Seven reasons why COVID-19 harms African Americans disproportionately

The following is an expert opinion piece by Daniel L. Howard, Public Policy Research Institute professor and fellow. His research includes the examination of epidemiological patterns of health outcomes that disproportionately affect African Americans, as well as minority health and health disparities. Here, he examines potential causes of why COVID-19 pandemic affects African Americans more severely than other demographics.

Recent data on the coronavirus pandemic shows that African Americans are much more likely to experience death from the coronavirus compared to other racial groups.

The projected deaths from coronavirus in 2020, with estimates in the hundreds of thousands to millions and its predominance among African Americans, will undoubtedly catapult it into the top five leading causes of death for African Americans.

While this appears to be alarming, it is, in fact, not surprising. When one looks at the historical context of racial health disparities, and specifically the marginal health of African Americans, this is not new information.

A long history of disparities

Data has shown similar trends for racial health disparities for decades now. The death rate of blacks has been higher than other populations, as seen as early as the first examinations of African American health in the 1880s. It’s noted historically that African Americans have greater morbidity and mortality than other Americans. And, many studies since have consistently shown that African Americans live sicker and die younger than other racial groups.

The term ‘racial health disparity’ is defined as differences in the prevalence and burden of diseases and adverse health conditions that exist among specific populations in the United States. The term originates from the landmark “Heckler Report” in 1985.

More research is needed to fully understand the factors that cause health disparities due to race in general, and specifically racial disparities in coronavirus cases. But, to do so, we must first understand ‘what is race’ and how is it related to health.

Recent and comprehensive studies of racial differences in health suggest that the cause of these differences is not genetically determined, as previously thought. Race is now seen as a societal construct, consisting of the intersection of historical conditions with economic, political, legal, social, and cultural factors, as well as racism. To understand the complex relationship between race and health, factors such as health behavior, stress, medical care, and a broad range of social and cultural resources have to be considered (known as ‘social determinants of health’).

So rather than viewing race as having a direct influence on health outcomes, race instead acts as an influence on many aspects of the health care experience which then impacts health outcome.

Health equity — or the absence of health inequalities in controllable aspects of health — results from having access to the social determinants of health, specifically those related to wealth, power and prestige.

Factors in COVID-19

In the case of the coronavirus pandemic, the racial disparities in deaths reflects racial differences in the way that African Americans live, work, and exist. These differences are a result of their ‘second-class citizenship’ with respect to their lower socioeconomic status in comparison to other racial groups.

Therefore, there are many factors that may contribute to these inequalities in the current pandemic.

First, the health status of African Americans identifies a higher prevalence of cardiovascular diseases, cancer, hypertension, diabetes, obesity, and sexually transmitted infections, i.e., HIV infections, when compared with whites. Higher rates of coronavirus among African Americans may be due to being more likely to have these conditions, which has been noted as a significant risk factor for coronavirus death.

Second, minority racial groups are more likely to experience multidimensional poverty than their white counterparts. Higher rates of coronavirus among African Americans may be due to being less likely to have basic resources or access to basic resources to provide protection against the virus, i.e., masks, gloves, sanitized wipes, etc.

Third, the nation is largely segregated, leaving racial groups exposed to different health risks and with varied access to health services based on where they live. Higher rates of coronavirus among African Americans may be due to being more likely to co-exist around others in their respective densely-populated neighborhoods and communities who are at higher risk from contracting the virus. And, there may be limited health facilities to seek care in these neighborhoods and communities that may have less resources.

Fourth, as of 2018, most groups of color remained more likely to be uninsured compared to whites. For example, blacks remained 1.5 times more likely to be uninsured than whites from 2010 to 2018. Higher rates of coronavirus among African Americans may be due to being more likely to be uninsured and, therefore, less likely to receive medical care after contraction of coronavirus.

Fifth, U.S. Census Data from 2010 revealed that whites have the country’s highest homeownership rate, while those identifying as being African American had the lowest homeownership rate, by almost half. Higher rates of coronavirus among African Americans may be due to being more likely to live in densely-populated apartments and other multi-person dwellings, rather than single-family homes, which reduces the ability to self-isolate and increases the exposures for contracting the virus.

Sixth, black households are much less likely to own a car than were white households, identifying a growing gap between car ownership in white and black households that spanned income levels. Nineteen percent of African Americans reported living in a household without access to a vehicle, compared to 4.6 percent of white Americans. Higher rates of coronavirus among African Americans may be due to being more likely to use public transportation to get to work, which reduces the ability to socially-distance and increases the exposures for contracting the virus.

Finally, 47 percent of blacks attend religious services at least once a week in comparison to 34 percent of whites. Higher rates of coronavirus among African Americans may be due to being more likely to mingle in public spaces with many other individuals, rather than practice social distancing, particularly prior to public health messaging to stay at home and to avoid large gatherings.

Moving forward

These are only a few of the possible factors that could influence the disproportionately high rate of coronavirus deaths among African Americans. Only further research will begin to provide the answers as to why these outcomes are occurring.

From a health policy perspective, challenges exist to reverse the current trend in coronavirus deaths among African Americans due to the historic, consistent, and pervasive societally-induced deficits within African American life.

However, a clear initiative to possibly reduce the spread of this virus in African American and minority communities would be the provision of widespread testing and monitoring for Covid-19. This would allow early detection among the infected, self-isolation and quarantine, and earlier treatment of the flu- and pneumonia-like symptoms before the illness progresses to the need for the ventilation of lungs.