By Stevenson Cerisier '22 (Bio Below)
Introduction
On January 20, 2020 the first confirmed case of COVID-19 Coronavirus was diagnosed in the United States. Two months later the WHO declared COVID-19 a global pandemic terrorizing the world. African Americans are disproportionately represented in COVID-19 cases and deaths. The elevated rates are due to various health disparities. These disparities are shaped by the fact that our policies and institutions create inequities in access to many resources that could help people make healthier choices, including seeking health care. How is it possible that African Americans can’t access testing and seem to show severe symptoms or dying at alarming rates from COVID-19? How are syndemics playing a role in how lethal COVID-19 is to African Americans? Is being African American linked to higher susceptibility to the virus itself? How can we fix these issues and improve conditions for African Americans? I am going to answer all of these questions by researching the effects of various health disparities in African Americans communities in the United States dealing with the coronavirus. With how new the COVID-19 pandemic is, there is not an abundance of research on the disease in many regions, so it would be best to look at the country collectively.
Susceptibility
There is a strong belief that African Americans are more susceptible to contracting COVID-19. According to the CDC, the places that African Americans live and work has an impact on their health (CDC 2020). Over time these places create conditions for African Americans that may lead to health risks, needs, or negative outcomes down the line. Pew Research Center (2020) claims that in comparison to 26% of African Americans who are likely to live in multi-generational households, 29% of Asians living in the U.S live in multigenerational households, 27% of Hispanics live in multigenerational households, and 16% of Whites live in multigenerational households. Multigenerational households are designed to provide space for multiple generations to live together under one roof. The basic idea of multigenerational living is that at least two adult generations live together. African Americans living in these homes may find it hard or impossible to take precautions to isolate sick family members if the space in the house is limited making them more likely to catch COVID-19. Thanks to COVID-19, most states had to follow mandatory stay at home orders while only allowing “essential workers” to continue to work.
There are many different states’ classification of essential workers but the ones I am specifically going to address are pharmacy employees, Mass transit and airport workers, food and agricultural workers, to include those who work in grocery stores and restaurants, building cleaners and janitors, those who work in trash collection and disposal, animal shelters, certain warehouse and fulfillment centers, food banks and mail and shipping service centers, and hospital employees. The risk of infection may be greater for workers in essential industries who continue to work outside the home despite outbreaks in their communities, including some people who may need to continue working in these jobs because of their economic circumstances. Nearly a quarter of employed Hispanic and Black or African American workers are employed in service industry jobs compared to 16% of non-Hispanic whites (CDC 2020). Black or African Americans make up 12% of all employed workers, but account for 30% of licensed practical and licensed vocational nurses (CDC 2020). These jobs are less likely to offer sick paid leave days, so workers without these might be more likely to continue to work even when they are sick for any reason. This increases their exposure to other workers who could have COVID-19 or can expose them to it. According to the Kaiser Family Foundation, COVID-19 is having disproportionate effects on ethnic minority groups. African Americans are accounting for 34% of confirmed cases with known race/ethnicity compared to 13% of the total population as of April 20, 2020. In the majority of states reporting data, African Americans accounted for a higher share of confirmed cases (in 20 of 31 states) and deaths (in 19 of 24 states) compared to their share of the total population (Growing Data Underscore That Communities of Color Are Being Harder Hit by COVID-19 2020). Brooking.edu claims African Americans in about every state with racial data available have higher contraction rates and higher death rates of COVID-19. In Michigan, Blacks make up 15% of the state population but represent 35% of people diagnosed with COVID-19 (Ray 2020).
Ability to Obtain Testing/Care
The CDC claims many members of racial and ethnic minorities live in neighborhoods that are further from grocery stores and medical facilities, making it more difficult to receive care if sick and stock up on supplies that would allow them to stay home. Existing health disparities, such as poorer underlying health and barriers to getting health care, might make members of many racial and ethnic minority groups especially vulnerable in public health emergencies like outbreaks of COVID-19. Compared to Whites, African Americans are almost twice as likely to be uninsured. In all age groups, blacks were more likely than whites to report not being able to see a doctor in the past year because of cost (CDC 2020). African Americans are also prevented from getting care because of distrusts in the health system, language barriers, and financial implications associated with missing work to receive care.
