COVID and Racism: How We All Pay

February 4, 2021
By Rose Veniegas, CCF’s Senior Program Officer, Health & Jarrett Barrios, CCF’s Senior Vice President, Strategic Community & Programmatic Initiatives

Racism makes us sick.

Last week’s New York Times story on the unequal impact of COVID-19 in Los Angeles County (“In Los Angeles, the Virus Is Pummeling Those Who Can Least Afford to Fall Ill”) told Angelenos what many of us already knew. The Coronavirus is making Los Angeles sick, but our communities are not all getting sick with the same frequency or the same force.

The pandemic underscores in multiples ways how being denied access to quality health care, housing, education and other basic needs lead to higher rates of COVID-19 exposure, infection, hospitalization and fatality. Because communities of color, poorer and immigrant communities are well aware that they are more likely to be denied access to any and all of these benefits, the news in the New York Times isn’t news in most neighborhoods in our city.

But since it’s been reported as news, let’s go a bit deeper into how health disparities are born of racism. When we think of racism, we often think of a derogatory slur, or perhaps a more subtle swipe that someone is unqualified or undeserving because of presumed race or ethnic origin. But racism exists in equal measure in the policies that determine whether to provide sufficient educational supports for youth whose first language is not English. It exists in the biases of health providers’ decisions about who needs pain medication and who doesn’t. It guides even the most basic assumptions of a shopkeeper when a customer buying cigarettes is thought to be passing a counterfeit $20 bill. The outcome of each of these is diminished quality of life and added stress that others need not confront.

On the receiving end of these stressor cumulations, people of color experience detrimental health impacts. In the same way that lack of sleep and dehydration reduce our immune response, the regular toll of being devalued and disrespected has an unhealthy impact on our bodies.

Racism and discrimination make us sick not only because of the psychological impact they have on us, but also on how they affect our behaviors like help-seeking in moments of crisis. Before COVID-19 had ever come to California, the African Americans and Latinx communities had dramatically lower rates of testing for diabetes than other ethnic groups. Perhaps unsurprisingly, a higher proportion of Blacks or African Americans had diabetes-related emergency room visits. Similarly, Latinx and Blacks or African Americans had higher rates of asthma and asthma-related emergency room visits. Yes, there’s a reason the federal government has included discrimination as a factor impacting health in the national plan called Healthy People 2020.

The broader impacts of structural and individual racism has been brought home during the pandemic. These issues also impact the health of our communities of color. In LA County, 8% of the population is African-American but two out of every four people experiencing homelessness were Black or African American. This is a housing issue but with clear health impacts. Before COVID-19, two out of every three uninsured Californians were Latinx. This is not just an issue with health impacts because of the obvious denial of care, but also because the complex stew of uninsured rates, fear of government and unfamiliarity with complex health care delivery systems that has led to one out of six immigrant adults in California who needed help with food, housing, health or other assistance have avoided seeking support in the pandemic.

Given this long history of disparity, why would it be news that COVID-19 has laid bare this inequality? Since the pandemic, these same groups have both lacked adequate access to tests for the virus and have suffered higher rates of death among confirmed cases. Latinx have the highest proportions of being hospitalized compared to their proportion in the population. Blacks or African Americans have the highest proportions of cases and deaths compared with their numbers in the County population. The erasure of some ethnic communities, too, has hidden their impacts. Asian, Pacific Islander, Native American and Indigenous populations are often lumped into general “Other” term, but native Hawaiians have the highest rate of COVID-19 cases based on their proportion in the population (840 per 100,000) compared with Latinx (114 per 100,000) or Blacks or African Americans (102 per 100,000).

During COVID-19 the true price of a positive Coronavirus test must also include, for many low-income wage earners, the cost of two or more weeks without wages. And the larger cost of losing future hours or employment by being left off the schedule.  And the cascading costs of being unable to pay rent, utilities or the car payment for the next month. While certainly well-intended, health orders urging those with diabetes, asthma, heart disease, cancer and HIV/AIDS to work from home and maintain physical distances simply can’t be counted on to help many workers of color. Even if they had affordable, reliable broadband to support remote work and child care, many have “essential” jobs that don’t permit it – indeed, they’re lucky if their workplaces even allow for effective social distancing with proper PPE.

In this discussion, we at CCF endorse the New York Times, but encourage them—and all concerned with visualizing these inequalities—to go deeper.  The U.S. Centers for Disease Control and Prevention has published a Social Vulnerability Index (SVI) to align resources for Black, Latinx, Asian and Pacific Islander communities. The factors embedded in the SVI represent those mentioned in the New York Times’ story and can be easily seen at work when overlaid with COVID-19 data.

This CCF map shows LA County’s most “vulnerable” communities (based on the CDC data) and case numbers compiled by community.  A map that overlaid COVID -19 fatalities similarly concentrates in the most vulnerable communities. Indeed, additional nuance can be teased out of the data beyond what the CDC shows us.  Take, for example, undocumented immigrants.  The American Community Survey tracks, using a generally accepted formula, where these residents are concentrated.  Those numbers are even more striking, suggesting that even treating a group like Latinx may be too broad a brush and that, within such communities, there are striking hierarchies of health based on immigration status, education and capacity to speak English.

While disheartening, this data does allow us to direct our resources more efficiently.  In a recent COVID-19 campaign with the LA County Department of Public Health, we were able to use these maps to hyper-target the most COVID-19 impacted census tracts for “promotora” education campaigns. As a foundation, we have also been able to target philanthropy at these unequal outcomes by supporting service-providers in high-impact communities and advocates calling for all of us to be named, counted, and served in health, education, housing and food assistance.

Yes, let’s keep asking for the data in public reports. Let’s keep urging that they show us in our neighborhoods, blocks and zip codes. Let’s keep showing how some of us receive a lot less from government because of racism past and present.

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