By Sara Frueh

Workshop examines what’s driving racial disparities and what can be done to remedy them

Black Americans are getting sick and dying from COVID-19 at higher rates than white Americans — the most recent manifestation of racial disparities in health that have long been evident in the United States.

“This novel coronavirus has laid bare what many in this panel and audience have known for many years relating to health inequities in this country,” said Gary Gibbons, director of NIH’s National Heart, Lung, and Blood Institute. Gibbons was speaking at a workshop held in June by the National Academies’ Roundtable on Black Men and Black Women in Science, Engineering, and Medicine that explored factors driving racial disparities in COVID-19 and what can be done to remedy them.   

Among the factors examined was structural racism — an issue that vaulted into public discussion following the deaths of George Floyd and Rayshard Brooks at the hands of police, National Academy of Medicine President Victor Dzau observed in opening the workshop.

“These senseless killings, and the widespread protests that followed, have awoken Americans to realize the structural racism that has plagued our nation for hundreds of years,” said Dzau. “It is an important period of reflection for our nation, as we confront the gross inequities that persist in our criminal justice system, in health care, and in our broader social systems and institutions.”

Sobering statistics on disparities

While helping a reporter research a story exploring how the crises of COVID-19 and racism overlap, cardiologist Clyde Yancy of Northwestern University recalled, he had an insight he found chilling: “I realized that my personal risk of death may have less to do with COVID-19 and more to do with the color of my skin.”

Based on data reported by 40 states, Yancy said, one in every 1,850 Black Americans has died from COVID-19 — a mortality rate 2.4 times higher than that for whites. Another way to think about that statistic is that if Blacks were experiencing COVID-19 at the same rate as whites, 13,000 more Blacks would be alive today, he said. “The disproportionality is real, the numbers are sobering and stark.”

One reason for the higher rates of infection is that Black workers are overrepresented in service industry jobs that put them in close contact with others, said Cato Laurencin, Roundtable chair and a professor at the University of Connecticut, who spoke about the factors shaping disparities.

Another factor has been inconsistent and insufficient information from government. “Most Black Americans live in the South, where guidance by governors on how to stay safe was found to be inconsistent with guidelines of the federal government,” said Laurencin.

Limited access to health care has also had an impact; for example, hospitals in predominantly Black neighborhoods are more likely to close down than hospitals in predominantly white neighborhoods.

In addition, unconscious bias among health care workers can influence the care Blacks receive, said Laurencin. For instance, research has revealed that fewer Blacks receive proper treatment, in terms of ventilators vs. self-quarantine, than whites do. He noted the case of Rana Zoe Mungin, a Black woman who was twice denied testing for COVID-19, and who ultimately died of the disease.

The impacts of systemic racism

Multiple speakers pointed to structural racism as shaping the factors that raise Blacks’ risk. “Racism is the system that uses race as a substrate to structure opportunity and assign value, and this system has many impacts,” said Camara Jones, past president of the American Public Health Association. “It unfairly disadvantages some individuals and communities…and unfairly advantages other individuals and communities.”

Institutionalized racism manifests in differential access to goods, services, and opportunities, such as quality housing, excellent educational opportunities, or a clean environment — factors that impact health, Jones said. For example, residential segregation leads to segregation in education, which then results in more people of color having front-line jobs that leave them vulnerable.

“We’re more likely to be infected because we are more exposed and less protected, and once infected, we’re more likely to die because we’re more burdened by chronic diseases, with less access to health care,” said Jones.

In addition to shaping the social and economic factors that influence health — known as the “social determinants” of health — racism is also a stressor that directly damages peoples’ health, multiple speakers pointed out. Laurencin noted that chronic diseases, heart attack, neurodegenerative disease, and even metastatic cancer have been documented to be influenced by racism.

Experiencing racism adds to an individual’s “allostatic load” — the accumulation of physiological stressors that affect health, Laurencin said. In a number of studies, Blacks have been found to have higher allostatic load that is not explained by poverty — “the weathering effect of living in a race-conscious society.”

Actions needed to address inequities

“While we are under the vale of COVID-19, I think we should use this time of disruption to reset our priorities and really elevate all of our communities,” said Mark Alexander, national secretary of 100 Black Men of America Inc. — one of many speakers who pointed to the need to improve the social determinants of health for Black communities.

Martha Dawson, president of the National Black Nurses Association, urged a shift in research funding toward these social determinants, as well as toward prevention and health promotion. “We need to have researchers partnering with individuals that are trying to provide safe housing, to ensure that our environment is clean, that we have safe water and food security,” said Dawson. “We need to move some of our research dollars into that space.”

In a keynote address, National Academy of Sciences President Marcia McNutt said that the National Academies are developing policies and mechanisms to ensure that all of its studies — whether related to the pandemic or not — consider current inequalities and how science-based solutions could reduce them.

“If we want to get through this emergency and also ensure that we’re prepared for the next crises that will surely come our way, we must address these systemic issues of inequality in our society — including in our STEM enterprise, in our health care infrastructure, in our economy, in our educational system, and in our communities,” said McNutt.

Participants also identified needed steps to address the immediate crisis of COVID-19 in Black communities. Laurencin pointed to the need for wider testing and contact tracing, for example, and urged the use of pop-up mini-hospitals to make health care for the disease more accessible. Dawson flagged the need for better tracking of and follow-up with patients who appear to have recovered from the virus.

Multiple panelists stressed the need for more effective communication to Black communities about COVID-19 and how people can protect themselves. Scot Esdaile of the NAACP called upon the health professionals and scientists at the workshop to aid these efforts. “I would love for you all to come together to get the most pertinent information and put it in laymen’s terms,” he said.

Communication of health information will be among the aims of the National COVID-19 Resiliency Network — a new project that Morehouse School of Medicine recently received a $40 million grant from HHS to develop, said Valerie Montgomery Rice, president of the school. The network will build partnerships to engage vulnerable communities, to provide culturally and linguistically appropriate information about COVID-19, to link the communities to the health care workers and social services they need, and to support access when vaccines become available.

Watch a recording of the workshop.