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(Covid-19)

The coronavirus pandemic has had a disproportionate impact on people of color and has put a spotlight on severe and significant inequalities.  The virus was the perfect storm for Black Americans who, thanks to decades of social and economic injustices, are much more likely to live in poverty, experience much higher unemployment rates, endure huge wage and wealth discrepancies, have less access to health care, suffer underlying health conditions that make the virus more deadly, live in at-risk housing conditions, take public transportation, and work in high-contact essential services (therefore, no telework) that expose them to lots of people.

 

At one point during the first year of the pandemic, Black Americans were SIX TIMES as likely to die from Covid than White Americans, and it didn’t get much better as time went on. During the Omicron outbreak in the winter of 2022, 34 percent more Black Americans died in rural areas, 40 percent more died in small to midsized cities, and 57 percent more died in larger cities and their surrounding suburbs.  To make a bad situation far worse, there were devastating mental health and addiction challenges as well. While overall drug overdose deaths increased 30 percent from 2019 to 2020, overdose deaths among Black people jumped 44 percent, around twice as much as the increase of overdose deaths among White people.

These massive disparities were evident from the earliest days of the pandemic.  A report from McKinsey & Company, a management consulting firm, released in April 2020, found that "the pandemic underscores the consequences of the structural disparities that have persisted in this country for centuries"  (read the report here).  It continues, "Black Americans will experience a disproportionate share of the disruption — from morbidity and mortality to unemployment and bankruptcy."  Highlights from the report:

Black Americans are almost twice as likely to live in the counties at highest risk of health and economic disruption.

Black Americans are not only more likely to be at higher risk for contracting Covid-19 but also have lower access to testing.  In addition, they are likely to experience more severe complications from the infection.

Black Americans are on average about 30 percent likelier to have health conditions that exacerbate the effects of Covid-19.

39 percent of jobs held by Black workers (seven million jobs in all) are vulnerable as a result of the Covid-19 crisis.  

The Brookings Institution went even further: “Disparities can be observed at all ages but are especially marked in somewhat younger age groups.  These disparities can be seen more clearly by comparing the ratio of death rates among Black and Hispanic/Latino people to the rate for White people in each age category.  Among those aged 45-54, for example, Black and Hispanic/Latino death rates are at least six times higher than for Whites…in every age category, Black people are dying from Covid at roughly the same rate as White people more than a decade older.”

 

In August 2020, the Centers for Disease Control and Prevention (CDC) reported that Black children are five times more likely — and Hispanic children around eight times more likely — to be hospitalized with Covid-19 than White children.  Read the entire report here.

amfAR, a nonprofit organization, found that "Covid-19 diagnoses decrease nationally as the proportion of White residents increases.  Counties that are 88 percent or more White have had the fewest Covid-19 cases throughout most of the U.S. epidemic."  Read more here.

A comprehensive analysis by The New York Times released in July 2020 found that:

Early numbers had shown that Black and Latino people were being harmed by the virus at higher rates.  But the new federal data — made available after The New York Times sued the Centers for Disease Control and Prevention — reveals a clearer and more complete picture: Black and Latino people have been disproportionately affected by the coronavirus in a widespread manner that spans the country, throughout hundreds of counties in urban, suburban and rural areas, and across all age groups.

Indeed, an earlier study released in May 2020 — led by researchers at amfAR and the Rollins School of Public Health at Emory University, and includes investigators from Johns Hopkins, the University of Mississippi, Georgetown University and the nonprofit PATH — found that "roughly one in five counties nationally is disproportionately Black and only represent 35 percent of the U.S. population, but these counties accounted for nearly half of Covid-19 cases and 58 percent of COVID-19 deaths"  (read the entire report here).  From the report:

Collectively, these data demonstrate significantly higher rates of Covid-19 diagnoses and deaths in disproportionately Black counties compared to other counties, as well as greater diabetes diagnoses, heart disease deaths, and cerebrovascular disease deaths in unadjusted analyses.  Moreover, in the absence of complete national-level data disaggregated by race, county-level analyses offer an immediate alternative to measure the disproportionate impacts of Covid-19 diagnoses and deaths among Black Americans.

 

Importantly, our analyses indicated that disproportionate rates of Covid-19 cases and deaths persisted after controlling for potentially confounding factors that might be associated with both high rates of Covid-19 cases and deaths and with high proportions of Black Americans.  Roughly one in five U.S. counties are disproportionately Black and they accounted for five of ten Covid-19 diagnoses and nearly six of ten Covid-19 deaths nationally.

