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(THREAD) Solutions to address COVID-19 racial disparities first require an understanding of contributing factors. In this thread, I briefly summarize recent explanations for racial gaps in C-19 mortality. I hope you'll share with those who may be interested.
1/ CHRONIC/UNDERLYING HEALTH CONDITIONS - Probably the most cited explanation. Goes something like this: African Americans are more likely to have heart/lung disease, asthma, diabetes, obesity, cancer, etc., which increases vulnerability to serious illness and death from C-19.
2/ LOW-WAGE/PRODUCTION/TRANSPORTATION/ESSENTIAL SERVICE JOBS - Blacks/Latinxs may be more likely to work in jobs that increase vulnerability to C-19 exposure. Workers in these jobs may require public transportation, be mandated to work and unable to working at/from home.
3/ Jobs (cont.). - Low-wage jobs may be less likely to offer critical benefits such as health insurance required to seek medical care, and essential service workers may be at greater risk due to required continuous interaction with the public.
4/ Jobs (cont.). Some were quick to pass judgement upon seeing images of buses/trains packed with brown and black people; however, the first question should be why they were on and had to use public transportation in the first place! It's NOT b/c they didn't understand the risks!
5/ INADEQUATE TESTING/TESTING DISPARITIES - Uneven access to testing is suspected as a factor that may have led to undetected outbreaks in minority communities and even contributed to beliefs that black and brown communities were immune. https://www.latimes.com/california/story/2020-04-07/l-a-releases-first-racial-breakdown-of-coronavirus-fatalities-african-americans-have-higher-death-rate
6/ Testing (cont.). Original testing requirements may have been inherently biased (e.g., Blacks may have been less likely to travel to places where cases were high). Longer wait times for results in some areas also may contribute to disparities. https://slate.com/news-and-politics/2020/03/how-racial-health-disparities-will-play-out-in-the-coronavirus-pandemic.html?fbclid=IwAR3I9pwsalr5R_8Ua_TSMjFUb1Ff-36X_qCoB0KcRAY_s7u_eLGekP4e2m8
7/ POVERTY & SYSTEMIC/STRUCTURAL RACISM - are cited by many as important contributing factors linked to underlying conditions, occupational vulnerability, and lack of access to critical resources necessary to maintain health. https://www.bridgemi.com/guest-commentary/opinion-michigans-coronavirus-response-must-confront-poverty-and-racism
8/ Poverty/Racism (cont.). It can hardly be debated that poverty contributes to lack of access to quality health care/health insurance, affordable housing, food/financial insecurity, and safe/clean water. Under/uninsured may be hesitant to seek necessary health care due to costs.
9/ Poverty/Racism (cont.). Lack of affordable/stable housing can contribute to multigenerational housing situations that create higher risk/spread of contagious diseases. Families may share close quarters when rent is unaffordable, making distancing/quarantining impossible.
10/ Poverty/Racism (cont.) Substandard housing also can contribute to increased likelihood of exposure to elements that increase risk of respiratory diseases (e.g., asbestos, mold, cockroach feces). https://www.washingtonpost.com/politics/2020/04/10/4-reasons-coronavirus-is-hitting-black-communities-so-hard/
11/ Poverty/Racism (cont.). Financial insecurity (e.g., lack of job opportunities) can lead to tough decisions - if I get sick, do I stay home or risk lost wages/permanent unemployment?
12/ Poverty/Racism (cont.). Poverty/food insecurity may decrease space available for stockpiling food & necessitate frequent trips to food banks, increasing exposure risk. Lack of access to healthy food linked with diabetes, an underlying condition that can increase C-19 outcome.
13/ Poverty/Racism (cont.). Lack of access to safe/clean water can make hand hygiene more difficult and heighten risk of infection, esp. in communities that remain without access to running water.
14/ Poverty/Racism (cont.). Environmental racism, which refers to the disproportionate impact of environmental hazards (e.g., waste, pollution, toxins) on people of color, linked with high rates of asthma and other underlying conditions that worsen C-19 course and outcome.
15/ It is impossible, and also inaccurate, to only name poverty and not systemic/structural racism as a critical contributing factor in understanding C-19 racial disparities. Racial disparities track both racism and poverty, and the two are inextricably linked.
16/ Some mortality data in Michigan seem to suggest C-19 racial disparities exist not only for poor Blacks, but Blacks as a whole, irrespective of SES. As with other health disparities, it's likely NOT just about poverty/social class. https://www.bridgemi.com/michigan-health-watch/black-communities-hit-harder-coronavirus-michigan-not-just-detroit
17/ Not surprisingly, structural racism, which refers, in part, to societal policies and institutional practices (e.g., redlining/segregation/Jim Crow), has been implicated by numerous experts in understanding C-19 racial disparities. https://iaphs.org/racism-in-the-time-of-covid-19/
18/ Naming racism makes some uncomfortable and even ornery, but call it what you will, differential treatment of U.S. racial groups, supported by longstanding institutional and societal structures, undoubtedly has contributed to the racial gaps we now see in C-19 mortality.
19/ MEDICAL MISTRUST - also has been implicated in C-19 disparities. An unfortunate/long history of maltreatment in medical research/practice (Tuskegee, Henrietta Lacks, J. Marion Sims) may explain why some are less likely to seek care and believe they won't be taken seriously.
20/ Mistrust, (cont.). Strained relations with the medical system may account, in part, for racial disparities in chronic underlying conditions and be particularly detrimental for C-19 treatment, when delays in seeking treatment can be fatal.
21/ IMPLICIT BIAS - The NYT reported that doctors may refer African Americans less for C-19 testing. On the basis of prior pain research, others have suspected that Blacks may be undertreated and require higher distress thresholds to receive treatment. https://www.nytimes.com/2020/04/07/us/coronavirus-race.html
22/ (MIS)COMMUNICATION - Poor and inconsistent information from government officials, possibly has contributed to anecdotal reports of beliefs, by some Blacks, that they were immune to C-19. As noted above, these beliefs also may be rooted in testing disparities.
23/ PRISON VULNERABILITY - Disproportionate representation among the U.S. incarcerated, esp. in the South, may exacerbate C-19 racial disparities. Close, shared quarters are likely to confer "structural constraints" on recommended hygiene. https://www.theatlantic.com/politics/archive/2020/04/coronavirus-unique-threat-south-young-people/609241/
24/ Underlying conditions, poverty/racism, occupation type, inadequate testing, medical mistrust, implicit bias, miscommunication, and prison vulnerability are some recent explanations for racial disparities in C-19. Data-informed solutions must address all, in earnest. /END
PS1/ STRESS also has been indirectly implicated in C-19 racial disparities. Poverty- and racism-related stress can accelerate aging (e.g., weathering), contribute to underlying conditions, and maybe even increase susceptibility to infection (hypothesis).
PS2/ I didn't highlight individual behaviors, which also have been implied by some to explain C-19 disparities. Anecdotal reports of failure to comply with social distancing guidelines do not explain the gaps, and can lead to victim blaming and misinformed guidance.
PS3/ Moreover, it is readily apparent from recent headlines and news coverage that reports of failure to social distance are not specific to Black and Brown people!
PS4/ Finally, I wish to note that this thread focused primarily on Black Americans, and Latinxs to a lesser extent, but they aren't the only groups affected. Media coverage should increase attention to C-19 disparities experienced by U.S. indigenous and other marginalized groups.
