Updated on May 21, 2020.
When the novel coronavirus initially made headlines early this year, one of the first things we learned was that it was especially dangerous to older people. That’s still true, although it’s now clear that young and middle-aged adults can get very sick and die from the virus, as well.
Soon, another pattern emerged. COVID-19 illnesses and deaths aren’t just affecting older adults at higher rates. They’re also disproportionately affecting people of color, especially African-American and Hispanic communities.
Early numbers suggested a sobering reality: A Washington Post analysis published on April 7 noted that majority-black counties had three times the rate of infections, and almost six times the rate of deaths, as majority-white counties.
Meanwhile, the first few states to release racial data on COVID-19 cases reported that African Americans were testing positive and dying at “alarming rates,” according to the New York Times. Hispanic communities were also suffering: Latino people in New York City, as with black New Yorkers, were dying from COVID-19 at twice the rate of white people, according to data released by the city’s health department on April 8.
The picture has become even sharper since then. Throughout the United States, 22 percent of counties are considered disproportionately African-American, meaning more than 13 percent of the population is black. Yet these counties accounted for more than half of all COVID-19 cases and almost 60 percent of COVID-19 deaths, according to data released on May 6.
Why is this happening?
Biologically, it makes sense that older adults would be more susceptible to severe cases of the disease. Our immune systems weaken as we age and at the same time, our underlying health problems—which can make COVID-19 more dangerous—multiply.
The reasons why this pandemic is hitting communities of color so hard, on the other hand, are more complex. They’re also likely more about social and economic issues than purely physical ones.
Understanding social determinants of health
To make sense of these issues, it’s important to first understand a concept known as social determinants of health. It’s defined by the Centers for Disease Control and Prevention (CDC) as “conditions in the environments in which people live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”
For example, people living in poor neighborhoods are less likely to have access to healthy foods. And while eating more fruits and vegetables (and less fatty, sugary and processed food) may not directly protect you against a global pandemic, it can reduce your risk of chronic health problems—like obesity, diabetes and hypertension—that make COVID-19 more dangerous.
Minority racial groups are more likely to experience poverty than their white counterparts. They’re also more likely to have lower education levels, higher rates of unemployment and worse physical health.
These disparities between races are related to multiple factors, says Monica Webb Hooper, PhD, a licensed clinical health psychologist and deputy director of the National Institute on Minority Health and Health Disparities—and they include longstanding problems such as institutional racism, discrimination and other barriers to preventive medicine and quality health care.
“A health disparity is one that adversely affects people who have experienced various forms of social disadvantage and greater obstacles to having optimal health,” says Webb Hooper. “It’s not just about individuals making bad choices or living a certain lifestyle. There are larger factors beyond those individuals’ control that affect their functioning.”
COVID-19’s impact on minority communities
In many ways, the novel coronavirus is just the latest example of how social and economic issues contribute to gaps in health care, and overall health, among people of color.
“Unfortunately, I was not surprised that we are seeing health disparities as it relates to COVID-19,” says Webb Hooper. “I think that this virus simply highlighted the existing disparities that you find across many different health conditions.”
Still, there are some factors specific to the coronavirus that may make this crisis particularly lethal for minorities. For example, research from the Harvard T.H. Chan School of Public Health suggests that people who’ve lived for many years in places with high levels of air pollution are more likely to die of COVID-19 than people who live in areas with less pollution. And according to the American Lung Association, people of color are more likely to live in places with high levels of air pollution.
It’s also clear now that staying home and avoiding close contact with others are two of the best ways for people to protect themselves against the virus. But depending on your living situation, that can be easier said than done.
“The most effective strategy known to reduce COVID-19 infection is social distancing, but herein lies a vexing challenge,” wrote Clyde W. Yancy, MD, chief of cardiology at Northwestern University, in an article published on the JAMA website in April.
“Being able to maintain social distancing while working from home, telecommuting, and accepting a furlough from work but indulging in the plethora of virtual social events are issues of privilege,” Dr. Yancy argued. “In certain communities these privileges are simply not accessible.” In other words, not everyone can stay home in relative comfort and security.
People of color are more likely to live in densely populated areas and work frontline jobs—as public transportation operators, grocery store employees and warehouse distribution workers, for example. And according to the Economic Policy Institute, only 16 percent of Hispanic workers and about 20 percent of black workers can telework, compared to 37 percent of Asian and 30 percent of white Americans.
“When you think about who is most likely to be exposed to COVID-19, you’re looking at factors that disproportionately affect racial and ethnic minorities and poor people in general,” says Webb Hooper. It’s important to look at the bigger picture, she adds.
“Groups who experience health disparities are sometimes blamed for their problems,” Webb Hooper notes. “But if they have to make a living and they’re not able to take appropriate precautions on the job—or if they’re living in a homeless shelter or in a crowded, multigenerational household—there’s little they can do about those factors.”
These same groups of people are also more likely to be uninsured or underinsured, and therefore may be hesitant to see a doctor if they do get sick. Research suggests that minority communities are less trusting of the health care system in general, because of issues such as language barriers, lack of diversity among medical staff and experiences of discrimination. When people of color do seek care, their symptoms may not be taken as seriously as those of white patients.
How to bridge the gap and stop the spread
Health experts say that, in order to stop the spread of COVID-19, these disparities must be recorded, studied and addressed. Testing for the virus must be readily available in vulnerable communities, and contact tracing—the process of tracking down people who may have been infected by those who test positive—must be “relentless,” wrote members of the Association of Black Cardiologists (ABC) in a May essay for the American Heart Association journal Circulation.
Lawmakers should also support free computer and internet access, the ABC authors argued, since both our education and healthcare systems are becoming more reliant on this technology. Paid sick leave, more funding for community food banks and suspensions of foreclosures and evictions can also help soften the blow that COVID-19 is having on poor and minority communities.
Some states, including Louisiana, Michigan and Massachusetts, have announced programs aimed specifically at addressing health disparities as they relate to the virus. And in early May, New York State launched an initiative to expand testing in communities of color. The CDC, meanwhile, has published information specifically about COVID-19 in racial and ethnic minority groups.
In his JAMA article, Dr. Yancy calls the present a “moment of ethical reckoning,” and pointed out that even when the spread of COVID-19 is under control, inequality in health care will persist.
Webb Hooper agrees. In a JAMA editorial published in early May, she and her coauthors wrote that the pandemic “presents a window of opportunity for achieving greater equity in the health care of all vulnerable populations.”
One key to reaching vulnerable communities is paying attention to and addressing their unique challenges. “Broad, uniform public health recommendations will need to consider the needs of disadvantaged populations to avoid unintended consequences,” Webb Hooper says. “It’s important that we find solutions, in ways that are responsive, in order to really create lasting change.”
