The Great Magnifier: How COVID-19 Makes Inequity Visible
As America continues to brace against and prepare for what comes next during this coronavirus pandemic, a simmering nationwide discussion is effectively highlighting that which those dedicated to health equity have always known:
While anyone can become sick with COVID-19 regardless of race and income, those from the most vulnerable communities will be most deeply impacted.
We already know how social determinants of health create higher rates of chronic medical conditions among people of color. We have data and a very clear understanding of how one’s zip code is a stronger indication of one’s life than one’s genetic code.
Still, prior to this pandemic, we had done little to address these social determinants, let alone the implicit bias and startling disparities in health care that have permitted them to persist.
Now, as we undoubtedly face certain dire statistics regarding race and COVID-19, we are forced to admit and explore how this data was set in stone long before this virus ever came into existence.
Before our framers even began drafting the U.S. Constitution, we can trace the beginning of this country’s current power and political structure to the 16th century process of colonization, when white Europeans displaced indigenous people and took away their land and sovereignty.
It was further codified when, as the newly formed colonies declared independence and settlers migrated across the North American frontier, women and people of color were denied the right to vote, the right to own property, and equal protection under the law of the U.S. Constitution, formalizing the practices of slavery and indentured servitude that further denied opportunities for education, land ownership, and basic freedoms in the 18th century.
It is this foundation, the one upon which our nation was built and from which it has developed through the 20th and 21st centuries, that has produced much of the gentrification, segregation, and urban displacement of people of color to inadequate housing in densely populated areas, where economic disinvestment contributed to poorer economies and food deserts and factory and environmental pollutants affected air and water quality.
Continued exposure, as well as systemically limited access to affordable medical care and nutritious food, has therefore continued to result in lack of access to primary care and higher rates of hypertension, heart disease, asthma, and diabetes among people of color today.
Now, while many think most high-risk people of color can and should shelter at home during the COVID-19 pandemic, the truth is many are not privileged enough to do so. Often without personal protective equipment, they are restocking our groceries, driving our buses, making and delivering our food, cleaning and disposing of our trash, and more, all because if in fact they do not work, they will not be paid.
Without the ability to shelter at home, these “essential” workers are forced to take fever reducers to get through shifts, so that if and when they finally see a doctor, their fever reads lower than required for COVID-19 testing and they are sent away.
Even if symptomatic, implicit bias embedded within our current medical standards and health care policies, as well as within the testing recommendations from the Centers for Disease Control and Prevention, will keep seemingly “healthy” persons of color between the ages of 20 and 50 from being properly evaluated.
That is why the first two deaths in Newark, New Jersey were African American males in their 30s – no one is yet looking through the right lens in which to test and treat them.
We are now also hearing anecdotal evidence that some younger black and brown patients who have audibly disclosed known pre-existing health conditions, including lymphoma and lupus, were still refused tests multiple times due to their age and lack of “worrisome” symptoms, and later died.
This lends itself to continued distrust of the medical community and further evidences the need for public health leaders to focus on and work to eliminate health disparities by setting equitable policies, practices, and recommendations for screening, treatment, and training, especially during crises.
For example, as we enter a difficult surge in this pandemic, are we considering which hospitals people of color are more likely to go to and ensuring they have the resources necessary, including respirators and ventilators? Are we making certain that all community members who exhibit symptoms are thoroughly listened to and physically examined prior to determining testing eligibility?
After all, urban cores of black and brown communities do not exist in isolation. Rather, they were created by redlining and zoning, adjacent to majority white suburban communities in which many work as essential service providers.
Inclusive health, education, and economic policies not only will dismantle the effects of structural racism in vulnerable communities, but also will shore up the rest of society. Addressing systemic inequity can be done and by doing so we can change the impact we are seeing now and into the foreseeable future.
Otherwise, when determinations need to be made as to who will have access and restorative funding, we can only imagine what will happen then.