Syndemics
Overall, all of these health disparities are taking a toll on African Americans thanks in large part to a syndemic. A syndemic is a set of linked health problems involving two or more afflictions, interacting synergistically, and contributing to excess burden of disease in a population. Syndemics occur when health-related problems cluster by person, place, or time (“Definition of Syndemic” n.d.). Comorbidities like hypertension and diabetes, which are tied to COVID-19 complications, disproportionately affect the African American community. But the alarming rates at which COVID-19 is killing African Americans extends beyond these comorbidities and can be attributed to decades of spatial segregation, inequitable access to testing and treatment, and withholding racial/ethnicity data from reports on virus outcomes (COVID-19 Killing African Americans at Shocking Rates 2020). The way our current policies are in place African Americans are faced with increased rates of structural violence; which is a political, economic, or social system in place that puts disadvantages towards one group of people that bring about harm. Many African Americans do not have the luxury of staying home during the pandemic due to the large gaps in wealth disparity. During a White House press briefing on April 10, U.S. Surgeon General Jerome Adams, MD, MPH, told people of color to "step up and help stop the spread so that we can protect those who are most vulnerable" (COVID-19 Killing African Americans at Shocking Rates 2020). The way the United States is handling COVID-19 is making African Americans endure social suffering. Social suffering is how a disease is worsened by societal biases or little social or government support, including limited resources; the pain and suffering of a disorder is not limited to the individual sufferer, but extends at times to the family and social network.
Conclusion
How can we move forward to decrease the health disparities, reduce the wealth gap, increase access to care, and improve the overall health for Africans Americans? It all begins with working with the communities that are at the highest risk. Public health interventions must involve members of these at-risk communities so that they are tailored to meet their needs, said Rebekah Gee, MD, MPH, (COVID-19 Killing African Americans at Shocking Rates'' 2020). Public health officials have begun targeting areas that are hot the hardest by creating drive-in testing centers in zip codes with the highest confirmed cases. Dr. Fauci stated, “Health disparities have always existed for the African American community… [coronavirus is] shining a bright light on how unacceptable that is because, yet again, when you have a situation like the coronavirus, they are suffering disproportionately. We will get over coronavirus, but there will still be health disparities which we really do need to address in the African American community” (Ray 2020). It is time that we change the policies in place, incorporating the needs of African Americans who have suffered for years by structural violence. It is unfortunate that COVID-19 is rampaging the African American community, but this may be the best chance at finally getting the reform this country needs.
Works Cited
CDC. 2020. “Coronavirus Disease 2019 (COVID-19).” Centers for Disease Control and Prevention. February 11, 2020. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html.
“COVID-19 Killing African Americans at Shocking Rates.” 2020. May 1, 2020. //www.medpagetoday.com/infectiousdisease/covid19/86266.
“DANIELLE COKE (@ohhappydani) • Instagram Photos and Videos.” n.d. Accessed May 8, 2020. https://www.instagram.com/p/B_AzK35FhJ7/.
“Growing Data Underscore That Communities of Color Are Being Harder Hit by COVID-19.” 2020. The Henry J. Kaiser Family Foundation (blog). April 21, 2020. https://www.kff.org/coronavirus-policy-watch/growing-data-underscore-communities-color-harder-hit-covid-19/.
Holshue, Michelle L., Chas DeBolt, Scott Lindquist, Kathy H. Lofy, John Wiesman, Hollianne Bruce, Christopher Spitters, et al. 2020. “First Case of 2019 Novel Coronavirus in the United States.” New England Journal of Medicine 382 (10): 929–36. https://doi.org/10.1056/NEJMoa2001191.
Gravlee, Lance. “It’s about Racism, Not Race, When Coronavirus Hits Communities of Color Hard | Column.” n.d. Tampa Bay Times. Accessed May 7, 2020. https://tampabay.com/opinion/2020/04/15/its-about-racism-not-race-when-coronavirus-hits-communities-of-color-hard-column/.
Pew Research Center. Million Americans Live in Multigenerational Households.” Pew Research Center (blog). Accessed May 7, 2020. https://www.pewresearch.org/fact-tank/2018/04/05/a-record-64-million-americans-live-in-multigenerational-households/. Record 64
Ray, Rashawn. 2020. “Why Are Blacks Dying at Higher Rates from COVID-19?” Brookings (blog). April 9, 2020. https://www.brookings.edu/blog/fixgov/2020/04/09/why-are-blacks-dying-at-higher-rates-from-covid-19/.
Singer, Merrill, Nicola Bulled, Bayla Ostrach, and Emily Mendenhall. 2017. “Syndemics and the Biosocial Conception of Health.” The Lancet 389 (10072): 941–50. https://doi.org/10.1016/S0140-6736(17)30003-X.
Bio: Stevenson Cerisier is a sophomore at Wake Forest University majoring in Health & Exercise Science and minoring in Health Policy & Administration. Currently Stevenson is enrolled in a course named Anthropology of Global Health where the main focus is a critical introduction to the interdisciplinary field of global health, focusing on contributions from medical anthropology. Stevenson is very passionate about the field of Public Health/ Global Health and he hopes that he can use this class to improve the health of his parents native country Haiti later in his life.
