Preliminary coronavirus disease (COVID-19) data has shown that Black and Brown communities have experienced the most pandemic-related deaths in the United States, according to a press release. Health experts are now demanding more racial data on the crisis.
Epidemics widen the gap between the haves and have-nots in healthcare, said Director of the Rutgers Global Health Institute Richard Marlink.
“We don’t have a healthcare system that universally takes care of our population so there’s going to be a large percent of people that either don’t have healthcare or fall through the cracks,” he said.
Marlink said these cracks often follow race lines and involve, at a minimum, institutional racism in society. Assistant Professor at the Rutgers School of Public Health Devin English pointed to government policies, according to the release.
“The reason for these disproportionate numbers of COVID-19 deaths in Black and Latinx communities is systemic racism,” he said, according to the release. “Government policies that promote segregation and undermine access to quality healthcare have fostered the spread of COVID-19 in these communities.”
Racism is a social determinant for the impact of COVID-19 on Black individuals and other communities, said Naa Oyo A. Kwate, associate professor of Africana Studies and the Department of Human Ecology.
“At the individual level, an abundant body of research has shown that experiences with racism are associated with greater risk of hypertension and many of the underlying conditions that worsen COVID-19,” she said. “At the structural level, racism in labor markets and workplaces, in the form of residential segregation, in the siting of resources including retail and health care, in housing quality and more means that African Americans are at greater risk of health risks in general and COVID-19 is no exception.”
Marlink said Black individuals, especially in urban areas in New Jersey and the rest of the country, have a greater incidence of chronic diseases such as heart disease and lung disease that increase the risk of complications from COVID-19. These diseases come from a lack of access to health care and prevention, he said.
There are also economic and social factors that contribute to the racial disparities, Kwate said.
“(Black individuals) are less able to engage in what we are calling social distancing, really, physical distancing, because they are more likely to work jobs that require interfacing with the public and cannot be done from home, such as service positions in retail stores,” she said. “They are more likely to live in high population density areas and in multifamily apartment buildings than in single-family homes. They have to travel further to access needed resources that are not located in their communities.”
Marlink said approximately 40 percent of Americans live in an economic situation where they would not be able to pay an extra $400 bill that comes in during the month. He said a recent survey said that in the New Brunswick area, 80 percent of the population are going to have trouble making next month’s rent payment
Economic setbacks like losing your job, being unable to leave the house for work or having to take care of kids who are now out of school makes the situation difficult for the poor in our country, he said.
Kwate said the COVID-19 situation is similar in rural areas that also experience high levels of poverty.
“Even in areas that are not especially poor, the spread in a small population can be very quick. Southwest Georgia currently has the worst COVID-19 burden in the state,” she said.
Hospitals in Black neighborhoods are more likely to close and the care that Black people receive in the settings they have access to is often worse, Kwate said.
“That means that for those that are ill with COVID-19, it will be more difficult to get the treatment they need to survive. It also means that individuals are more likely to have conditions that are not well controlled, setting them up for a more severe experience with the virus,” she said. “The fact that in this country we tie health insurance to employment means that (Black individuals) are more likely to go without health insurance, pushing the population toward a sicker overall profile.”
Marlink said this situation should make us rethink how we approach healthcare and public health.
“That means investing in everyone’s health,” he said. “An epidemic shows us that we’re all in this together. If we can have true universal healthcare in the United States it should be accessible to all populations, including our non-citizens. If you’re talking about an epidemic, it’s silly to say we’re only going to treat people who are citizens.”
Kwate said underlying risk will not change without addressing the upstream social determinants of healthcare. Many of these are baked into institutional policies and practices, she said.
“We may not have the money, but we need to make that investment now or the resurgence of the epidemic will come back in different ways and different parts of the country,” Marlink said. “It won’t be one wave like what’s happened the past three months, but it’ll be different waves if the dust doesn’t settle. Nationally, I think we really need to invest in our public health system.”