Dismantling Systemic Racism Also Tackles COVID-19 Disparities
We Are Not Choosing Between Protests and the Pandemic
America is reeling from interconnected crises: the public health crisis of the coronavirus pandemic and the societal crisis of police brutality and systemic racism. Some public health experts caution that protests across the country could lead to a resurgence of COVID-19. But Black Americans like me do not have the luxury of choosing which crisis to prioritize. The country’s leaders must also address both in this moment.
Indeed, dismantling systemic racism will mitigate some of the drivers of health disparities that have led to greater numbers of COVID-19 cases and deaths among African Americans and other minorities. Police brutality and other forms of systemic racism in the United States impact the lives, health, and well-being of African Americans. You can readily envision the psychological health effects of the individual and collective traumas experienced by the Black community. A growing body of research now shows that the chronic stress experienced by minority communities also has a very real physiological effect that contributes to health disparities in a number of disease areas.
The American Medical Association, the American Academy of Pediatrics, the American Public Health Association, and other medical and public health organizations agree that police brutality and other forms of systemic racism negatively impact health. A recent review by Dr. David Williams at Harvard University outlined the evidence linking negative health outcomes to various forms of racism: structural or institutional racism (e.g., societal laws and policies), cultural racism (e.g., unconscious bias), and individual-level discrimination. Different studies have shown an association between racism and heart attacks, chronic heart disease, obesity, and high blood pressure. Heart disease, obesity, and high blood pressure have all been identified as underlying health conditions that put people at greater risk of dying from COVID-19.
Racial and ethnic inequalities in health have long been documented for historically marginalized groups, and studies have revealed differences in health outcomes even after accounting for socioeconomic status. Recent studies also show an association between racism and early indicators of disease, including inflammation, destruction of protective DNA elements called telomeres, and abnormal levels of hormones. Taken together, all of this evidence suggests that chronic stress from systemic racism affects individuals on a biological level, leading to disease at an earlier age, more severe forms of disease, and higher death rates.
When data emerged about the disparate impact of COVID-19 on under-served communities, debate surfaced about possible causes: individuals from minority communities may be more likely to be essential workers, have less access to diagnostic testing and healthcare, and be more likely to have underlying health conditions. Sometimes these discussions insinuated that those with underlying health conditions were to blame for their COVID-19 risk. Recognizing that environmental and societal factors play a role in these underlying health conditions and other health disparities is a step towards reducing barriers to health equity.
This moment of profound national crisis provides a unique moment for government policy action. Governor Andrew Cuomo and other leaders have called for more research to understand the causes of COVID-19 disparities. While some research will be helpful, there have been countless task forces and reports on health disparities for decades. It is time to translate talk into action. The protests against police brutality in all fifty states and more than 100,000 deaths from COVID-19 should equip federal, state, and local leaders with the political will to act.
To reduce COVID-19 disparities over the short-term, policymakers must ensure greater access to testing in minority communities, provide equitable access to new drugs and vaccines as they are developed, and require greater workplace protections for essential workers, among other actions. Policies like the U.S. Centers for Disease Control and Prevention’s (CDC) initial requirement that an individual must have been exposed to someone who has tested positive for COVID-19 in order to get a test only served to perpetuate disparities. Under this guideline, if most people you knew were not able to get tested for COVID-19, you would also not be able to get tested.
To reduce health disparities over the long-term by dismantling systemic racism, it will necessitate the commitment of policymakers who must implement reforms and require accountability in the face of opposition by police unions and other groups. The calls to de-fund police departments may sound radical at first glance but can be the impetus for a thoughtful re-investment in social systems that improve housing, mental health services, schools, and other social services instead of always calling on an over-militarized police force that is not trained or equipped to deal with social issues. Those new to the cause can be effective by connecting with advocates in their community and demanding action from their local policymakers, where many of these decisions and investments are made.
America is reeling from multiple crises. Now is the time to heal the root causes of the systemic ills that plague us.