Greater health disparities in places with a greater concentration of Black Americans is not unique to Covid-19.  Similar patterns have been reported for other conditions such as HIV, air pollution, cancer, and low birth weight and may be derived from the fact that in the United States, race often determines place of residence.  Ninety-one percent of disproportionately Black counties in these analyses are located in the southern United States  a region where most Black Americans reside (58 percent) that also ranks highest in unemployment, uninsurance, and limited health system capacity or investment.  These deficits are underscored by the finding that Covid-19 deaths in disproportionally Black counties occurred at higher rates in rural and small metro counties.

From a report from the Economic Policy Institute:

Black workers make up about one in nine workers overall; they represent 11.9 percent of the workforce.  However, Black workers make up about one in six of all front-line-industry workers.  They are disproportionately represented in employment in grocery, convenience, and drug stores (14.2 percent); public transit (26 percent); trucking, warehouse, and postal service (18.2 percent); health care (17.5 percent); and child care and social services (19.3 percent).  While, in the near term, this protects them from job loss, it exposes them to greater likelihood of contracting Covid-19 while performing their jobs.

Given the disproportionate representation of Black workers in front-line occupations where they face greater risk of exposure to Covid-19, it is not surprising that illness and deaths are disproportionately found among Black workers and their families.  African Americans’ share of those who have died from Covid-19 nationally is nearly double (1.8 times higher than) their share of the U.S. population.  The ratios are even higher in some states: in Wisconsin and Kansas, the rate of African American deaths is more than four times as high as their share of the population in those states.  By comparison, Whites account for a smaller share of deaths than their share of the population.

The Centers for Disease Control (CDC) reports weighted population distributions in an effort to reflect racial/ethnic distributions of the geographic locations where COVID outbreaks are occurring.  These weighted population distributions indicate that African Americans represent a larger share of the population in areas where outbreaks are occurring than their representation in the population overall (18.2 percent compared with 12.5 percent).  Therefore, one of the reasons for disproportionately higher rates of Covid deaths among African Americans is the fact that they are more likely to live in areas that have experienced Covid outbreaks.  Even accounting for this fact, African Americans still have higher death rates than their weighted population shares would indicate.

Underlying health factors put Black workers and their families at greater risk for contracting Covid-19.  Black workers also face greater underlying pre-pandemic health insecurities that make them more susceptible to the coronavirus.  According to one demographic assessment of vulnerability, an estimated 30 percent of the country’s overall population live in the counties at greatest risk of health and economic disruption from Covid-19, while a much higher share — 43 percent — of Black Americans (17.6 million) live in those same counties.

Preexisting health conditions compound the risks faced by Black workers.  Preexisting health conditions — such as diabetes, hypertension and asthma — are associated with greater risk of death from the coronavirus.  African Americans experience all of these illnesses at higher rates than Whites.  The greatest racial disparities exist in the prevalence of diabetes (1.7 times as likely among African Americans as among Whites) and hypertension (1.4 times as likely).  Air pollution has long been known to increase risk of heart and respiratory disease, heart attacks, asthma attacks, bronchitis, and lung cancer.  Therefore, environmental racism — the disproportionate impact of environmental hazards on health outcomes among people of color — is a contributing factor to these racial health disparities.  According to a 2018 report by a group of scientists at the EPA National Center for Environmental Assessment, published in the American Journal of Public Health, people of color are disproportionately affected by air pollution due to their proximity to particulate-matter-emitting facilities.  African Americans suffer the most, with exposure 54 percent above average.

Black workers and their families face greater risk of exposure to the coronavirus because they are more likely to live in densely populated housing.  The health and economic risks associated with Covid-19 are not limited to individual workers, but also affect their families and communities.  The high rate of contagion associated with the coronavirus has made social distancing critical to slowing the spread of infection.  However, in smaller or more densely populated home environments, it can be more difficult to effectively isolate vulnerable family members from those who have been infected or who face greater risk of exposure to the virus because of their work conditions.  For example, those who live in multi-unit dwellings, such as apartment or condo buildings, tend to reside in more densely populated areas where more people share highly trafficked common spaces than those who live in single-unit detached dwellings.  54.5 percent of African American households live in single-unit structures, compared with 74.2 percent of White households.  On the other hand, 29.2 percent of African American households live in structures that include five or more units — more than double the rate of White households.

Black workers are more likely to live in multigenerational households with older family members who are at high risk of contracting the virus.  African Americans are also more likely to live in multigenerational households where there may be older family members who are considered high risk. Black workers are twice as likely as White workers to live in households with three or more generations, such as a grandparent living with children and grandchildren.  While older people have been encouraged to isolate themselves as a preventative measure, this presents a challenge in homes where other members of the household must work outside of the home.

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