2020 seems to be the year pretense was blown away. Lots of us got to see our world anew as a global pandemic swept across our communities. As schools shut down, parents gained a new level of respect for their children’s teachers. As lockdown and quarantine measures spread across the country, we recognized how crucial and important fundamental jobs like mail carriers and grocery store workers were. But possibly the largest and most ingrained level of pretense and ignorance that COVID has been blown away for many of us is the structural level of racism many people but specifically black Americans still face today. And coupled with the dangers of COVID-19, it is killing them.
The hardest hit demographic by the COVID pandemic has been largely people of color. But in the US, it’s specifically the black community that has seen the most devastation. They are disproportionately most of the coronavirus cases and deaths in many states and the numbers don’t seem to be slowing down. There are many factors as to why this may be the case but the underlying lynchpin to it all is structural racism.
Structural racism is a system of discriminatory policies that assign privilege and power on the basis of race. And it is an obstacle black Americans face every day in every facet of their lives. Structural racism can be seen in housing policies, seen in the legacy of redlining to deny mortgages to black Americans, job hiring rates, with black Americans with black sounding names getting less interview calls, and educational opportunities, with less funding and opportunities for black students in predominantly black schools. Just in this past year alone, we’ve seen this structural racism play out as black Americans are shown they are not safe wearing hoodies or even sleeping in their own beds. Structural racism creates a world where a certain subsection of the population is not meant to thrive and grow. Black Americans are the poorest ethnic group in America. They have had the lowest median household income for the past fifty years. In 2014, the average black income measured at $35,398, compared to $53,657 for all races. Poverty is highly correlated with poor health and increased morbidity. And in a time of a global pandemic, this makes black Americans substantially more vulnerable to the virus.
Heart disease, obesity, diabetes, asthma, and elevated blood pressure are all correlated with poverty. They are also all the key targets for a perfect COVID victim. These health concerns are rooted in decades of poor housing, lack of access to healthcare, and exposure to higher rates of violence. Asthma is often related with poor housing conditions and black Americans are often living in areas of poor housing and are therefore disproportionately affected from asthma. Black neighborhoods are also often found to be ‘food deserts’ meaning very few supermarkets are available and those that are, often don’t have a good variety of fresh and quality produce, leading to unhealthy diets. Violence is also a major determinant in health disparities. It is not only a major cause of injury, disability, and premature death in young black Americans but it also causes extreme levels of stress with many people living with undiagnosed PTSD. And high levels of stress can physically affect the body by increasing the chances of mental illness, high blood pressure, or even strokes.
But one could argue that these are all external health factors. They are things that theoretically can be improved upon with perhaps a change of address. But structural racism can even be found in the way we approach internal health factors as well. Sickle cell disease is found in any ethnicity across the globe but in America, many people associate the disease with the black community because the mutation was found in many slaves during the transatlantic slave trade. Sickle cell affects more than 100,000 people and it is a painful vaso-occulsive disease that can result in substantial suffering. Without treatment, sickle cell disease can affect all organs and is associated with a decreased quality of life and a shortened life span altogether. But although sickle cell was first described more than 100 years ago, the development of disease modifying therapies has stagnated because of inadequate funding, partially attributed to structural racism. Take for instance, cystic fibrosis. Cystic fibrosis affects mostly white American and on a whole, affects one third fewer Americans than sickle cell. According to the Cystic Fibrosis Foundation, there are approximately 70,000 cases of cystic fibrosis worldwide, while sickle cell affects 100,000 people in just the US alone. But cystic fibrosis receives 7 to 11 times the research funding per patient, which results in disparate rates of development of medications. Currently the FDA has approved four medications for sickle cell and fifteen for cystic fibrosis.
We’ve also recently witnessed another failing on better understanding of internal health for the black community. Chadwick Boseman, the star of Marvel’s Black Panther, died this year of colon cancer. When he was first diagnosed, he was already at stage 3. Black Americans have the highest incidence and mortality rates of colorectal cancer of any ethnic group in America. Black Americans make up 13.4% of the entire US population but have the highest mortality rate for colorectal cancer. For example, black Americans with colorectal cancer have a 35% higher mortality rate than white Americans with the same cancer. Some of the disparities can be explained by differences in access to care, cancer screening, and other socioeconomic factors, but they aren’t enough to explain the wide gap between why black Americans seem disproportionately prone to this type of cancer. Many, like Chadwick Boseman, find out much too late about their diagnosis, leading to high mortality numbers. This shows there needs to be more research done to better understand the ethnicity specific factors to this disease, including genetic and environmental related risk of colorectal cancer. But not enough funding has been provided over the years to research this particular type of cancer and its reach, leading to a lack of better treatment and screening options for many afflicted black Americans.
