Robert A. Hummer, Howard W. Odum Professor
It is clear that the United States is experiencing tremendous health tolls from Covid-19: 1.3 million documented cases thus far, hundreds of thousands of hospitalizations, and over 80,000 confirmed deaths. These figures are all increasing rapidly, despite recent good news in some places that we are “flattening the curve.” In the coming months and years, sociologists, demographers and epidemiologists will be at the scientific forefront both documenting the incredible toll of this global pandemic and explaining its causes and consequences.
One of the distinct Covid-19 trends that social and health scientists have already begun documenting in our country is racial/ethnic disparities—in rates of diagnosed cases, hospitalizations, and mortality. The race/ethnic-specific data already released and examined clearly show that Blacks are suffering from far higher rates than Whites across all health dimensions of the pandemic. In New York, Chicago, Atlanta, and Detroit. In Louisiana, North Carolina, Florida, and California. It’s difficult (impossible?) to find an exception. Data analysis from some places are also beginning to demonstrate higher case, hospitalization, and death rates among the Latinx and Native American populations. Thus, it is already painfully obvious, only a few months into the pandemic, that the health and mortality effects of Covid-19 are not equally shared across subgroups of the U.S. population. In contrast, Black, Latinx, and Native American individuals, families, and communities are bearing far more than their share of this deadly disease.
Reactions to the unfolding racial/ethnic trends have differed quite markedly. Some have found them peculiar. Trump, for one, expressed initial surprise at a press conference when data documenting such trends were first being disseminated. However, the trends would not have been a surprise had he been at all interested in history and injustice in our country. Some have placed blame for these trends on minority individuals and communities. In his recent regular opinion column in the Raleigh News and Observer, for example, J. Peder Zane suggested that personal behavior, rather than structural racism, may explain Black-White disparities in Covid-19 cases, hospitalizations, and deaths. Such an opinion ignores decades of research findings on the causes of racial/ethnic health disparities. Further, invoking individual behavior as an explanation for racial/ethnic health disparities blames victims for such trends; it is an explanation that is ignorant at best and blatantly racist at worst. On the other hand, some leading health officials, including Dr. Anthony Fauci of the National Institutes of Health, have spoken eloquently of the need for U.S. society to address longstanding racial/ethnic health disparities. At the same time, such ruminations typically fall short of offering specific ways that such disparities need to be addressed.
As a sociologist who has long studied patterns and trends in U.S. population health, I unfortunately do not find the racial/ethnic trends in Covid-19 health outcomes we are now experiencing to be at all a surprise. And the trends are certainly not due to personal behavior. At the same time, there are solutions to racial/ethnic disparities in health—albeit ones that are not necessarily popular among either those in power or among the majority of the American public.
The trends are not a surprise because fundamental cause theory developed by sociologists Jo Phelan and Bruce Link and empirical evidence developed by sociologists going all the way back to W.E.B. Du Bois predict and demonstrate that groups who are systematically discriminated against in society will suffer the worst health outcomes. Racism, operating through society’s major institutions is the culprit. As such, crises like Covid-19 simply expose the underlying inequalities that have been created by a racist society.
What to do? One possibility is that people of all races and nationalities treat each other with greater kindness and respect in our new Covid-19 world. That would be a decent start. However, such individual-level change in behavior is not going to eliminate racial/ethnic disparities in health. Far from it. Systematic problems demand systematic solutions. Moreover, we can’t rely on Covid-19 specific technical solutions, such as universal vaccination, to eliminate racial/ethnic disparities in health. While universal vaccination would be enormously important in defeating Covid-19, racial/ethnic health disparities in health will endure … in heart disease, diabetes, cancer, stroke, respiratory diseases, HIV/AIDS, and whatever the next pandemic brings us. Indeed, there is no vaccination for racism.
What decades of research in the area has taught us, and continues to teach us, is that a bold and admittedly unpopular public policy agenda is needed that will truly and fully dismantle the legacy and continued scourge of racism. At its heart, such an agenda involves major changes in the laws (e.g., inheritance) that structure the enormous property and wealth disparities that privilege White Americans, generation after generation, in comparison with their minority group counterparts. True educational equity is a second key pillar. For far too long, including at present, educational access and quality has been tied to institutional racism in the forms of local property tax funded school systems, privately funded preschools and academies, and college and university costs that put far too many minority students in far too much debt for far too long. While Black, Native, and Latinx children and adolescents have made enormous strides in increasing years of educational attainment over the last half-century, the nation’s educational laws and policies are still stacked against them in a myriad of ways. Similarly, major policy changes and bold efforts are needed to address the historical and continued ways that racism has structured the nation’s criminal justice system, political representation, healthcare system, housing and zoning laws, and workplaces.
Until we are ready as a society to commit to bold and aggressive systematic solutions for entrenched systematic problems, racial/ethnic disparities in health will endure. Tragically, in the meantime, Black, Native, and Latinx individuals will bear the brunt of suffering and death from new diseases like Covid-19 as well as from old ones like heart disease, cancer, stroke, diabetes, pneumonia, HIV/AIDS, and many more.