Speaking about Health Disparities — A teachable moment about structural racism
by Curtis Smith, Carina Cione, Deziree Jackson, and Ernesto Castañeda
On November 11, 2020, Dee Margo, Mayor of the city of El Paso, Texas told national audiences on Good Morning America that he did not need any additional resources to help the city deal with a surge in COVID-19 cases before adding, “our population is 85% Hispanic and we’re four times more prevalent to being hospitalized because of COVID than any other normal [pause] occasions (sic). We are a highly vulnerable population.” He blamed the negative impact of the pandemic on El Pasoans while simultaneously denying the need for further aid or to impose stricter lock down policies. His statements negated the fact that he is largely in charge of the local response to the situation.
Mayor Margo’s refusal to admit the reality of the pandemic’s effects on El Paso is worrisome because the death rate is staggering. His response, or lack thereof, is reflected in the data. Since his statement that El Paso had “all the resources it needs,” more than 272 El Pasoans have died from COVID-19 complications and more than 21,000 people have tested positive for the virus. According to statistics published by the city, the cumulative number of positive cases in El Paso reached 88,500 on December 3, 2020. Washington, DC, a city with a similar population size to El Paso, has experienced 21,842 positive cases, amounting to only one-quarter of those in El Paso. A major difference between these cities lies in COVID-19 preventive regulations.
Sadly (and all too often), casual assertions like Margo’s are made in daily conversations with little push-back. However, it is shocking to hear it declared on Good Morning America that El Paso is apparently doomed to suffer with the pandemic because the demographics of the city are somehow to blame for higher rates of COVID-19. This is a misconstruction of “health disparities.” Blaming the ethnic make-up of the population is an example of methodological racism. Therefore, the Mayor’s statement offers a teachable moment about race and racism. We hope that the following discussion is helpful in courses on race and ethnicity, and beyond.
The problem with pointing to the supposed biological basis of race
Disparities in health exist, indeed. COVID-19 infection and mortality rates are higher among Black, Latin*, and Native American populations, but they should not be referenced alone without the historical and broader social context. Simply put, Black and Latin workers are more likely to work in “essential” positions and are still working outside of home during the pandemic, and thus are more exposed to the virus. Researchers have long been aware of the phenomenon that Black and Latin populations are more represented among what sociologist Arne Kalleberg (2011) calls “bad jobs.” The CDC also reports that racial and ethnic minorities are more commonly employed by industries that require workers to continue working despite the pandemic, including agriculture, healthcare, delivery, and public transportation services. Simultaneously, some of these industries have also suffered the most significant financial losses and laid off many employees.
Some Latin groups also experience more barriers in finding desirable employment. For example, some white people in management positions and hiring committees choose to hire white candidates more often. They base their decisions on similarities with white candidates and “their gut” (Reskin 2011).
Since Black and Latin populations are structurally prevented from getting into positions that may keep them safer from COVID-19, blaming their race and ethnicity as a cause is problematic. It also relies on eugenic ideas to explain the social phenomenon. To be clear, race is not biological; it is a hierarchical social construction that has historically disadvantaged racial minorities, which has caused disparities in home ownership (Massey 2015), incarceration (Alexander 2010), education (Hartshorne 1992), and in health outcomes.
Ironically, some research shows that Latin groups may actually be healthier than other groups. What researchers have called the “Hispanic Health Paradox” is a phenomenon long studied in academia, but rarely referenced in popular culture. For decades, researchers have struggled to explain why Hispanic populations show better indicators of health than whites or other groups despite often lower socio-economic status. Evidence of the Hispanic Health Paradox is in direct opposition to the assertions of Margo who implies that the large Latin population in El Paso is to blame for increased cases in the city. Here, social determinants of health are on full display. Although the Latin community appears to be in better health in some research findings, structures of power bar racial and ethnic minorities from access to healthcare services and safe jobs, creating unhealthy conditions for disadvantaged people. These health disparities caused by structural oppression result in increased exposure to COVID-19 and in the development of health conditions that can cause hospitalization from COVID-19.
Essential workers who are immunocompromised and have pre-existing conditions are not exempt from reporting to work. In this way, health disparities hit racial and ethnic minorities twice as hard because they have disproportionately higher rates of health conditions that put them at risk of complications or death from COVID-19. For example, 26.9% of those who have died from COVID-19 in El Paso had pre-existing conditions that rendered them particularly vulnerable to hospitalization.
This is further reflected in analyses of a large health survey we conducted across El Paso in 2011–12. The study revealed that 37.5% of the El Paso’s Hispanic population had been previously diagnosed with a health condition, like hypertension, obesity, or kidney disease, which the CDC marked as “high risk” for hospitalization if they were to contract COVID-19. In fact, more than one-quarter had two or more health problems. So, when statements about health disparities and groups “at risk” are made, it must be remembered that the causes are not racial or cultural, but structural. Poor working conditions can negatively affect health in ways that include stress, hypertension, or being unable to afford a comprehensive health insurance.
The problem with pointing to the culture of race
What Oscar Lewis (1959) called “the culture of poverty” in his 1961 book The Children of Sanchez is often used as an excuse by policy makers who throw their hands up in the air and blame the victims instead of truly understanding the larger social context that produces certain coping mechanisms.