So there are external and internal factors affecting black health. These are already setting up a perfect storm for COVID to take over. But what about once you get inside a hospital? Surely black Americans can find protection inside a hospital. Well, first, you’d have to decide if you can afford it. Many Americans are realizing just how dire the health care situation is in America now. But black Americans are especially feeling it. 55.5% of black Americans have reported having private health coverage compared to 75.4% white Americans. And during this global pandemic, many black Americans are working frontline jobs where taking a day off for a hospital visit is not feasible or possible. 44% of black Americans said in April that they or someone in their household had experienced a job or wage loss due to the pandemic, compared to the 38% of white Americans. And 73% of black Americans said they did not have emergency funds to cover three months of expenses, compared to 47% of white Americans. But even if they could find the time and money to see a doctor, the black community has had a historically mistrustful relationship with doctors for decades. Returning to sickle cell disease, many black sickle cell sufferers would find themselves facing doctors who didn’t believe their pain. Some doctors would conflate the opioid addicts and sickle cell victims and denounce the sickle cell sufferers as drug seekers.
Medical disbelief over black pain is nothing new. Black maternal death is 2.5 times higher than their white counterparts. Serena Williams and Beyonce both famously recounted their difficult and life-threatening birth stories and how they had to demand for extra care. According to the CDC, black women are three to four times as likely to be at risk of pregnancy-related deaths as white women. Or, as ProPublica reported in a piece, black women are 243% more likely than white women to die of pregnancy or childbirth related causes. Research has shown that it didn’t matter the education and financial background of these black mothers. Serena Williams, a world champion athlete, or Beyonce, a world famous singer, both had problems having medical experts believe their pain. Raegan McDonald-Mosley, chief medical officer for Planned Parenthood Federation of America has said, “You can’t health-care-access your way out of this problem. There’s something inherently wrong with the system that’s not valuing the lives of black women equally to white women.” And lest you think this issue stems perhaps more in sexism than racism, the mortality rate of black newborns, regardless of gender, in hospitals shrunk between 39% and 58% when black physicians took charge of the birth. By contrast, the mortality rate for white babies was largely unaffected by the doctor’s race. Researchers from George Mason University analyzed and captured data on 1.8 million hospital births in Florida between 1992 and 2015. They found that black newborns were three times more likely to die in the hospital than white newborns. But this disparity dropped significantly when a black doctor was put in charge of care.
There is a deep level of mistrust between the medical community and the black community. And this is a dangerous divide to have during a global pandemic. One way to repair that trust, some have suggested, is to have black patients meeting with more black doctors. But unfortunately, currently only 5% of physicians in the U.S. are black. And this goes back to the levels of structural racism many black Americans face from the moment they are born to the first day of school to the first day of applying for a job—it is not easy to thrive in a world that has been structural built against you.
Given all of these factors, it is quite clear why the black community is being particularly hit hard during this pandemic. In Michigan, black Americans make up 14% of the state’s population but they account for 41% of coronavirus deaths. In Louisiana, black Americans are 33% of the population but they count for more than 70% of the state’s coronavirus deaths. Economically, socially, physically, they have all the risk factors that make them the perfect target for this virus. But it is now, after a global pandemic has blown away all pretense and illusion, that we can see just how deeply entrenched structural racism is in our systems and the level of health inequities it has caused. The distrust and discrimination makes it difficult for some medical professionals to communicate with black communities during a time when communication, education, and outreach is vital. Coupling all of this with confusing directives from many states, a lack of a federal plan to address this crisis, and a constant shortage of tests and testing centers, COVID-19 has caused a devastating impact on the black community during this pandemic.
Such rooted racism has no easy fix. It is something that will take decades to undo and repair but that shouldn’t let us feel overwhelmed or powerless to aid the people who are so in need of proper care and protection, especially now, during a global pandemic. As the events of 2020 have shown us, we no longer have the excuse of ignorance. We should pay attention to state and federal policies that are being proposed and use our votes as our voices. We should elect and support those who want to help raise every community and not just the ones they choose to patronize. Just as we will either succeed or fail together in beating this global virus, we must all work together as one to truly dismantle this unfair and discriminatory system or racism.