Structural racism exacerbates health disparities amid COVID-19

Black individuals are now representing the majority of new cases of COVID-19 in Philadelphia and across other major cities.


In Philadelphia, race, class and health are inextricably connected.

Philadelphia communities with high concentrations of Black residents have significantly less access to primary-care physicians compared to other communities, the Philadelphia Inquirer reported in 2016. Philadelphia, a city with a Black population of 43 percent, has the fourth-highest rate of asthma prevalence in the nation, according to a May 2019 report by Next City, a nonprofit media network focusing on urban issues.

Philadelphia was already struggling with widespread racial health disparities before the first confirmed case of COVID-19, a strain of coronavirus, was reported on March 10 — since then, the majority of new cases of COVID-19 in Philadelphia are affecting Black individuals, the Inquirer reported.

As confirmed cases of COVID-19 are rising at disproportionately high rates among Black communities, we need to evaluate what factors are contributing to widespread racial health disparities and take immediate action to protect communities that are especially vulnerable amid this pandemic.

Early reports on available COVID-19 case information has found that nearly all Philadelphia zip codes with the highest rates of positive COVID-19 cases have a population composed of majorly people of color, the Inquirer further reported

Although the state has yet to report municipal-level data and not all city-wide data is available yet, it is clear the majority of new COVID-19 cases are from Black patients, the Inquirer reported.

This is following nationwide trends of disproportionately high rates of Black patient deaths from COVID-19. In Chicago, for example, 72 percent of virus-related fatalities are from Black patients despite Black individuals making up less than one-third of the city’s population as of April 7, the New York Times reported.

As a result, Black communities already face high rates of chronic illness in many cities throughout the country, Vox reported. For example, Black Americans are at a higher risk for heart disease, hypertension, diabetes and asthma, the Cut reported. Asthma specifically can lead to a higher risk of getting significantly sick from COVID-19, according to the Centers for Disease Control and Prevention.

“Those pre-existing conditions that may be more prevalent in some populations are also going to put them at higher risk for hospitalization or dying from this disease,” said Aimee Palumbo, an assistant professor of epidemiology and biostatistics with a focus on the social determinants of health.

These disparities are the result of centuries of slavery and racial discrimination that have brought poor health conditions and economic outcomes for Black communities, Vox further reported. 

While viruses may not discriminate, the conditions facilitating the inequitable spread of COVID-19 disproportionately affects Black communities, with longstanding geographic and economic barriers to quality health care.

“We know from a lot of the research on geography, and from systemic racism, cities in general tend to be segregated by race and white neighborhoods tend to have better resources, both in terms of the environment as well as food and health care, compared to communities of color,” said Lauren Olsen, a sociology professor with a focus on medical sociology.

Geography and place of residence play a large role in facilitating racial health disparities by determining access to high-quality education, housing, fresh foods and outdoor space, all of which affect health outcomes, according to a 2016 report by the Harvard T.H. Chan School of Public Health.

Exposures to environmental risk, like air pollution, and access to environmental amenities, like green space, at least partially account for the racial and class-based disparities in poor health outcomes prevalent before the COVID-19 outbreak even began, said Jeremy Mennis, a professor of geography and urban studies with a focus on the neighborhood, environmental and social contexts of health behaviors and outcomes.

These geographically determined inequalities in access to resources create the underlying conditions that could leave communities of color at higher risk of fatality upon contracting COVID-19.

But class also exacerbates these effects — individuals in lower socioeconomic classes are at a higher risk of contracting COVID-19, which can ultimately lead to a wider spread of the virus in a self-reinforcing cycle that only worsens the spread of COVID-19, the Times reported.

Black individuals are more likely to lack health insurance compared to whites, with Black families spending a higher rate of their family income on health care premiums compared to the average American family, according to a December 2019 report by the Century Foundation, a progressive, nonpartisan think tank. 

Poverty plays a significant role in these racial health disparities, said Kevin Henry, a geography and urban studies professor whose research focuses on medical geography and health disparities.

“From a structural standpoint, if we could pull lots of people out of poverty and have people live on higher standards of living, you would see some of the disparities go away,” Henry said.

Wealth can also affect whether someone has to physically go into work and if that job is in close proximity to others, even if they’re not feeling well because they can’t afford to stay home, which thus puts them at a higher risk of contracting COVID-19, Palumbo said.

Between class, geography and access to health care, COVID-19 is disproportionately affecting Black communities in cities across the nation. It’s no wonder Black individuals are more than twice as likely to see COVID-19 as a threat to their health compared to whites, the Atlantic reported.

Our economic and health care systems have systematically discriminated against the Black community for too long, and while these issues have existed for centuries, the current pandemic highlights these inequalities.

Although racial health disparities may never fully go away, providing increased access to health insurance and primary-care physicians, rising wages and a “philosophical change” in how we think about poverty could facilitate the beginning of less inequitable health outcomes, Henry said.

Personally, it’s appalling to see these disparities be further exacerbated by individuals like Joel Freedman — as the owner of Hahnemann University Hospital, Freedman refused to open his then-closed hospital to COVID-19 patients overflowing from other hospitals unless the city paid him an absurd $1 million a month, the Times reported. That hospital, which houses nearly 500 beds, had once served communities of individuals experiencing poverty in Philadelphia, according to Scientific American.

Freedman is the figurehead for denying access to medical care for individuals in need, and that philosophy needs to change immediately.

We cannot allow race to continue to be a risk factor for COVID-19 and other health conditions — we need to do better, and that starts with helping those most in need, right now, when they need it most.

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