A Virus That Discriminates

Saba Rawjani dives deep into pre-pandemic health disparities in the U.S. and ones that COVID-19 has brought to the forefront.

June 14, 2020

"The reality is that race has an impact on the socio-economic status you can accumulate, which in turn affects resources like access to housing and healthcare."

I remember when Professor Merlin Chowkwanyun made the above remarks in our Social Determinants of Health class. I remember the unsettling thoughts that raced through my mind; how unfair is it that one’s access to good health is contingent on the color of their skin? 

And then, this past April, U.S. Surgeon General Jerome Adams discussed the inequity that African Americans have been facing amidst the coronavirus outbreak. I felt the same unease; race impacts health, and the Coronavirus is just the latest instance of the burden that minorities face in our country. Although prominent figures such as NIAID director Dr. Anthony Fauci, CNN's chief medical correspondent Dr. Sanjay Gupta, New York Governor Andrew Cuomo and even the WHO Director-General Dr. Tedros Adhanom Ghebreyesus continue to express that from the perspective of age, COVID-19 is an equal threat to all of humanity and does not discriminate. Yet, the virus does discriminate and it has brought to surface one of the United States’ gravest issues: racial disparities are pervasive in our healthcare system.

Coronavirus disproportionately affects minorities 

The statistics surrounding COVID-19 incidence tell a clear story: 

Percentage of populations and share of COVID-19 deaths across US states in the African American community.
State Minorities % Population Minorities % of Coronavirus-related Deaths
Illinois  14 42
Michigan  14 41
Louisiana  32 70
New York 30 43

In spite of all efforts, care for minority groups is falling short; communities of color are more susceptible to the disease and face barriers obtaining access to testing, treatment, and basic sanitation products.

We’ve heard this story before

The inequity exposed by this virus is nothing new. Racial health disparities have existed in the United States for generations, including the relative incidence of diabetes, obesity, opioid abuse, and heart disease. For example, in 2015 it was seen that Hispanic and Black individuals have the highest rate of incidence for both hypertension and obesity. Sadly, the reach of racial health disparities even extends to our children; in 2019, Dr. Charles Modlin, a urologist and kidney transplant surgeon at the Cleveland Clinic, showed that “black babies continue to die at disproportionate rates – nearly four times more often than white babies. That racial disparity touches African-American infants from well-off households as well as poor ones.”

Where are we going wrong?

The question is not whether we have an issue in our care for minority groups, but rather what we are going to do to fix it. This requires a clear view of the root causes of the disparities highlighted above. Health inequities are dependent on several factors, with issues ranging from lack of access to clean water to unsafe work environments to poor education for minority populations. Research shows that there is a strong relationship between health literacy and health disparities among minority populations. With a predominantly English-language health care system, 41 million Spanish-speaking Americans face issues such as understanding their own insurance plans, having comprehensive conversations with their healthcare providers, and fully complying with health guidelines and preventative measures.

Dr. Margarita Alegria, Chief of the Disparities Research Unit at Massachusetts General Hospital and Mongan Institute expressed in The Hill that “Amid a pandemic, it can be a matter of life and death…without interpreters, [native Spanish speakers] can’t understand what their doctors and nurses are telling them, and they can’t make informed decisions about their own medical care.” It is necessary for all healthcare institutions to echo what Dr. Alegria and her team are doing by bridging this gap and developing methods to ensure that patients are receiving information they can understand. However, it is equally important for public health practitioners and educators to introduce intervention models that can improve literacy rates among minority non-English speaking communities and focus on empowering them to actively take part in their own healthcare, which has been shown to improve health care quality and outcomes. With more education and higher literacy rates, individuals are more responsive to public health directions, more likely to self-regulate their health behaviors, and achieve better long-term health outcomes.

In addition to disparities in literacy, minority groups also face disproportionate access to clean water; an issue that became a foremost concern for public health officials following the Flint water crisis in 2014. In South Carolina, community organizations are supplying clean water for the elderly in majority-black communities because their taps are releasing brown, contaminated water, and many of them cannot leave their homes to purchase bottled water during the pandemic. In Michigan, some black families share water with their neighbors because they don’t have enough clean running water. This makes social distancing a difficult task and puts them at greater risk for contracting the virus.

Minority groups are also more likely to face housing disparities. In her book, A Terrible Thing to Waste, Harriet Washington found that “African Americans who earn $50,000–60,000 annually — solidly middle class — are exposed to much higher levels of industrial chemicals, air pollution and poisonous heavy metals, as well as pathogens, than are profoundly poor white people with annual incomes of $10,000.” We can see that this disparity spans across all geographic regions, whether rural or urban. Exposure to high levels of pathogens increases the chances of being diagnosed with asthma, lung disease, and other immunocompromising illnesses; health conditions that the CDC has labeled as high risk to the virus.

There’s hope, and it’s closer than you think!

As grave as the numbers and realities are, there are people and organizations striving to fill the racial health disparity gap. Look no further than our Mailman community. For years, Professor Diana Hernandez, a native of South Bronx, has worked on issues related to housing and its impact on health in minority communities. Her ongoing investment in social impact real estate and her dedication to projects that tackle issues related to smoke-free housing compliance policies and examining air quality in homes is the kind of leadership and direction we need for change. On May 7th, Columbia Mailman School professors including Drs. Hernandez, Micaela Martinez, and Markus Hilpert testified to the New York City council on disparities related to race and socioeconomic status amid the coronavirus crisis. Dr. Martinez raised the issue that “in New York City, they saw quite early on that Queens and the Bronx were being hit harder [by the virus] than other boroughs, and knowing the differences in demographics and socioeconomic status across NYC boroughs, they suspected health disparities were playing a role.”

In the area of food security, Professor Sara Abiola is leading projects that look at the implementation of the Supplemental Nutrition Assistance Program (SNAP) at the state-level. Dr. Abiola and her team are working to uncover the nature of food distribution using policy surveillance and legal mapping methodology. With their work, they hope to better understand the nature of food insecurity during the coronavirus pandemic and answer questions related to the inequities related to food distribution and access.

The coronavirus is a critical lesson for all of us and a cry for a more just health system, especially for those who experience inequality based on the color of their skin. We must strive to build a country where division is not a product of diversity. I hope one day we can reach a level of equality such that when a public health student hears about racial health disparities in class, it’ll be a lesson of history and not the current day.

Saba Rawjani is a 2021 MPH candidate in Health Policy & Management. She received a BS in Neuroscience and Mental Health from Carleton University. She is the president of Bloom Girls Mentoring and is currently interning at the Cleveland Clinic.