The Haze of Health Disparities

This week, I read about Health and Human Services Secretary Alex Azar’s recent statements on COVID-19 and underlying health conditions.  In the interview, he emphasized that “minority communities [are] particularly at risk here because of significant underlying disease health disparities and disease co-morbidities.”

I’ve been hearing “health disparities” mentioned a lot in the media as an explanation to the problem of why black people in the U.S. are more likely to be infected and die from COVID-19.  But no one’s talking about the underlying causes of those health disparities.

When Azar talked about it, he simply stated, it’s “an unfortunate legacy in our health care system that we certainly do need to address.”

Picking this apart a bit, “unfortunate” is a weirdly underwhelming way to describe thousands of people dying.  And “legacy,” has a bit of a yesteryear feel to it.  This issue needs to be described for the horrific level of now that it is.

This is illustrated by Georgia’s decision to re-open for business for example.  The Governor has stated that it’s a risk he thinks is worth taking – at the expense of those most likely to develop severe illness or die from COVID-19.  Worth is implicitly defined – the worth of jobs, of economic stability, of corporate growth.  Risk is also implicitly defined.  Blacks comprise the largest percentage of those with COVID-19 in Georgia and it’s worse for Black women who make up nearly 40% of diagnoses compared to 30% for white women in that state.  One of the risks is that a disproportionate number of Black people will die.

Alex Azar’s next statement in the interview was, “this is not about fault,” meaning, in the context of the article, that we shouldn’t be blaming people for their own bad health.

Unfortunately, many white people do just that.  I hear white people say, “if they didn’t eat [this] or do [that].”   “If they weren’t so…[fill in the blank]…”

Talking about health disparities needs to be more specific – to paint a more accurate picture of what’s actually going on that leads to the disparities.

When people talk “health disparities” in the media, I picture a slow-moving hazy cloud of grey settling over the conversation.  It’s like a layer of smoke lazily resting over everything and  describing what’s happening, but not why it’s happening.  The smoke obscures the root cause of the health disparities – systemic racism.

For some, “systemic racism” is just as hazy as “health disparities,” so here are three examples to help bring more clarity:

  1. What would happen if our decision-makers didn’t place high-pollution factories in neighborhoods occupied mostly by people of color?

Did you know that growing up in and living in areas of the country with high levels of air pollution leads to higher rates of childhood asthma and other respiratory illnesses?   That facilities that have the highest toxic air emissions are located in the poorest, lease diverse (read: not a lot of white people) sections of cities and towns? And that regardless of wealth, African Americans are more likely to be exposed to high-particulate matter in the air – associated with lung disease, heart disease and premature death…?

  1. What would happen if our decision-makers guaranteed healthcare for all Americans?

Did you know that blacks are 1.5 times more likely to be uninsured than whites, even with what’s left of the Affordable Care Act?  Did you know that people of color in this country are more than twice as likely to be paid poverty-level wages – jobs that don’t come with health insurance?  Do you know how many people avoid going to the doctor when health issues are small because they can’t afford it, only going when it becomes life-threatening?  Or when it develops into a chronic (cough, underlying, cough) health condition?

  1. What would happen if our decision-makers ensured that there was safe drinking water available to all Americans?

Did you know that in Detroit, MI, as of the end of April 2020, there were an estimated 10,000 people still without running water in their homes?  That this was happening more than a month into the COVID-19 pandemic where the City of Detroit was one of the worst-hit regions in the country?  Where frequent hand-washing was touted as the best prevention against contracting COVID-19?  Did you know that some Flint, MI residents still rely on bottled water because the pipes in their homes are as yet unsafe?  And that Flint is in the county with the fourth highest number of deaths in Michigan?

These three points just scratch the surface, there’s innumerable other factors that all combine to form a giant web of systemic racism in our country which hurts people of color.  A few more examples: school “choice” policies allowing those with the resources to opt out of local schools and choose “better” schools, leaving local, usually poorer, schools struggling with inadequate resources to offer remaining students; discriminatory policing practices, prosecutions and sentencings leading to people of color being arrested, convicted and imprisoned at much higher rates than white people; employment policies and practices that privilege white-sounding names on job applications while screening out anyone with a “record,” even for unrelated offenses.

These are just a few strands in the web of systemic racism.  It’s why we have race-based health disparities in the COVID-19 pandemic (and also when COVID-19 is not here).

The action step this week is simple.  White people, name this “systemic racism” in your conversations, on social media, whenever you can.  Stop calling it sad and unfortunate.  When people talk about “health disparities” and “more likely to have underlying health conditions,” reply with, “did you know that’s driven by systemic racism?” 

For more information on what you can do to address the COVID crisis among Black, indigenous and other people of color, read through the NAACP’s Coronavirus Equity Considerations.