Calling out Racism as the Root Cause of Health Disparities Must Be the New Status Quo
Early in the pandemic, a friend sent me a children’s book that attempted to explain the novel coronavirus to the youngest among us. The book depicted SARS CoV-2, the virus that causes COVID-19, as a large, looming specter that appeared abruptly in a small African village, morphing from one terrifying form to the next, preying upon the most vulnerable, and sending everyone into hiding, leaving the marketplace empty. By the middle of the book, villagers, masked and carrying ample supplies of hand sanitizer, had mobilized to vanquish this new foe. They taught each other about transmission risk and how to wash their hands for 20 seconds and helped their neighbors in need. A few pages later, just as abruptly as it appeared, the virus had vanished. People took off their masks, cheered in exaltation, and ran right back to the marketplace. Back to the status quo.
Oversimplified, yes. A bit too morbid for small children, maybe. But the metaphor is apt. From its mercurial clinical manifestations to its high death rate, COVID-19 has bred intense fear and disquiet. As an infectious disease physician, I recall walking through the nearly empty halls of the hospital, passing a few health care providers, several maintenance workers, and one or two patients, during the first week of quarantine. The communal sense of trepidation was palpable.
Also, like the specter in the tale, the real COVID-19 preys on the most vulnerable, many of whom in this country are Black and Latinx individuals. Though factors such as older age and the presence of co-morbid conditions like obesity and hypertension are important predictors of severe COVID-19 infection, the roots of our vulnerability run much deeper. It is shaped by the adverse social, economic, and political context in which we live and is based in the structural racism that has limited access to health care, redlined mortgages, segregated neighborhoods, imprisoned Black and Latinx men and women, and curbed the potential of Black and Brown people for centuries.
Data supporting the impact by race and ethnicity are incontrovertible. The death rate from COVID-19 among Black people is 2.3 times higher than among Whites. Collectively, Black individuals comprise approximately 13% of the U.S. population but have suffered approximately 24% of the deaths from COVID-19 deaths. Among Latinx, data from specific locations unveil a disturbing story. In New York City, the early epicenter of the pandemic in the U.S., Latinx individuals is 2.1 times higher than among their White counterparts. Furthermore, in New York State, Latinx comprise 19.2% of the population but have suffered 26.6% of deaths.
SARS-CoV-2 may be “novel,” but these disparities are not. Black people in the U.S. have significantly higher death rates than Whites for all-cause mortality, across all age groups. For example, among people living with HIV, the age-adjusted death rate is 6.6 per 100,000 among Blacks, compared to 0.9 per 100,000 among Whites. I quarrel with the multitude of commentators who have stated that COVID-19 has illuminated racial and ethnic disparities. To illuminate is to clarify or explain something that was not understood previously. But nothing was ever really misunderstood about the stark, and frankly grotesque, racial and ethnic disparities in health outcomes in this country. To state otherwise is to admit that one was walking around with blinders on.
What is unprecedented, at least in my lifetime, is the acknowledgment of structural racism as the root cause of these obvious disparities. Pre-COVID-19, many talked about race. Some talked about inequality. A few even talked about structural inequity. But talking about racism made people feel uncomfortable. And for too long, the ethos of ‘benign neglect’ was the societal status quo. Following the release of the data highlighting the disparities in COVID-19 cases and deaths among Black individuals in Chicago and Louisiana, news outlets have dedicated space to structural racism. This momentum has been fueled by the egregious (and also not new) murders of Black men and women by people sworn to serve and protect and the resultant nationwide Black Lives Matter protests. The newfound willingness of mainstream society to call out structural racism — the foundation upon which the U.S. continues to build — as the primary driver of health disparities is fundamental to dismantling those structures.
The bigger picture of health disparities is not new. However, calling out racism is. Maintaining this frank discussion is the first step to long-overdue, constructive action. We must not return to the status quo.
Written by Bisola Ojikutu.
Bisola Ojikutu, MD, MPH, is a senior advisor at JSI. She is also an assistant professor of medicine at Harvard Medical School; an infectious disease physician at Brigham and Women’s and Massachusetts General Hospital; and associate director of the Bio-behavioral and Community Sciences Core within the Harvard University Center for AIDS Research.