How to reduce the racial gap in COVID-19 deaths

Shoppers browse in a supermarket while wearing masks to help slow the spread of coronavirus disease (COVID-19) in north St. Louis, Missouri, U.S. April 4, 2020. Picture taken April 4, 2020.  REUTERS/Lawrence Bryant

Crises like the COVID-19 pandemic highlight inequities that are enacted on the bodies of Black Americans. In states across the country from Michigan to Maryland, Blacks have higher rates of COVID-19 diagnoses and deaths. Blacks represent over 70% of COVID-19 deaths in cities like Chicago, counties like Milwaukee County, and states like Louisiana. In St. Louis, 100% of the COVID-19 deaths were Black Missourians.

Recently, I wrote about how structural conditions are the main reasons for the racial gap in coronavirus deaths. I argued that under-funded and underserved neighborhoods, a higher representation among the “essential,” low wage workforce, and pollutants manufacture racial health disparities and expose Blacks to increased diagnosis and death from COVID-19. Blacks also have a series of deleterious interactions with institutional trustees such as healthcare providers and police officers that exacerbate life stressors. Senator Elizabeth Warren stated, “Decades of structural racism have prevented so many Black and Brown families from accessing quality health care, affordable housing, and financial security, and the coronavirus crisis is blowing these disparities wide open.”

To date, the U.S has employed “a colorblind policy” to COVID-19, as stated by Stephen Thomas, Director of the Center for Health Equity at the University of Maryland. However, a colorblind approach cannot bring about equity when both the healthcare system and the structural conditions that inform it are so unequal. Focusing on the most oppressed and vulnerable among us creates a pathway toward health equity that will help everyone beat this pandemic.

I propose a series of policy recommendations to reduce the likelihood of exposure, contraction, and death from COVID-19 for Black Americans. These recommendations also apply to low-income workers and people living in rural areas with limited healthcare access.

Immediate release of demographic data

Data on race, place, gender, and age should be readily available for social scientists, epidemiologists, and other public health researchers to formulate better preparedness plans for the upcoming waves of COVID-19. Data help not only to direct resources, but they also help to learn from places that seem not to have apparent disparities. In Ohio, Blacks are less likely than their percentage of the state to die from COVID-19. Experts need to investigate why this outcome exists in Ohio. Places with positive outcomes hold the keys toward equity.

Testing and triage centers need to be placed in Black neighborhoods

People need to be tested and provided treatment quicker. This is not happening due to failures in the healthcare pipeline and the inequities that manifest in the location of healthcare facilities. When people are sick, stop sending them home alone to take an irregular public transit system and with no resources to purchase the medication they need. When this occurs, people are effectively being sent home to die alone. Senator Warren stated, “We need the government to step up in a big way to ensure that communities of color have equal access to free testing and treatment. Congresswoman Pressley and I aren’t going to let up until we see solid data and real progress.”

As more COVID-19 testing facilities are rolled out, it is important to be thoughtful about location. CVS Health’s Atlanta location—Georgia Tech—seems to make sense, initially. However, the zip code where Georgia Tech is located has a Black population of only 14% compared to 54% for the rest of the city. In New York City, most of the testing centers and primary COVID-19 response hubs are not located in the areas with the highest number of cases, which happen to be in predominately Black neighborhoods.

Predominately Black churches may be ideal locations for testing, triage, and treatment. Black churches continue to be the glue that holds many Black communities together. During this crisis, they are proving essential for Black families by giving out food, laptops, and funds. Building on the proposed Health Empowerment Zone Act, Black churches can serve as “health action zones” to bridge federal, state, and local resources with community resources. Health action zones are popular in the United Kingdom and have some similar goals to former President Obama’s promise zones and the state of Maryland’s Heath Enterprise Zones.

Additionally, Black churches can help to overcome trust issues related to healthcare and continue to be beacons of hope in the midst of perceived hopelessness. My research with Abigail Sewell shows that Blacks are more likely to trust Black Protestant churches. Blacks relative to Whites are less likely to trust healthcare, and for good reasons. The United States has a long and torrid history of abusing Black bodies for medical and financial gain, such as the Tuskegee Syphilis Study. Research shows that knowledge of the Tuskegee Syphilis Study significantly decreases healthcare utilization among Black men. However, attendance at Black Protestant churches increases healthcare utilization among Blacks.

Essential workers need paid leave

Paid leave is critical for essential workers. Low-wage workers are not only contracting the virus at higher rates, but they are exposing others because they come to work sick and go home sick. Most cannot afford to miss a day at work. Implementing paid leave will help essential workers seek the medical care they deserve and reduce the potential spread of the virus.

Essential workers deserve hazard pay

Hazard pay is desperately needed for new “essential” frontline workers. The U.S. Department of Labor states: “Hazard pay means additional pay for performing hazardous duty or work involving physical hardship.” The U.S. Department of Commerce notes, “Hazardous duty means duty performed under circumstances in which an accident could result in serious injury or death,” such as being exposed to a deadly virus due to limited personal protective equipment and lack of training on using that equipment. Though it is nice for companies like Walmart to provide one-time $300 bonuses, this is not enough for a person risking their lives day after day, week after week.

The federal government and states need to provide a living wage

The newly minted “essential” workers need a living wage. The minimum wage varies by state based on cost of living differences. The problem, however, is that the minimum wage has not kept pace with inflation. In Tennessee, the minimum wage is $7.25 per hour. If a person works 40 hours per week, they make $1,160 per month before taxes. The average rent for an apartment in Nashville is about $1400. A majority of Americans are in favor of a $15 minimum wage, including nearly 90 percent of Blacks. This is because the Black community is most impacted by low wages. Higher wages reduce dependency on federal and state aid and increases local investments.

Universal healthcare

The COVID-19 pandemic highlights the importance of equitable healthcare and the flaws with the current system. The U.S. spends 25% more per capita on healthcare than any other country and over 100% more than Canada. Over the past 20 years, U.S. healthcare spending has doubled. If people have more equitable healthcare coverage, the number of people with untreatable pre-existing conditions will decline and healthcare costs will drop. More healthcare equity also puts less strain on hospitals, emergency departments, and first responders who deal with people when their conditions have worsened rather than when they initially become ill.

In conclusion, the racial gaps in COVID-19 diagnoses and deaths are unacceptable. In upcoming stimulus packages, the federal government needs to ensure that its policies are addressing the persistent inequities in the healthcare system that lead to Black Americans being more likely to bury their loved ones.