by Ernesto Castañeda, Abby Ferdinando, Carina Cione, Jhamiel Prince, Deziree Jackson, Emma Vetter, and Sarah McCarthy
The coronavirus pandemic has been racialized since its emergence in the United States with some leading political figures and the news media referring to it as the “Chinese virus.” With the growth of infections in the U.S., media attention has primarily focused on emergent health disparities in both rates of infection and mortality. The conversation on racial inequities thus far has centered primarily on African-Americans. In contrast, the impact of COVID-19 on Latin people has received less attention.
We hypothesize that the disproportionate rate of minorities working in essential positions and with preexisting medical conditions are two prominent explanations that account for the increased exposure of minorities and the racial disparities regarding COVID-19 mortality rates.
Discussion about health disparities is important. However, this still runs the risk of further racializing and sensationalizing the impacts of the current public health crisis. How to measure and discuss racial disparities in public health has been debated for some time. Accurate data on racial and ethnic disparities in COVID-19 are vital, but there is also a need to contextualize cautionary information from public health authorities about which populations are the most vulnerable.
We must be cautious because race is often used as a justification for unequal outcomes. Uncontextualized claims about racial health disparities can be misinterpreted as evidence of genetic differences among categorical groups. As Dr. Ibram X. Kendi, Director of the Antiracist Research and Policy Center at American University, explains people hearing of these differences can unfairly blame minorities. Dr. Kendi poses the question: why are black Americans to blame for their increased exposure to the virus and their higher death rates when inequalities such as racism, exploitation, and lack of resources all contribute to their health disparities? We need to account for all the factors that lead to health disparities instead of assigning blame to vulnerable and excluded groups.
The first peer-reviewed article that addresses health disparities related to the coronavirus outbreak in the United States was published on April 3, 2020, in the Journal of Racial and Ethnic Health Disparities. Using data from the Connecticut State Department of Public Health, Laurencin and McClinton address implications of higher infection and death rates for African Americans in Connecticut. They highlight that of the 3,141 cases at the time of their research (April 1, 2020), 50% had missing racial and ethnic data. Notably, 18% of the U.S. community is Black, yet 33% of hospitalized cases were among Black people (CDC 2020).
In New York, the Bureau of Communicable Disease Surveillance System reported that as of April 16, 92.3 of every 100,000 deaths occur among Blacks, and 74.3 of every 100,000 deaths are among Latinos. In comparison, the White and Asian death rates are 45.2 and 34.5 per 100,000 people, respectively. These numbers are understood to be low estimates since this data only covers an estimated 88% of lab-confirmed cases, effectively leaving out asymptomatic and non-lab confirmed cases.
For hundreds of years, institutions have maintained racial hierarchies that are responsible for the vast majority of health disparities in the United States. Therefore, it is possible that Black and Latin communities are exposed to the virus more often as a result of institutionalized racism that places less value on minority lives. Perhaps they contracted the virus before other racial groups and experienced its impacts in its incipient stage. Everyone has not yet been exposed to the virus, so it is too early in the pandemic to know what the final extent of racial health disparities and the differences in the burden of diseases from COVID-19 will be. However, the early numbers in New York City, as shown above, show a very troubling trend.
Early on, some believed that African Americans were immune to the coronavirus, as shown in articles published in the New York Times, and the Los Angeles Sentinel. Some of the reopen proponents seem to believe that white and “patriotic” Americans are also immune to COVID-19. Clearly, neither of these ideas ring true — individuals across racial and class lines can and will be affected by the pandemic. So why are African Americans and Hispanics contracting the virus more often and dying from the virus more often than their white counterparts? Communities of color face many structural inequalities, racism, poverty, residential segregation, and access to quality health care that affect the propensity to infection. This, alongside the United States’ history of inadequately addressing the needs of underserved communities during times of crisis, we can expect that communities of color will have an especially difficult time recovering from this pandemic.
As of May 1, Illinois reported that Latinos made up the racial group with the highest number of confirmed cases within the state. In Arlington, Virginia, while only 15% of the population is of Latin origin, 51% of COVID-19 cases are among Latin individuals. The disproportionate impact of COVID-19 on Latin communities across the U.S. represents a significant issue that has so far been excluded from the larger conversation. Notably, the Latin community is an integral part of the labor force. In 2018, 17% of the national labor force was comprised of documented Latin workers. This number does not account for another estimated 5.1% of the labor force that is made up of Latin American undocumented workers. Furthermore, the CDC reports that in 2020, at least 25% of the Latin population in the U.S. is employed within the service industry, including hospitality, transportation/travel, delivery, food, healthcare, and education services. Many of these sectors require continued work throughout the public health crisis and put workers at increased risk of exposure to the coronavirus.
