Social Inequities and Racial Gaps

An Examination of COVID-19 in the Context of Race, Class, and Ethnicity

BIPOC communities have shouldered the greatest share of the COVID-19 burden in the United States (Covid-19 Hospitalization and Death by Race/Ethnicity, 2020). There is nothing, scientifically speaking, to indicate some kind of genetic predisposition to COVID-19 rooted in race or ethnicity. Studies suggest that there is no innate vulnerability to the virus among Black, Hispanic, and Native communities, and yet, researchers across the board have documented disproportionately higher rates of infection and mortality in these same populations.

A myriad of factors, often referred to in the field of public health as “social determinants,” help to characterize the interplay of health care, sociopolitical, and economic disparities that foster this increased vulnerability. Examining these social determinants allows us to better understand and explain why some communities have been more intensely impacted by the pandemic than others.

Framing this Issue in the Work of Environmental Justice

Finding it challenging to appropriately ‘measure’ equity factors, we have employed a four pronged approach to our discussion. Rooted in the field of Environmental Justice work, we have chosen to examine differential health outcomes through the lense of intersectionality, embeddedness, indispensability, and scale.

Intersectionality speaks to the idea that 'layering' factors have the potential to increase a population’s vulnerability. Embeddedness considers the complexity of the structural components that increase 'background' levels of community vulnerability. Indispensability asks which services and populations are dispensable in today’s economy and who makes up the “essential workforce.” Scale, critical to any geographic based analysis, explores the “place effects” and the differential impact COVID-19 has had at various spatial and temporal scales.

COVID-19 by the Numbers: Race and Ethnicity Statistics

Intertwining factors shape vulnerability dynamics across communities, quantitative data and analysis support findings that some Americans are more vulnerable in the face of COVID-19 than others.

Figure 1: “Race and ethnicity are risk markers for other underlying conditions that affect health including socioeconomic status, access to health care, and exposure to the virus related to occupation, e.g., frontline, essential, and critical infrastructure workers" (CDC Covid-19: Hospitalization and Death by Race/Ethnicity).

Among reported COVID-19 cases analyzed by the CDC, 33% or persons were Hispanic, 22% were Black and 1.3% were American Indian or Native Alaskan. “These findings suggest that persons in these groups, who account for 18%, 13%, and 0.7% of the U.S. population, respectively, are disproportionately affected by the Covid-19 pandemic (Stokes et. al, 2020). Furthermore, In New York City, the preliminary calculations as of July suggested that the COVID-19 associated death rate for Black people is 20 per 100,000; the rate for Hispanic people is 22 per 100,000; the rate for white people is 10 per 100,000; and for Asian people, 8 per 100,000 (Oppel et al., 2020).

The incongruency in COVID-19 transmission and mortality rate across racial and ethnic lines is resultant of social inequity. Using the framework described above, we walk through some of the major factors that contribute to this phenomenon.

BIPOC Communities Face Greater Risk of Contracting COVID-19

Long-standing systemic health and social inequalities have hindered the resilience of BIPOC communities in the face of the COVID-19 pandemic.

Relating to the idea of intersectionality, comorbidities emerge as a leading cause of the unparalleled death rates in BIPOC communities. Defined as the presence of one or more co-occurring health conditions, comorbidity factors, specifically the elevated rates of hypertension, heart disease, diabetes, and asthma seen in the BIPOC population, increase COVID-19 vulnerability (Shah et al., 2020). The nature of these co-occurring diseases is not happenstance, on the contrary, according to the CDC we tend to see increased disease precursor behaviors in impoverished communities.

Broadening this idea, poverty, lack of access to health care, educational disparity, and housing inequality all represent embedded structural components that increase ‘background’ levels of community vulnerability. Systemic racism and discrimination within these systems puts ethnic minority groups at increased risk for COVID-19. Simultaneously, this same history of racism and discrimination defines the make-up of the county’s prisons, another environment hard hit by the pandemic and examined in the following sections. Rooted in historic policy, these social determinants of health play a major role in the spread and lethality of the virus (Health Equity Considerations & Racial & Ethnic Minority Groups, 2020).

Addressing the idea of indispensability, a paradox emerges. While the BIPOC community accounts for a large proportion of the jobs deemed essential, members of this workforce are treated as dispensable. This dynamic and the systematic issues driving it will be examined in later sections.

