The pandemic lays bare structural inequities that need fixing across all aspect of American society. Kimora “Kimmie” Lynum was “the type of kid that would brighten your day,” her cousin, Dejeon Cain, told a local news outlet in Florida. “She loved her mom, dad, grandma, uncles, and aunties.”
Kimmie, who was nine years old, died last month of Covid-19, following a sudden spiking fever. Her family did not know she had the disease until it was too late, Cain said.
Kimmie is one of an alarming number of people of color whose lives have been upended or cut short by the coronavirus. Black people are nearly three times more likely than whites to contract Covid-19 and more than twice as likely to die from the disease, according to a report published last week from the National Urban League.
Beyond those raw statistics, people of color are suffering grossly disproportionate health and economic consequences from the Covid-19 pandemic — impacts that could take years to recover from. But for recovery to happen, the pandemic must serve as a wake-up call to the deep social and racial inequities that have left Black people, in particular, more vulnerable to the effects of the pandemic and less able to bounce back from this or any health or economic crisis.
Nobody thinks it’ll be easy.
“For generations, communities of color have faced vast disparities in education, in job opportunities, in income, in inherited family wealth, and in health care,” said Michelle Williams, dean of Harvard T.H. Chan School of Public Health. “The Covid-19 crisis has laid bare these issues.”
With widespread Black Lives Matter protests playing out in the background, Williams and other public health experts are now contemplating the piled-on problems of the pandemic amid a time of great hope, and greater-than-ever need, for positive social upheaval. It’s all tied together, they say.
“Sadly, the ill effects of this pandemic will be felt for many years after we’ve pushed back the virus,” Williams said. “Delays and deferral in medically managing noncommunicable disorders like hypertension and diabetes — conditions already disproportionally high in black communities — will only worsen.”
In the United States, white men outlive Black men by about 4.5 years, on average, and white women outlive Black women by around 2.7 years. These disparities are rooted in well-known, systemic social stressors and inequities that leave Black Americans with higher rates of heart disease, diabetes, obesity, and other chronic conditions.
“Being Black in America also means enduring psychological stresses linked to premature biological aging,” Williams said. “All of these health issues conspire to make viruses like Covid-19 that much more severe.”
Being Black is a risk factor for poor health not because of underlying biology, but due to a host of disadvantages and disparities that start at birth. Black babies are 2.5 times more likely than white babies to die before their first birthday.
Across the country, the heaviest industrial polluters are concentrated in areas with high minority populations. Air pollution causes asthma, heart attacks, and strokes, according to the Environmental Protection Agency, and leads to some 100,000 premature deaths a year in America. The health effects begin at birth and pile up with time, says Afif El-Hasan, a pediatrician in California who focuses on asthma.
“People who’ve been living long term in areas of high pollution have reduced natural defenses in their bodies, and it makes it easier for Covid or any other infection to be invasive,” El-Hasan explained.
Up to 40 million Americans face evictions in coming months, according to an analysis by the Aspen Institute; about 80% of them are Black or Latino.
Recent research found anyone who spends a lifetime in a heavily polluted region of America is more likely to die from Covid-19 than people who’ve lived in clean air. There are short-term risks, too. Spikes in pollution this spring, when the EPA relaxed regulations, were shown to directly contribute to a rise in new Covid-19 infections and deaths.
People don’t choose to live in bad air. Many Black people live where they do largely because of decades and centuries of policies by governments and businesses that forced them into social and geographic boxes that remain difficult to get out of.
The ripple effects of the pandemic extend far behind public health. About 36% of renters didn’t make rent on time in July, according to a survey by the platform Apartment List. Up to 40 million Americans face evictions in coming months, according to an analysis by the Aspen Institute; about 80% of them are Black or Latino. A surge in foreclosures would follow, the institute predicts, particularly among individual “mom and pop” property owners, who are the landlords of about 47% of all U.S. home rentals and in many cases don’t have the resources to pay their mortgages without the rental income.
Today, about 71% of white Americans own a home, which has long been considered the #1 way to build wealth. The figure is 41% for Blacks and 45% for Hispanics. Lenders are 80% more likely to deny mortgages for Black applicants even today, according to a recent Zillow analysis. Mortgage denial rates are highest in neighborhoods that are predominantly Black, and in those areas, Black people are still denied disproportionately compared to whites.
The resulting financial disadvantage, which carries from generation to generation and extends back to slavery, Jim Crow laws, and redlining that denied Black people mortgages starting in the 1930s, is profound. Typical household wealth, measured by the median (with half of households above and half below) is $17,150 for Black people, $171,000 for white people — 10 times as much.
The wealth gap is inextricably linked to other systemic inequities, such as pollution exposure, lack of health care and, ultimately, a glaring health gap. Put simply: “The greater one’s income, the lower one’s likelihood of disease and premature death,” according to a report from the Urban Institute and the Center on Society and Health.
Jason Hargrove, a Black bus driver in Detroit, expressed his anger in a Facebook post earlier this year after a woman on his bus coughed several times without covering her mouth. Two weeks later he died of Covid-19.
Black people make up 13.4% of the U.S. population, but almost 30% of bus drivers are Black, as are nearly 20% of all food service workers, janitors, cashiers, and stockers, writes Rashawn Ray, an associate professor of sociology at the University of Maryland and a fellow at the Brookings Institution. Blacks and other people of color represent a disproportionate chunk of these “essential” and “frontline” workforces unable to work from home and tend to kids, making them exposed to the virus more than others, other research shows.