After carefully analyzing health disparities among Hispanics in El Paso, Texas, our data suggest that Latin people in El Paso, about 83% of the population, have comorbidities that may make them more vulnerable to complications from COVID-19 (as described in a recent report). Additionally, there are high poverty levels and low levels of healthcare coverage for Latin people in El Paso.
Structural factors, underlying medical conditions, and increased exposure to COVID-19 disproportionately put Black and Latin people in more vulnerable positions during times of “normalcy” and more so during the pandemic. We should consider structural and historical inequalities when assessing public health measures that aim at both prevention and recovery. We should be cautious in our reporting of racial and ethnic inequities to ensure that data is contextualized with an understanding of structural factors that cause disproportionate rates among minority groups. African Americans and Latinos may show higher rates of infection as compared to other groups because they are more likely to work in essential jobs. These essential jobs may have not been considered “essential” before the pandemic, yet they are now clearly seen as essential, and they expose the workers to COVID-19. Are working-class folks, specifically women and men of color, being forced to sacrifice so that all continue to receive packages and go to the grocery stores? Those who got sick first had a higher risk of dying because of the novelty of the disease and because medical systems in certain cities were overwhelmed by the number of new cases. As time passes, scientists learn more about how to treat the disease and get closer to developing a vaccine.
It is challenging to draw definite conclusions because the pandemic is still ongoing, and because data that is currently available on race and ethnicity may be limited. We will not know the disparities in mortality rates among racial, ethnic, and religious lines until a greater proportion of the overall population is exposed and tested for the virus, and all of the new data has been gathered, checked, and analyzed. If health disparities persist, we must ensure that racial minorities’ behaviors or genomes are not blamed for this extra burden, but rather structural inequities. What is clear is that cities and towns with higher numbers of working-class African Americans and Latin people should be prepared to conduct extensive community-based health education and outreach as well as provide referrals to critical medical care for these populations at higher risk. We also have to be honest about who is put at risk by the partial reopening of the economy — low-income workers often Black or Latin workers.
Universal policies can work to reduce health disparities during the next pandemic. These could include increasing the minimum wage, a universal basic income, expanding Medicare and health coverage, releasing those with immigration and non-violent offenses from prison and detention centers, reopening the borders to nurses and healthcare workers, professionals, and agricultural workers. Providing amnesty to undocumented workers doing essential work during the pandemic would go a long way to support the individuals that we have finally come to recognize as essential for society to work. By increasing labor protections, recognizing the undocumented as people, and reducing the costs of healthcare, we can help the working, and middle class increase their income. That would not only improve their health and reduce health disparities but also increase community health, making us all more resilient. For these reasons, we must build more equitable and sustainable economic and health systems while acknowledging our interconnectedness.
Ernesto Castañeda in Professor at the Department of Sociology at American University in Washington, DC, where he is a faculty fellow with the Center for Health, Risk, and Society, and affiliated with the Center for Latin American and Latino Studies, and the Metropolitan Policy Center. Carina Cione, Abby Ferdinando, Jhamiel Prince, Deziree Jackson, Emma Vetter, and Sarah McCarthy are students in the Sociology Research and Practice Master’s Program at American University. Thanks to Deanna Kerrigan and Daniel Jenks for their feedback.
The data was gathered as part of the project “Social Determinants of Physical and Mental Health of Migrant and Transient Populations: Health Disparities amongst Hispanics in El Paso” which was supported by Award Number P20MD00287 from the National Institute on Minority Health and Health Disparities to UTEP’s Hispanic Health Disparities Research Center. The content is solely the responsibility of the authors and does not necessarily represent official views of the National Institute on Minority Health and Health Disparities or the National Institutes of Health.
Published under Creative Commons you are free to republish this article both online and in print as long as you do not edit the piece, ensure that you attribute the authors, and mention their institutional affiliation. Creative Commons images from Unsplash by CDC, UN, and Daniel Lee.