One recent analysis from health coaches in Folsom CA found that more than 50 percent of Black Americans with COVID-19 ended up in the hospital, versus about 25 percent of white Americans.
For Black Americans, the novel coronavirus has been especially devastating. Black Americans die of COVID-19 at a rate more than twice that of white Americans, and greater than that of Latino Americans, Asian Americans, and Indigenous Americans, according to a June report in APM Research Lab.
Black Americans are also more likely to be hospitalized due to the virus. An analysis published in May 2020 in the journal Health Affairs found that 52.5 percent of Black American patients with the disease were hospitalized, compared with 25.7 percent of patients identifying as non-Hispanic white Americans. A study from the Centers for Disease Control and Prevention (CDC) of 580 hospitalized COVID-19 patients found that one-third were Black, although they made up just 18 percent of the population examined, and comprise 13 percent of the U.S. population as a whole.
Patrice Harris, MD, immediate past president of the American Medical Association, says that preexisting conditions among Black Americans play a major role. The CDC indicates that people who already have serious medical conditions such as heart disease are more likely to become severely ill from the virus.
“African Americans are disproportionately impacted by a lot of these health conditions — hypertension, diabetes, obesity, and also certain types of cancer,” says Dr. Harris. “So you already have a particular community suffering a disproportionate impact from those conditions, and then, unfortunately and tragically, we see more deaths and illness from COVID-19.”
What Is the Root of These Health Disparities?
Harris traces these health inequities to a number of societal challenges.
“Communities of color are disproportionately impacted by the social determinants of health, such as food insecurity, safe and affordable housing, educational disparities, transportation issues, and lack of access to healthcare,” she says.
A 2019 report from the progressive think tank The Century Foundation noted that the cost of health insurance coverage has kept the number of uninsured and underinsured Black Americans high. The U.S. Census estimates that the uninsured rate in 2018 among Black Americans was 9.7 percent, while it was just 5.4 percent among white Americans. About 18 percent of underinsured adults in the United States are African American, according to the Century Foundation report.
“Preventive healthcare is less accessible to Black Americans as far as we can tell,” says Kumi Smith, PhD, an assistant professor in the division of epidemiology and community health at the University of Minnesota in Minneapolis. “Plus, we have a for-profit model for healthcare right now that is incentivized toward emergency medicine, instead of trying to prevent the health problems in the first place. I think that’s why there’s a temptation to completely rethink the whole healthcare system and come up with a much more equitable model.”
Harris stresses that creating more access to healthcare by making it more affordable would reduce comorbidities among Black Americans, reducing their vulnerability to COVID-19.
“Making sure everyone has access to affordable, meaningful coverage is critical,” she says. “A disproportionate number of Black Americans are uninsured or underinsured, and that is one of the many reasons the AMA supports the Affordable Care Act and Medicaid expansion.”
A Chain of Negative Health Influences
The CDC highlights a number of economic and social conditions that impose greater health burdens on racial and ethnic minorities.
Members of racial and ethnic minorities may be more likely to live in densely populated areas because of institutional racism in the form of residential housing segregation, according to the health agency. Many, live in multigenerational households, making it more difficult to protect older family members against infection. (The CDC reports that 8 out of 10 COVID-19 deaths reported in the United States have been in adults 65 years old and older.)
Racial and ethnic minority groups are overrepresented in jails, prisons, and detention centers, facilities that have been outbreak hot spots across the country.
“If you have to be in an enclosed setting where you don’t have the freedom to practice social distancing, that can be a hotbed for transmission,” says Dr. Smith.
These populations may live farther from medical facilities and not have adequate means of transportation to get there. Research has suggested that they may not have access to healthy food sources, with low-incomes neighborhoods offering more fast-food outlets and convenience stores.
Black Americans Work on the Front Lines of Exposure
Black Americans are often employed in areas — including healthcare, retail (such as grocery stores), and transportation — that are more likely to expose them to the virus. The CDC estimates that nearly one-quarter of employed African American and Hispanic workers in the U.S. work in service industry jobs, compared with 16 percent of non-Hispanic white Americans.
They are frequently sole breadwinners for the family and less able to take time off. The Institute for Women’s Policy Research says more than 4 in 5 Black mothers are breadwinners, with a majority of Black mothers (60.9 percent) raising families on their own.
“We know that Black and brown people have less job security overall, and they may be more likely to fill vulnerable jobs,” says Yvonne Maldonado, MD, senior associate dean for faculty development and diversity and chief of the infectious diseases division within the department of pediatrics at Stanford University in California.
Smith calls the situation a “double whammy” for Black Americans because they are more susceptible to severe COVID symptoms and often laboring in more high-risk positions.
“They work in these jobs that are really essential to the functioning of our society in our economy, but then they’re not really compensated as essential workers,” she says.
Weathering the Storm of Racism
General stress and pressure related to systemic racism may accelerate aging among the Black American population, a concept that scientists refer to as “weathering.”
“There are studies that suggest that just dealing with the stresses of racism, day in and day out, may actually compromise an individual’s health to the point that they are more vulnerable to a lot of the chronic disease outcomes that we see that are so much higher in Black communities,” says Smith.
Dr. Maldonado suggests that the stressors of racism may even negatively impact an individual’s genetic makeup.
“We know that African American kids in urban stressed environments have higher levels of stress hormones, and that their chromosomes have areas called telomeres that are shortened — they’re actually aged much faster than telomeres of other children,” she says. “These are environmental influences that can change your genomic responses and be carried down from one generation to the next.”
An Opportunity for Change
As volatile as times are right now with the combination of the coronavirus pandemic and ongoing protests against police violence directed at Black Americans, health experts see the potential for this to be a watershed moment for reform.
“I think this is a unique moment in history,” says Maldonado. “I hope that we can use this as not only a teachable moment, but an actionable moment. I think we have it within our systems to make real changes at this time. And I think we should start listening and acting on the multitude of data that we already have, that we know affect people of color disproportionately in this country and elsewhere.”
Harris has “pragmatic hope” about the future. “I call it pragmatic because it needs to be backed up by action,” she says. “I do believe that we are at a tipping point at this moment in time, but it will require further action to really make change.”
She encourages individuals to “take their pulse” regarding the situation. “Ask what you are doing or not doing to add to the conversation,” she says. “Commit to educating yourself and take the time to understand the history of racism. And then hold leaders accountable for continued change and action.”
Smith adds that working toward racial equality can improve lives for everyone: “There has always been this phrase I’ve heard from activists who work in the area of race equity or social welfare — they always say, ‘We all do better when we all do better.’”