The corona virus pandemic has highlighted critical issues in the U.S. economy and society that have led to unnecessary hardship, suffering, and deaths. The infection and death rates have been higher among people of color than among whites. In addition, low-income households and people living in densely populated areas are at higher risk for COVID-19 than others. These three risk factors occur concurrently for many, resulting in a particularly high-risk population. [1] (See my previous post for more detail.)

There are multiple factors that lead to the corona virus hitting people of color harder than whites. It is important to recognize and acknowledge that these disparities are not linked to individual decisions and behaviors, but to longstanding characteristics of the social and physical environments they live in in the U.S. These social determinants of health, as they are called, are most often driven by public policies and spending patterns, as well as by institutional racism. [2]

One of the reasons for the elevated death rate among people of color, low-income households, and people living in densely populated areas is that COVID-19 is especially dangerous to people with underlying health problems, particularly respiratory conditions, given that the virus typically attacks the lungs. Chronic health problems, including asthma, are higher among these at-risk populations. Research has found that respiratory conditions that make one vulnerable to the virus are more likely among people with long-term exposure to air pollution and that a small increase in exposure to fine particulate air pollution — tiny particles in the air — leads to a significant increase in the COVID-19 death rate. Low-income and densely populated areas (whose residents are disproportionately people of color) have higher levels of air pollution due to higher levels of vehicular exhaust, emissions from buildings’ heating systems, and emissions from power generation and industrial plants. Coincidentally, less than two weeks after the research on air pollution and COVID-19 was released, the Trump administration declined to impose stricter controls on the lung-harming particulate pollution that the researchers identified as hazardous.

People of color and low-income households typically live in densely populated areas where they have more face-to-face contact with other people, which makes exposure to the virus more likely. Multi-family housing, crowded living conditions (i.e., many people for the size of the dwelling unit), and more crowded streets and stores increase contact and exposure. Non-white and low-income people are also more likely to rely on public transportation and to work in essential front-line jobs (such caregiving, public transportation, grocery store work, or delivery jobs), which put them in close contact with other people. [3] One dramatic recent example of a high exposure-risk job is work in meat processing facilities, where infection rates have been very high and where workers are primarily people of color.

Research has documented that chronic health conditions are linked to the high levels of stress that people of color experience, including the stress of discrimination and what are referred to as adverse childhood experiences (ACEs). ACEs have been found to contribute to a higher prevalence of chronic adult health conditions such as high blood pressure, heart disease, diabetes, obesity, and anxiety disorders. In addition, the stresses of economic insecurity, neighborhood and household violence, and discrimination, collectively sometimes referred to as allostatic load, have been linked to higher rates of chronic health conditions. Not surprisingly, then, people of color and those in low-income households have higher rates of these chronic health conditions. This puts them at higher risk for infection, serious illness, and death from the corona virus. For example, the prevalence of diabetes is 66% higher among Blacks than whites and elevated blood pressure is 49% higher. People of color have more chronic health conditions even when researchers compare them with whites with similar levels of education and income.

Finally, people of color and low-income households are at high risk because they have less access to health care, both based on the locations of services and due to lack of insurance. In addition, they receive lower quality and biased care when they receive health services, adding to their risk. For example, a 2003 National Academy of Sciences report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care” documented bias in the medical system. It examined 480 studies and found that for every medical intervention Black people and other people of color received poorer-quality care than white people, even when income and insurance were equal. [4]

All of these factors contribute to COVID-19’s higher infection rate, greater severity of illness, and higher death rate for people of color. This makes it extremely important to have good data on race and ethnicity for COVID-19 tests and patients in order to effectively target testing, response, and treatment. These data are needed for our society as a whole to effectively control the spread of the virus and develop effective treatment. Because these data were not being captured, a group of U.S. Senators and the American Medical Association both sent letters to senior federal officials at the Department of Health and Human Services underscoring the importance of capturing data on race and ethnicity in all COVID-19 response activities.

I hope we will learn lessons from this COVID-19 pandemic and address the issues and risks faced by people of color, low-income households, and those living in densely populated areas. These lessons should include the need to address inequality and racism to make our economy and society fairer and to help our country live up to its ideal of equal opportunity. This would make access to life (literally), liberty, and the pursuit of happiness available to all Americans, both in good times and in the face of the inevitable, next pandemic. To do so, we will need to implement effective long-term fixes for the critical issues of racism and inequality in the U.S., which have been laid bare by this pandemic.

[1]      Ryan, A., & Lazar, K., 5/10/20, “Disparities drive up coronavirus death rates,” The Boston Globe

[2]      Villarosa, L., 4/29/20, “ ‘A terrible price’: The deadly racial disparities of Covid-19 in America,” The New York Times Magazine (https://www.nytimes.com/2020/04/29/magazine/racial-disparities-covid-19.html)

[3]      Osterheldt, J., 4/11/20, “With virus, racism is underlying ill,” The Boston Globe

[4]      Villarosa, L., 4/29/20, see above


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