“During a highly contagious pandemic like Covid-19, Black workers, and consequently their families, are overexposed,” Ray writes. “In this regard, staying home during a quarantine is a privilege.”
Meanwhile, the pandemic continues to decimate the job market. As of July, unemployment stood at 9.2% for whites, 12% for Asians, 12.9% for Hispanics, and 14.6% for blacks. Black women have faced the largest job losses.
A learning gap has long plagued U.S. K-12 schools, with Black and Hispanic students scoring, on average, two to three years behind white students on standardized tests, according to the McKinsey & Company, a research firm.
The gap will likely widen if schools rely solely on online learning, which is less effective, especially for low-income students who don’t have access to high-speed internet or parents available to offer academic supervision, the company concludes in a recent report.
Where classrooms and daycares do not open, essential workers are forced into impossible choices. Unlike schools, for-profit daycare centers are threatened with permanent closure, which will likely disproportionately affect people of color and the poor, and “also has important implications for income and educational inequality, racial equity, geographic equity, and a potentially significant decline in the number of mothers in the labor force,” according to an analysis by the Center for American Progress.
People across the country are struggling to pay the bills right now. A survey of low-income households conducted in May by researchers at Indiana University found 13% were already unable to pay their energy bills the previous month, 9% had received an electricity utility shutoff notice, and 4% had had their electric utility service disconnected.
“Energy insecurity is already a widespread problem in the U.S.,” the researchers write. “It disproportionately affects those at or below the poverty line, Black and Hispanic households, families with young children, people with disabilities, and those who use electronic medical devices.”
They estimate that 800,000 low-income households may have recently had their electricity disconnected — based on data from this spring. The problem could get worse as the economy continues to struggle, the researchers say. And the impact could be deadly in summer heat, especially for older people, young children, people of color, and the poor.
Millions of Americans, particularly people of color live in “food deserts,” where a supermarket’s fresh produce and other healthy food are impractically far away, and local stores and fast-food chains are overloaded with junk food. The worst food deserts tend to be in dense, poor urban areas, contributing to “food insecurity,” defined as not having enough money to properly feed a family.
Before the pandemic, 37 million Americans suffered food insecurity, including 11 million children. Black and Hispanic families are twice as likely to suffer food insecurity compared to white families, multiple organizations have found. The nonprofit charity Feeding America says the crisis is most acute in Navajo County, Arizona, where 43% of the population are Native American.
By the end of April, food insecurity had doubled compared to previous levels, affecting more than 20% of U.S. households and 40% of households with mothers with children 12 and under, according to the Brookings Institution.
Food deserts and food insecurity have been linked directly to increased rates of diabetes and other chronic diseases — risk factors for worse outcomes from Covid-19 — again, particularly among people of color.
People without health insurance are less likely to visit a doctor for any reason, including to get tested for Covid-19. While just 8% of white Americans under age 65 are uninsured, the figures are 11% for Blacks, 19% for Hispanics, and 22% for Indigenous people, according to the Kaiser Family Foundation.
Increasingly, health experts say the U.S. health care system is broken and in need of structural fixes to better serve marginalized communities, which will ultimately serve all Americans.
“Covid-19 is a disease of communities and networks, a pathogen that floats along the infrastructures of human relations,” a small group of doctors and researchers wrote recently in the Journal of the American Medical Association. “Only by better strengthening networks and supporting all communities will anyone, and everyone, return to well-being.” They argue for everything from improving education of doctors to building community health centers that better serve local needs.
“Having single-payer universal healthcare would be a tremendous help in terms of Covid specifically.”
Others say the health inequities can only be properly remedied with a single-payer health care system, in which basic, essential health care is paid for by the government, similar to how Medicare works. That alone would not address all health inequities, but it would be a start.
“Having single-payer universal health care would be a tremendous help in terms of Covid specifically,” Sabrina Strings, PhD, a sociologist who studies race, gender, and the sociology of medicine at the University of California, Irvine, said. “But because health disparities are fundamentally rooted in racism and sexism, single-payer health care is not going to eradicate that. Only a willingness to address the structural forms of oppression in our society will improve those kinds of inequalities.”
The very systemic nature of the underlying problems means change, if it comes, will require not just awareness by marginalized groups, but a sustained investment of desire and effort by all Americans, on a level that’s unprecedented, Strings contends.
“There is a growing awareness of the many different types of ‘isms’ that are still plaguing America,” said Strings, author of Fearing the Black Body: The Racial Origins of Fat Phobia. “However, this is not the first generation to be awakened to this reality. I don’t have any evidence that the hippies of the 1960s and ’70s were less aware of these problems than Gen Z. So that gives me a little bit of pause. I want to feel hopeful, but I know we’ve been here before.”
Williams, the Harvard health school dean, agrees the task is tall, requiring “radical, large-scale investment” in public health, housing, and environmental justice, among other efforts. But she remains hopeful that the Covid-19 crisis can be a springboard for systemic change.
“If we remain vigilant about voting, if we hold our elected officials accountable, and if we each do our own part to help each other, hope can turn into reality,” Williams said. “It is up to us to keep pushing for social justice on scale.”