Opinion | What's behind the racial disparity in COVID-19 cases

Melissa Creary and Paul Fleming

Melissa S. Creary and Paul J. Fleming are assistant professors at the University of Michigan School of Public Health

Data show that black Americans are disproportionately impacted by the coronavirus pandemic. In Michigan, black Americans account for 40 percent of all COVID-19 deaths in the state, while only representing roughly 14 percent of the total population. During a recent press briefing, White House Coronavirus Task Force members highlighted that this disparity between racial populations is due to “underlying medical conditions” such as diabetes, hypertension obesity and asthma. This is a pattern seen all too often—racial health disparities that display the black population as more likely to have many common diseases. What did the White House mean by “underlying health conditions” and what causes it?

What is truly underlying in this narrative are the structural inequities from a social, environmental and political context that dictates the rates for these diseases—like diabetes, hypertension, and asthma—all of which are found to be more prevalent in the black populations when compared to white.

Public health experts have identified that “social determinants of health”—the conditions in which you grew up, live, learn, work, and play—are key drivers of these disparities and  are much more important and influential than individual behaviors or genetics. In this context, when talking about populations and linking their disproportionate infection and death rate to “underlying medical conditions,” what's really being said is that this population has had poorer access to things like quality housing, clean air, a living wage or preventative health care. 

Black Americans tend to have worse conditions than other Americans because of historical and structural racism embedded in policies and institutions. It is not one’s race that inherently leads to health outcomes, it is where your race falls in the power hierarchy of your society that can matter for the embodiment of inequality. In other words, any disproportionate disease burden among black Americans is the result of being exposed to an environment that has not valued black health and well-being to the same extent as white Americans. 

Many black Americans have been segregated through redlining policies into neighborhoods with underfunded schools. The segregation caused by redlining combined with lax industry regulations and “not in my backyard” attitudes have placed many industrial polluters in communities of color. This disproportionate exposure to environmental toxicants—a concept known as environmental racism—has left Black Americans to have an asthma prevalence that is 39 percent higher than White Americans.

Put simply, race is not a risk factor—racism is.

To solely state that “underlying medical conditions” created the disparity in COVID-19 cases and deaths without highlighting the historical and policy context is like saying the Flint Water Crisis was caused by lead dissolving off water pipes. It may be true, however it ignores the social context of what really happened

For COVID-19, the pieces to this complicated disparities puzzle are still being put together.  Some states have just begun reporting race-related numbers. But statistics by themselves do not tell us much about the root causes of a particular health issue, only telling us part of the story when it comes to the spread of this disease. It is crucial to examine the social, environmental, and historical factors that are creating the conditions for a particular health disparity to exist. 

Reshaping public policies to create conditions where all Michiganders, regardless of race, can be healthy is essential as we look ahead and plan for the future.

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Comments

Beverly Seymour
Sun, 05/03/2020 - 9:31am

What about diet? So many black women are overweight. A Lot of those physical conditions are affected by diet. If you look at the food baskets of women in the stores, the food in there so often reflects weight of the buyer. Overeating or eating diets too rich in fat, calories, sweets, chemicals will cause people of any race to be less healthy. A person of any color (and there are white people who do the same thing) will have more health conditions due to too much sugar, fat and chemicals. Everything is not about race, and everything is not white people's fault.

JLK
Sun, 05/03/2020 - 1:02pm

Yes, even those diet considerations can be based in racism if you look closely. Fatty, sugary foods tend to be mass-produced and cheaper to purchase. Black families who have been unable to accumulate wealth from generation to generation due to racist policies tend to have lower paying jobs that require them to work longer hours. That means they have little time for meal preparation and tend to fall back on processed foods that require little preparation. Fresh fruits and vegetables tend to be expensive, comparatively. You also should keep in mind that the poorest neighborhoods tend to have fast food restaurants and their $1 menus everywhere, but not grocery stores offering fresh produce.

Also, it is impossible to simply look at someone and determine if they are obese or healthy. I have several friends who eat much healthier diets than I do, but weigh 50 pounds more than I do. The snap judgment tells people that I'm the healthiest in the group. In reality, I was just blessed with a small bone structure and high metabolism that makes it seem like I have a better diet. These are complex issues, and there is plenty of information if you would like to learn more to counter the stereotypes you offer here.

Matt
Mon, 05/04/2020 - 11:01am

Or maybe junk or fast food is just a whole lot easier with far less effort to consume than fresh/ home prepared meals? Maybe it is just easier to give kids something sweet than to try to coax them into eating something relatively healthy? Why do you think certain fast food restaurants locate in minority neighborhoods? Do you seriously believe that there is a conspiracy to deprive minorities fresh vegetables or that maybe retailers and restaurants just react to their actual sales?

Kevin Grand
Mon, 05/04/2020 - 7:36am

This had my interest right until it fell into this old and tired fallback argument:

"Black Americans tend to have worse conditions than other Americans because of historical and structural racism embedded in policies and institutions. It is not one’s race that inherently leads to health outcomes, it is where your race falls in the power hierarchy of your society that can matter for the embodiment of inequality."

People have long since ignored that boy who kept crying "wolf".

Suzanne Smith
Mon, 05/04/2020 - 9:09am

While mass transportation can not be discounted, anyone walking through a black or hispanic neighborhood can easily see they are not staying 6 feet away from each other. A dozen videos on Youtube show police breaking up parties and gatherings in black communities. Its hard to feel bad for people who have to work with the public, when those same people wont go home and stay inside or keep on a mask in public. Google a recent picture of a crowded subway and see how many are wearing masks.

Bob B.
Mon, 05/04/2020 - 9:19am

I certainly cannot argue against the impact of environmental damage on the lives of people exposed to such conditions, but let's not forget the impacts of personal behavior and accountability. I've resided in the city of Detroit and surrounding communities and experienced reverse discrimination during Coleman Young's tenure. His name on almost every piece of city owned property and the "you owe me" mentality prominent in the African American urban community was down right scary. Interestingly enough, the same mentality did not exist in Dearborn, the Ambassador Bridge area, Poletown, Greektown or even near downriver. Everyday I prayed that I would get in and out of the city safely. And I finally did. I moved. My minority work mates make the same wage as me. They have the same health care coverage. They have the same access to stores and clinics and churches. They have even better access to colleges and financial aid. When is the African American population going to live in the today, instead of continuing the blame past generational activities for the life style they choose to live?