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Racial and Ethnic Disparities During the Pandemic

This week’s COVID Q&A features Professor Elyas Bakhtiari, a faculty member from William & Mary’s Department of Sociology. In his research, Professor Bakhtiari studies how institutionalized social inequalities shape patterns of health outcomes and health disparities, particularly for racial and ethnic minority groups. We asked him to share his insights on health disparities and the COVID-19 pandemic.

Q.  What do we know about racial and ethnic disparities during the COVID-19 pandemic?

A.  We have seen substantial disparities in the impact of COVID-19 across ethnic and racial lines in the United States, whether looking at infections, hospitalizations, or mortality. Latino and Black Americans have been three times as likely to become infected with the coronavirus as their non-Hispanic White counterparts, according to CDC data. Although Black Americans make up 13% of the U.S. population, they account for nearly one-quarter of all COVID-19 deaths for which race is known. That disproportionate impact was even higher in some cities at the height of the initial March and April wave. As the pandemic has continued to spread to different parts of the country, Latino and Native American populations have also disproportionately suffered from the virus. According to the CDC, Native Americans have the highest rate of per-capita hospitalization from COVID-19, nearly five times as high as the hospitalization rate for non-Hispanic Whites.

Q.  Why are we seeing these racial disparities during the pandemic?

A.  The shortest answer: Systemic racism. We can think about the causes of health and illness at a variety of levels. It’s not just about what happens when a pathogen enters the body, but about how the structure of society determines who gets exposed to a virus and how many resources they have for dealing with it if infected. If we trace the patterns of COVID-19 mortality “upstream” from the disease itself to the risk factors that influence the likelihood of infection or the severity of the illness, we find that those risk factors are shaped by the social conditions in which people live. For example, social distancing has been central to public health efforts to mitigate the spread of COVID-19. Data from the Bureau of Labor Statistics reveals that, even before the pandemic, the ability to work from home was stratified by race and socioeconomic position, leaving many low-income and minority populations more exposed to the virus due to their occupations. Or consider another study that found a link between air pollution and COVID-19 death rates. Black and Latino populations are often disproportionately exposed to air pollution, in part due to a history of racialized housing policy that has shaped residential segregation in U.S. cities. Even access to something as simple as handwashing can be stratified. Some Native American reservations hit hard by COVID-19 don’t have regular running water. We could do this exercise for a number of risk factors and find that a long history of structural inequality has left many ethnic and racial minorities with fewer resources for either avoiding exposure to COVID-19 or more susceptible to mortality once exposed.

Q.  Are these unequal outcomes unique to COVID-19?

A.  Although the COVID-19 pandemic has drawn more attention to racial and ethnic disparities in health, the patterns emerging from it are unfortunately not unique. Most major causes of death exhibit similar disparities in outcomes. In fact, the unequal patterns of COVID-19 mortality are driven in part by underlying disparities in pre-existing conditions that can make the infection more severe. Black and Native American populations have substantially higher rates of diabetes, hypertension, and other conditions that can increase the COVID-19 case fatality rate. Again, the origins of these inequalities often lie upstream in the social conditions that shape people’s lives, including factors like chronic stress from a dealing with conditions of poverty or discrimination. Although the pandemic has only been with us for a few months, the disparities we’re seeing are the result of a long history of inequality that has impacted some of its victims for a lifetime.

Q.  What types of policies would reduce these health disparities?

A.  This is another question we can think about at multiple levels. Allocating treatment and prevention resources, at the state or federal level, to places and people that we know are especially vulnerable should be an immediate priority. Hospitals and health care organizations can also adopt internal policies to prevent potential bias in treatment decisions, which reports suggest may have led to Black patients being less likely to receive a COVID-19 test than White patients with the same symptoms. Because of the social origins of most health disparities, policy solutions don’t have to be limited to health and health care fields. In my seminar on “Social Inequality and Health,” we talk about the notion that “all policy is health policy,” and I think that’s true in the pandemic, as well. Policies that guarantee paid time off work, protect tenants from eviction, or provide support for childcare would make it easier for everyone to practice social distancing without fear of losing a job or home. Ultimately, though, unless we address the larger-scale systemic racism that shapes inequalities in education, housing, policing, and nearly every other sector of society, we will see similar disparities emerge with the next pandemic.

Q.  You mentioned your course on Social Inequality and Health. What other courses do you teach that can help William & Mary students learn more about these issues?

A.  Every semester I teach a course on Medical Sociology, which not only examines how social conditions determine health outcomes, as we are seeing with the pandemic, but also how society shapes the practice of medicine and even our shared assumptions about what constitutes health and illness. I have taught the Social Inequality and Health seminar a couple of times previously, but I am excited this fall to pilot it as one of William and Mary’s new COLL 350 courses focused on Difference, Equity, and Justice. We are going to spend a lot of time discussing this question about what the patterns of the COVID-19 pandemic reveal about our current social context.

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