United States history is threaded by a string of racial inequality and oppression of the lower socio-economic class. In this moment that disparity is more visible than ever, and policymakers are faced with a choice: continue down the path we are on and create another painful stitch in our history or start on a new thread of progress. Health disparities, particularly between Black and White Americans exist systemically throughout the United States.
The spread of the coronavirus pandemic highlights these stark differences as we have witnessed increased rates of infection and death among poor Black and Hispanic communities. That trend is reflected in statistics from major cities and states around the United States. In Chicago, 72% of the fatalities are Black Americans, 70% in Louisiana, and 41% in Michigan (5). The Center for American Progress reports that the, “compounding effect of existing inequities [putting] people of color in an increasingly precarious situation,” as to why poor urban minorities are disproportionately affected by the virus (5).
Many of these “existing inequities” were laid out by Nancy Krieger, a professor of social epidemiology at the Harvard Chan School of Public Health, in an interview with the New Yorker. Krieger said that poor minorities are disproportionately impacted by the coronavirus because they are more likely than wealthier, white people to live in crowded conditions, work in service jobs that translate to greater exposure and can’t afford to skip a day on the job, take public transportation, and lack access to affordable healthcare and health insurance (2).
Another factor that appears most relevant to this discussion, is the existence of environmental injustice in low-income, minority neighborhoods. The practice that occurs in many areas of allowing zoning for large, disruptive industrial sites in areas that are poorer, means that these communities often have a greater exposure to air and water pollution. Cities and private companies target these areas for industrial development because they carry less political and economic clout to fight back against the damage that may be done to their community. Also, these sites are often constructed with the promise of new jobs and economic progress for the area. In reality all that industry just leads to greater pollutant production, which means poor, urban, minority communities suffer the consequences of that pollution at startling levels (1). According to the National Academy of Sciences Survey 51% of Black Americans live in cities or a metropolitan area, and of those living there, most are incredibly likely to be exposed to air pollution (5).
That exposure to pollution means that black and hispanic communities have higher rates of the pre-existing conditions that make coronavirus patients much more vulnerable to negative effects. According to Sacoby Wilson, an Environmental Health Scientist at the University of Maryland, a pollutant that is most common in urban areas is PM2.5. This chemical that, typically ingested as particulate matter in the air, can cause asthma, heart disease, elevated blood pressure than can lead to stroke, greater infant mortality rates, greater change of birth defects, and low birthweight in babies, diabetes, cancer, and premature mortality. The presence of PM2.5 and other pollutants in these areas means the people living there a more likely to have experienced any one, or multiple of these conditions. In particular, the connection between living in a neighborhood with exposure to PM2.5 and having asthma, heart disease, and/or diabetes is what make death rates higher for Black and Latino communities. For example, Detroit Michigan is known for having lots of pollution and health effects because of it and Detroit also sees one of the highest mortality rates from Covid-19 (1).
The health disparities that exist due to environmental injustice are problematic on their own and are obviously exacerbated by the covid-19 pandemic. But the presence of that pandemic has actually brought these disparities to the forefront of our national consciousness like never before. In an interview with Yale Environmental 360 Sacoby Wilson put it this way: “One thing that Covid-19 has done, it has made a lot of populations we made invisible, visible” (1). The quality of life that has often been deprived of black and hispanic Americans living in poor parts of cities is finally being exposed by this pandemic. That exposure is incredibly important to the next steps policymakers choose as the response to the pandemic continues because this situation is an opportunity to correct the political and medical decisions that have left the socio-economically disadvantaged behind.
Unfortunately, this is not the trend that we see occurring thus far in public response to the pandemic. Robert Bullard, a Professor of Urban Planning and Environmental Policy at Texas Southern University and scholar considered to be the father of Environmental Justice, observed of the response thus far that, “There’s a whole segment of society that’s invisible to policy framers, and everything I’m hearing so far about how we’re supposed to deal with the coronavirus assumes we all have the same level of affluence” (4).
