A study published on November 18 in the journal PLoS One focused on how racism within a community — rather than just among healthcare workers or other individuals — affects COVID-19 cases and deaths. Researchers looked at COVID-19 cases and racial attitudes on a county level, overlaying health information with data about racial attitudes collected through Harvard University’s Project Implicit— an online assessment of a person’s explicit (conscious) and implicit (unconscious) biases and prejudices. They also accounted for other variables including the overall health of the community, prevalence of health insurance coverage, and average income. All in all, the study encompassed about one-quarter of all U.S. counties. The researchers found that counties that had both large Black and Hispanic populations and high levels of racism had more COVID-19 cases and deaths than areas with similar demographics but less racism at the community level. Higher levels of both explicit and implicit racism were linked to a greater number of COVID-19 cases in Black communities, the study found, but only implicit racism appeared to have an impact on how many of those people died. While past research on health disparities and COVID-19 has largely focused on racist attitudes of individuals, few studies have looked at communities as a whole. “Racism at a community level is indicative of systemic racism in that area, and this study adds to the body of work that shows that racial attitudes and racism have very real influences on people’s health,” says George Cunningham, PhD, professor of health and kinesiology at Texas A&M University in College Station, Texas, who coauthored the study. “People are much less likely to admit that they like their own race more than others, but many more will make more ambiguous, quick judgments or decisions that are implicitly racist, and those decisions perpetuate systemic racism within communities at large.” RELATED: Black Americans Have Been Hit Hardest by COVID-19 — Here’s Why
A Mounting Pattern of Inequity
According to Natalia Linos, ScD, executive director of the FXB Center for Health and Human Rights at Harvard University in Boston, people often think of explicit and implicit racism as two different things, with the first worse than the second. But racism is racism, she argues, and community-created structural racism is how systems reproduce inequities. “COVID-19 didn’t create deep inequities, it revealed them,” she says, pointing to the deep-rooted pattern of Black Americans experiencing some of the poorest health outcomes in the country. Black children are 10 times more likely to die of asthma than their white counterparts, and Black women over age 30 are 4 to 5 times more likely than white women to die from pregnancy, the Centers for Disease Control and Prevention (CDC) reports. A study published in May 2017 in the journal Social Science and Medicine found that while Black women have overwhelmingly worse pregnancy outcomes across the country, these outcomes were even worse in communities with higher levels of racial prejudice. Black Americans are more than 2.5 times more likely than white Americans to contract COVID-19, almost 5 times more likely to require hospitalization, and twice as likely to die, CDC data shows. While the CDC notes that it’s rare for a person under age 21 to die from COVID-19, almost 80 percent of those who have lost their lives were Hispanic, Black, Native American, or Alaskan Native. “That disparity among younger people is important because that gives us information on the idea of who is disposable,” says Dr. Linos. “This is racism, not race. There is no genetic or biological reason that we should be seeing these health outcomes replicating the same patterns.” Linos says that people are too quick to make the argument that Black Americans are disproportionately harmed by COVID-19 because they have higher rates of underlying conditions such as hypertension and heart disease. “We have to admit that it is racism, even in cases where underlying conditions are at play,” she says. “It’s because the way our system has shaped the ability of certain groups to lead healthy lives.” Dr. Cunningham says that community-level data can be used to outline how racism is impacting health outcomes across the nation, and then help determine better structures, laws, and policies that can begin to shrink health disparities. “A lot of us predicted that this was going to play out on racial lines because that is how racist our country is. It was predictable, but it wasn’t inevitable. We can have a COVID-19 strategy that is explicitly focused on health inequity,” says Linos.
