Abstract
The long, fallacious history of attributing racial disparities in public health outcomes to biological inferiority or poor decision making persists in contemporary conversations about the COVID-19 pandemic. Given the disproportionate impacts of this pandemic on communities of color, it is essential for scholars, practitioners, and policymakers to focus on how structural racism drives these disparate outcomes. In May and June 2020, we conducted a 6-state online survey to examine racial/ethnic differences in exposure to COVID-19, risk mitigation behaviors, risk perceptions, and COVID-19 impacts. Results show that Black and Hispanic individuals were more likely than White respondents to experience factors associated with structural racism (eg, living in larger households, going to work in person, using public transportation) that, by their very nature, increase the likelihood of exposure to COVID-19. Controlling for other demographic and socioeconomic characteristics, non-White respondents were equally or more likely than White respondents to take protective actions against COVID-19, including keeping distance from others and wearing masks. Black and Hispanic respondents also perceived higher risks of dying of the disease and of running out of money due to the pandemic, and 40% of Black respondents reported knowing someone who had died of COVID-19 at a time when the US death toll had just surpassed 100,000 people. To manage the current pandemic and prepare to combat future health crises in an effective, equitable, and antiracist manner, it is imperative to understand the structural factors perpetuating racial inequalities in the COVID-19 experience.
Highlights
Like many other infectious diseases, COVID-19 has had disparate impacts on communities of color throughout the United States, with Black individuals experiencing substantially higher exposure, illness, and death rates than White individuals
Fallacies of physiological dysfunction and flaws ‘‘validated’’ a dogma that Black bodies were only fit for forced labor, which could ‘‘vitalize’’ the blood, ‘‘expand the mind,’’ and ‘‘improve the morals’’ of the enslaved who would otherwise ‘‘indulge in idleness and invariably [fall] victim to ‘unalterable physiological laws.’’’7,10,11 When enslaved people resisted or absconded from service by running away, their behavior was further pathologized as drapetomania, a disease that could be remedied by ‘‘whipping the devil out of them.’’7 This and other ‘‘diseases’’ of the Black body were presented as empirically based maladies, legitimized in medical journals, and used to support racist ideology and discriminatory policies, creating a sentiment of culpability within the Black community for health disparities
Health disparities for communities of color during the COVID-19 pandemic are clearly driven by structural conditions
Summary
Like many other infectious diseases, COVID-19 has had disparate impacts on communities of color throughout the United States, with Black individuals experiencing substantially higher exposure, illness, and death rates than White individuals. A root cause of these trends is structural racism, which has permeated our medical, social, and economic systems since before the United States was a country. Just over 100 years ago, Dr L.C. Allen addressed the general sessions of the American Public Health Association meeting with a racism-fueled diagnosis of the reasons for poor health outcomes among Black Americans.[1] His rhetoric about the ‘‘negro’’ population of the South being susceptible to a greater morbidity burden echoed late 18th and early 19th century medical descriptions of blackness as a fundamental marker of inferiority. Myths about differences between Black and White bodies, such as larger genitalia, smaller skulls, weaker lungs, stronger bones, and imperviousness to pain, were central to the rationalization of slavery.[3,4,5,6,7,8,9] Fallacies of physiological dysfunction and flaws ‘‘validated’’ a dogma that Black bodies were only fit for forced labor, which could ‘‘vitalize’’ the blood, ‘‘expand the mind,’’ and ‘‘improve the morals’’ of the enslaved who would otherwise ‘‘indulge in idleness and invariably [fall] victim to ‘unalterable physiological laws.’’’7,10,11 When enslaved people resisted or absconded from service by running away, their behavior was further pathologized as drapetomania, a disease that could be remedied by ‘‘whipping the devil out of them.’’7 This and other ‘‘diseases’’ of the Black body were presented as empirically based maladies, legitimized in medical journals, and used to support racist ideology and discriminatory policies, creating a sentiment of culpability within the Black community for health disparities
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