoms were mistreated by three different sets of medical professionals. Because Ms. Mungin’s coronavirus symptoms were not taken seriously, she went without proper treatment for several days and ended up requiring a ventilator for a month. This death, along with others, can be attributed to false beliefs that suggest Blacks are biologically different and have higher pain tolerances than Whites. Disturbingly, a study found 50% of its participants– who were White medical students or residents- believed in statements such as “Black people’s nerve-endings are less sensitive than Whites” or “Blacks have stronger immune systems than Whites.” Such beliefs can cause health professionals to ignore Black Americans’ legitimate medical concerns, to administer inadequate medical treatment, and can lead to adverse outcomes- such as death. Sadly, it is hard not to imagine that ill Black Americans may be refused proper treatment during this health crisis – just as Ms. Mungin was– because of their skin color.
Black Americans also have a greater risk for the coronavirus because of their occupations. According to the U.S. Bureau of Labor Statistics, Black Americans are overrepresented in the healthcare field, the food industry, and transportation occupations. Each of these fields have been deemed as essential during this COVID-19 crisis, thereby increasing Black Americans’ likelihood of coming into contact with infected people. This relationship between testing positive for the coronavirus and being an essential worker can be observed in New York City. West Queens and my hometown, Southeast Queens, are two of New York City’s hardest hit communities by the coronavirus. Southeast Queens is a majority Black community and 20% of its residents work in healthcare, while only 13% of New York City residents are employed in this field. The majority of residents in West Queens are Latino and 20% work in hospitality, accommodations, and restaurants, while only 12% of New York City residents are employed in this field. Because these two communities report a higher proportion of essential workers than New York City as a whole, their residents are less likely to social distance adequately and more likely to interact with infected individuals. This example shows that Black Americans may be more vulnerable to coronavirus exposure because they are more likely to be employed in essential areas, and are expected to work.
Government officials should begin to acknowledge the covert influence that social factors have on Black American health when discussing COVID-19’s burden on the U.S. Black population. Federal and state policies that equitably address the health needs of Black Americans are necessary in this nation so that Black Americans are not disproportionately burdened in a future health crisis.
