Today we welcome Dr. Bridgette M. Brawner as a guest Nerdy Girl to discuss racial disparities and COVID-19. She is an Associate Professor at the University of Pennsylvania School of Nursing. Find her on Twitter at @DrBMBrawner.
A. One word: racism. In all of its forms (e.g., individual, institutional, structural).
There is no genetic or biological basis for “race”. Yes, there are shared genetic traits among certain groups of individuals, but this does not speak to race. That’s because race was a socially constructed way of categorizing people that has changed over time, location, etc. This presents a challenge when these categorizations were used to deem non-Whites to be inferior, with laws and systems put in place to enforce and maintain this declaration. Just to show a few of the affected groups, this land was stolen from Native Americans through genocide, built on the backs of stolen African slaves and continues to be cultivated by Latinx migrant workers (who are viewed to be good enough to do the labor that we don’t want to do, but face deportation at a moment’s notice). When you break down COVID and other health inequities, these groups consistently bear the morbidity/mortality brunt. Therefore when we see racialized patterns in health (or disease), we need to avoid the trite inclination to default to assuming an inherent flaw in Black and Brown bodies that increases susceptibility to disease and death. We can’t say, “oh it’s because ‘those people’ are: lazy, don’t exercise, eat unhealthy foods, are risky, won’t social distance…”. Instead, we have to consider that the numbers reflect the biological effects of a shared lived experience; shared social and structural violence, shared historical and generational trauma, because of skin color. One practical example is the development of high blood pressure and/or diabetes due to chronic stress and overactivation of the body’s stress response in reaction to daily discrimination, mistreatment, trauma (including vicarious trauma…like watching videos of Black people murdered by police and vigilantes) experienced as a person of color in the U.S. #COVID19 just happens to be the health issue drawing our attention now, but HIV, maternal and infant mortality, cardiovascular disease, etc. had already been crying out to wake us up for decades.
Q. How have segregation, population density, and essential jobs interacted with race to impact this epidemic?
A. Segregation, redlining (systematic denial of loans, mortgages, insurance) and other discriminatory practices dictated not only where people of color could live and work, but also the types of resources that were available in their communities. From fresh produce to quality healthcare to adequate educational resources, communities of color were historically disenfranchised—and continue in cycles of disinvestment. With larger numbers of people occupying smaller areas, population density increased along with the spread of different communicable diseases (i.e., tuberculosis). Fast forward to a present-day example, housing projects continue to be predominantly comprised of Black and Brown populations. Speaking from experience growing up in Brooklyn, NY, it is impossible to be socially distant or avoid inhaling coronavirus particles on elevators shared with 100s of a people a day. Similar to prior epidemics, coronavirus thrives on close proximity, underlying health issues and a lack of leadership to address the root problems. Many of our large cities are still plagued by racial residential segregation. With Black and Brown groups disproportionately infected with coronavirus (relative to the % of populations they account for), it’s not surprising that the virus will continue to spread in their living, work and social circles.
We do not have universal healthcare in the U.S. Access to testing, diagnosis and care is tied to labor. This is particularly a problem when thinking about health inequities because we have a racially stratified workforce. Some Black and Brown workers hold lower paying positions and do not have the same benefits at Whites (i.e., paid sick leave). So when coronavirus hit and the country was advised to be “safer at home” and shelter in place, Black and Brown populations were disproportionately represented in the essential workforce and therefore had increased exposure to the virus, without ANY personal protective equipment in many cases. Similarly, without paid sick leave, or employers who granted other means of time off (without fear of being fired), some people went to work symptomatic or at increased risk for becoming infected. They were forced to choose between keeping a roof over their head and spreading/getting coronavirus, and they chose basic needs for survival. It is unconscionable that in the self-proclaimed “best country in the world” we don’t have better options for our citizens…
Q. How have differences in access and quality of care impacted racial disparities in COVID cases and deaths?
A. We have mountains of evidence—across health conditions—to show that Black and Brown people are less likely to receive diagnostic testing, treatment, etc. than Whites. On a personal level, I cannot tell you how many people had coronavirus symptoms but were initially denied testing as we watched celebrities and others with resources tout their COVID-19 results. Many of the ones I know went on to be hospitalized (and intubated) with bilateral pneumonia that could have been caught sooner. Part of the care disparity stems from providers not believing what Black and Brown people say about their symptoms, attributing their symptoms to other causes (without adequate workup/investigation) as well as the blatant racism and discrimination that exist in the healthcare system. This is in addition to medical/healthcare system mistrust on the part of patients who delay seeking care until things are “really bad”. They are tired of being victimized and enduring microaggressions from the very people who vowed to help their health-related concerns.
Q. What can be done?
A. To address #COVID19, and other health inequities, we must dismantle racism at each level it operates on:
1) Individual/interpersonal—check our own biases, and those of others, to eliminate oppression and discrimination against people of color; work toward reconciliation in populations through open dialogue, shared learning experiences with people from different cultural groups and allyship.
2) Institutional- overhaul policies, practices and procedures that benefit Whites at the expense of people of color. Especially for healthcare, in addition to implicit/unconscious bias training, we need to make sure that education on the social determinants of health and racial justice are infused throughout school curricula. Additionally, violators need to be held accountable and have consequences for their actions.
3) Structural- reparations. People hate the word, but you cannot truly atone for FOUR CENTURIES of injustice without support to those who are affected. How? Creative mortgage and community improvement programs to increase home ownership and improve the built environment in neighborhoods (versus gentrifying them, which displaces non-White residents and makes the areas better for Whites to move in). Universal healthcare so that the ability to be healthy is a right and not a privilege. Investment in struggling public school systems so that education quality is equitable with that received in affluent public schools. So many others, but I defer to the reparations experts.
In addition to addressing racism, we can curb coronavirus in its tracks in Black and Brown communities if we: 1) increase testing and connection to care, 2) implement policies that require employers to take care of their workers, particularly essential staff (e.g., PPE, paid sick leave), and 3) critically consider alternative childcare opportunities to promote safety and avoid/minimize potential exposures. This all has to be done in partnership with existing community organizations in those areas (e.g., faith-based institutions, grassroots organizations). There is no need to reinvent the wheel or ignore the expertise of those already engaged in this work.
The virus is only shedding light on what was already going on. Many of us have been speaking on it for decades. As devastating as COVID-19 is, it has been the impetus to engage more people in the fight against #racism and #health #inequities, and toward #racialjustice. My insights may sound like doom and gloom, but they aren’t. Hope is NOT lost. We can each play a role (no matter how big or small) in dismantling racism and its aftermath, eradicating health inequities and ensuring we are better prepared to fight future health challenges together.
Suggested Resources:
Dorothy Robert’s “Fatal Invention: How Science, Politics, and Big Business Re-create Race in the Twenty-first Century”
Ta-Nehisi Coate’s “Between the World and Me”
Ibram X. Kendi’s “How to be an Antiracist”
Sue et al. “Disarming Racial Microaggressions: Microintervention Strategies for Targets, White Allies, and Bystanders”