Margo seems to be referencing that Hispanics tend to host large gatherings in their homes. The pandemic has brought increased awareness of such gatherings in all cities in the U.S. and around the world. However, continuing large social gatherings has been problematic in all cities — whiter cities in the same state of Texas, like Austin, outright protest the idea of masks, gather in much larger numbers, and do not follow social distancing guidelines. Anti-mask protests have been held across the country in predominantly white cities like Hartford, Boise, and St. Paul, where protestors tote Trump flags and denounce the effectiveness of COVID-19 regulations. To say that more Latin individuals are contracting and dying from COVID-19 because they host gatherings or live with extended family in their homes shifts culpability away from people who refuse to wear masks or follow CDC guidelines.
The racism of Margo’s words and the national agenda
Unchecked statements like Margo’s blame structural racism on the people who have been purposely and systematically disadvantaged, and allow government officials to neglect their own responsibility to aid in decreasing the number of COVID-19 cases and deaths. By pointing only to city demographics as a supposed cause of higher rates of COVID-19, Margo sidesteps his own direct role in ignoring the impact of the virus and increasing the number of cases. When statements about health disparities are not properly contextualized, they can be understood by some to be the fault of groups carrying the burden of a disease.
This is not the first time that Mayor Margo has used offensive language in discussions on the pandemic and the City’s response. Three weeks prior to his appearance on Good Morning America, the Mayor insisted that Representative Peter Svarzbein’s attempts to temporarily shut down indoor restaurant dining were “Gestapo-like” and “dictatorial.” Representative Svarzbein, who represents the West Side of El Paso on City Council, is a Jewish descendant of a Holocaust survivor who had been terrorized by the Gestapo.
Addressing racism and holding people accountable should be an individual and collective priority. However, discussing Mayor Margo’s discriminatory speech is especially crucial in light of the new Executive Order 13950. On September 22, Trump signed the “Executive Order on Combating Race and Sex Stereotypes,” prohibiting federal agencies, contractors, and grant recipients from conducting diversity training and programs that discuss “diverse topics,” such as critical race theory, implicit bias, white supremacy, racism, white privilege, and more. As the African American Policy Forum exerts, this equity gag order “reflects the formal adoption of a twisted ideology that treats anti-racism as racism against white people, treats feminism as sexism against men, and seeks to extinguish anti-racist and anti-sexist training from federal agencies.” Following this Executive Order, Stanford University released a statement (later recanted) banning explicit remarks such as “systemic racism exists at Stanford.” Sadly, tools formerly used at the university by professors and staff to dismantle racist and white supremacist ideology are now forbidden.
Given the points above, we can conclude the following:
-It is dangerous and unscientific to attribute ultimate causation to ethnic, racial, religious, or cultural differences.
-It is also dangerous and inaccurate to deny that different outcomes may correlate with gender, race, and stigmatized categorizations. These differences are not genetic but product of a history of discrimination and exclusion (for instance see Castañeda 2018).
Therefore, studying racial disparities is not racist itself as long as we are clear that these different outcomes are the result of unequal chances rather than the explanation for the poverty, exclusion, or subordination of a group. Hispanics may be healthier than could be expected given their socioeconomic status, but they are still more susceptible to contract and die from COVID-19 because of having jobs that expose them to the public and co-occurring underlying conditions. Nonetheless, ethno-racial fatalism denies that there are policies that can be put in place to help vulnerable groups. The fact that COVID-19 is more likely to impact minorities calls for public policies that protect them.
*We use Latin to avoid using a gendering ending a,o,x (see Castañeda 2019). The great majority of Latin people in El Paso are of Mexican origin.
Alexander, Michelle. (2020). The new Jim Crow: Mass incarceration in the age of colorblindness. The New Press.
Castañeda, Ernesto. 2019. Building Walls: Excluding Latin People in the United States. Lanham, MD: Lexington Books.
Castañeda, Ernesto. 2018. Immigration and Categorical Inequality: Migration to the City and the Birth of Race and Ethnicity. New York, NY: Routledge.
Hartshorne, K. (1992). Crisis and challenge: Black education 1910–1990. Cape Town: Oxford.
Kalleberg, Arne L. (2011). Good jobs, bad jobs. New York.
Lewis, Oscar (1959) The Children of Sanchez: Autobiography of a Mexican Family. Random House. New York City.
Massey, Douglas S. (2015). The legacy of the 1968 fair housing act. In Sociological Forum (Vol. 30, pp. 571–588).
Reskin, B. F. (2011). Rethinking employment discrimination and its remedies. The inequality reader: Contemporary and foundational readings in race, class, and gender, 378–88.
Curtis Smith, Ph.D. is faculty at Bentley University in Boston, MA. Author of the forthcoming book “Red-Tape Warriors: Housing the Homeless through Aggressive Advocacy.”
Deziree Jackson and Carina Cione are researchers at the Immigration Lab and M.A. candidates in the Sociology Research & Practice program at American University in Washington, D.C.
Ernesto Castañeda, Ph.D. is an Associate Professor of Sociology at American University in Washington, D.C. Author of “Building Walls: Excluding Latin People in the United States,” fellow at the Center for Health Risk and Society and Founding Director of the Immigration Lab. Twitter @DrErnestoCast
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