Each of the important defenses against the virus, before the vaccine was developed demonstrate how assumption leaves poor, minority individuals and families without protection. First and foremost, testing for the virus, that has long been our first line of defense against the spread of COVID-19, is much more readily available for wealthy people. Drive through testing excludes those who don’t own cars, and Latinx and Native American households are 2 times less likely to own a car, and that number grows to 3 times less likely for Black Americans. Also, many people in lower socio-economic situations don’t have the same access to healthcare as their wealthier, whiter counterparts, which is a requirement for many testing facilities (4).
Social Distancing, an expectation from many governments, is also something that is not as accessible to Black and Brown communities. Of respondents to the Census, only 20% of African Americans reported being able to work from home, and only 16% of Latinx respondents said they could. Being forced to go into work puts employees at much greater risk (4). Also, many people in these communities don’t have the ability to live in single-family homes so instead we see multi-generational households where the virus can spread much more easily because there is far less room for isolation.
And finally, keeping people out of stores means that online shopping has increased in popularity and companies like Amazon need to be careful about their shipping routes as they often disproportionately cross through poor neighborhoods with a greater population of minorities (4). All of this and more demonstrate a problematic lack of acknowledgement of differing levels of access that communities have by the government.
The newest and most important line of defense is, of course, the COVID-19 vaccine. The distribution of this lifesaving injection certainly requires considerations of equity but is that what we see happening? The Washington Heights neighborhood of New York City has “never seen so many white people,” Dr. Susana Bejar of the Columbia University Irving Medical Center commented after volunteering at a vaccination event there in January of this year (3). Her comment exposes a larger issue seen across the country with vaccination rates. Early statistics show the vaccination rate is much lower for black and hispanic populations in many areas. The event in Washington Heights, a majority Latinx and low-income neighborhood, demonstrates the inequities in the process that we are witnessing throughout the country. Much of the lack of access came from the sign-up process that was not accommodating for non-English speakers and those who aren’t tech savvy. The result was that people from more affluent parts of the city registered for vaccination slots in Washington Heights and took the spots that could have been much more beneficial to the actual residents of the neighborhood (3).
Nationally, the trend is similar. The Kaiser Family Foundation reports, “early warning flags about potential racial disparities in access and uptake of the vaccine” (6). Some cities, like Washington D.C target less affluent, less white neighborhoods in their administration of the vaccine. There is an important place-based element to the spread and severity of the COVID-19 pandemic particularly because of these environmental justice issues (6). So it appears that a place-based response to the pandemic, like in the nation’s capital, that favors those more disadvantaged places, is the best way to ensure an equitable and just response to the pandemic. That is how we can take this situation and use it to acknowledge and begin to repair the painful history that plagues medical policy in the United States.
References:
Bagely, K. (2020, May 7). Connecting the Dots Between Environmental Injustice and the Coronavirus. Retrieved February 02, 2021, from https://e360.yale.edu/features/connecting-the-dots-between-environmental-injustice-and-the-coronavirus
Chotiner, I. (2020, April 14). The Interwoven Threads of Inequality and Health. Retrieved January 28, 2021, from https://www.newyorker.com/news/q-and-a/the-coronavirus-and-the-interwoven-threads-of-inequality-and-health
Ellis, N. (2021, January 30). A vaccination site meant to serve a hard-hit Latino neighborhood in New York instead serviced more Whites from other areas. Retrieved February 02, 2021, from https://www.cnn.com/2021/01/30/us/new-york-vaccine-disparities/index.html
Jackson, D. (2020, May 26). Derrick Z. Jackson: Fighting for a just COVID-19 response. Retrieved February 02, 2021, from https://www.ehn.org/coronavirus-environmental-justice-2645619098.html
Sternlicht, A. (2020, April 07). Higher Coronavirus Mortality Rates For Black Americans And People Exposed To Air Pollution. Retrieved February 02, 2021, from https://www.forbes.com/sites/alexandrasternlicht/2020/04/07/higher-coronavirus-mortality-rates-for-people-exposed-to-air-pollution-black-americans/?sh=6b3e3e1c362f
Shapiro, A. (2021, January 28). Early Data Shows Striking Racial Disparities In Who’s Getting The COVID-19 Vaccine. Retrieved February 02, 2021, from https://www.npr.org/sections/coronavirus-live-updates/2021/01/28/961703505/early-data-shows-striking-racial-disparities-in-whos-getting-the-covid-19-vaccin
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