Approaching these issues from the final geographic lens, we can also discuss the social determinants of place and how vulnerability patterns are spatially oriented by scale. As we have entered this second major wave of the pandemic, rural communities are experiencing some of the greatest COVID-19 risk. According to recent studies, among these rural populations, BIPOC communities are, by far, the most vulnerable to COVID-19 (Health Equity and COVID-19). With older populations, higher rates of underlying chronic disease, and limited access to healthcare, many rural communities are considered ‘highly vulnerable’ according to the CDC’s social vulnerability index (Rural Communities, 2020).

Prisons

The US prison system is an area where equity issues play a major role in the disproportionate impact of COVID-19 on BIPOC. As of 2017, Black people represented 12% of the U.S. adult population but 33% of the sentenced prison population while whites accounted for 64% of adults but 30% of prisoners (Gramlich 2020). The disproportionate percentage of Black people in prisons combined with the prison system’s poor preparation for disease outbreak has resulted in serious issues of inequity.

Incarcerated individuals are at a higher risk of exposure, as correctional officers and other staff frequently leave the facility and then return (Hawks 2020). Furthermore, social distancing is typically physically impossible in most prisons. According to Frederick Altice of the Yale School of Medicine, prisoners share toilets, bathrooms, sinks, and dining halls. These settings are in no way equipped to deal with an outbreak (Burki 2020). Overcrowding, insufficient sanitation, poor ventilation, and inadequate healthcare also contribute to the seriousness of infectious disease spread (Franco-Paredes 2020). Because BIPOC communities are disproportionately represented in prisons, they too, face a disproportionate share of the COVID-19 impact.

While some prisons have acknowledged the issues presented by COVID-19 and responded by releasing prisoners held for nonviolent crimes (Burki 2020), there has been a call for broader policy efforts to reduce the number of minorities who are sentenced to correctional supervision in the first place (Nowotny 2020).

Figure 3: Prisons are “in no way equipped” to deal with COVID-19

Essential Industry Workers

Despite the massive transition to remote work, over half of the US population still has to attend in-person jobs (Brenan, 2020). While the exact number of COVID-19 infections resultant of workplace exposure is unknown, job sectors such as health care, food processing, meatpacking, agriculture, public transit, retail, and sanitation, all face higher risks of infection (CDC, 2020). Most of these essential worker jobs are low paying, with long hours, and often have employers that care more about profits then the well being of their workers.

People of color makeup 50% of essential workers in food and agricultural industries and 53% of essential workers in industrial, commercial, residential facilities and services (Poydock & McNicholas, 2020). These essential roles are filled by people who have been systematically disadvantaged. Nearly 70% of essential workers do not have a college degree, 10 percent having less than a high school diploma (Poydock & McNicholas, 2020). Studies suggest that there is a direct connection between lack of access to higher education and unemployment (Kamenetz, 2018).

Today, the unemployment rate for Black Americans is higher than that of the national average (Vanken Smith & Rosalsky, 2020). Fear of unemployment motivates people to continue working, even if this work increases the likelihood of exposure. Additionally, most people who work in essential industries don’t have the financial stability to take time off, even when they have fears of contracting the virus.

Figure 4: How To Keep Your Essential Workers Safe During COVID-19
Figure 5: Essential workers during COVID-19: At risk

BIPOC essential workers often lack the necessary support to protect themselves against their increased vulnerability. Black Americans are nearly twice as likely to be uninsured when compared to their white counterparts and increased unemployment due to COVID-19 has only broadened this health care disparity (Sohn, 2017). Additionally, BIPOC are less likely to have money saved incase of a health emergency.

Every essential worker is affected by the health and safety issues created by COVID-19, however, the additional challenges that BIPOC populations face results in greater disparities. Essential workers are rendered dispensable, and therefore treated as though their health and wellbeing is not important. In reality, the only way life has continued during this pandemic is on the backs of essential workers.

Concluding Remarks

Using the critical environmental justice framework of intersectionality, embeddedness, indispensability, and scale, we see that members of the BIPOC community have been more seriously impacted by COVID-19. This is not because of genetic differences, but rather due to the intersectionality of the social determinants of health, and a history of societal racism against the BIPOC community. Overall, the impact of COVID-19 can be summarized by a quote from Sacoby Wilson, an environmental health scientist at the University of Maryland, “One thing that Covid-19 has done, it has made a lot of populations that we made invisible, visible. Nursing home populations. The meatpacking industry. Prisons. Communities impacted by environmental injustice. These are communities that we’ve thrown away. We’ve made them invisible, but Covid-19 has made them visible” (Begley, 2020).

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