COVID-19 has reshaped our expectations of 2020. The virus changed the way we live, the way we interact with each other, and the way we look at health and illness. Personal celebrations and public gatherings that would have been defining moments of the year are now virtual experiences or are rescheduled to recognize the medical and economic threat posed by the virus. But as we pin our hopes on 2021, some things simply cannot wait. 2020 is still the year of the census, and COVID-19 is showing us that the census matters now more than ever.
In recent months, we all find ourselves in a situation unlike any many of us have experienced in our lifetime, but it is growing increasingly clear that the ways that we experience the effects of COVID-19 differ significantly. As states and cities throughout the nation began to release initial disease and death rates, a clear pattern emerged: COVID-19 was not the “great equalizer.” Minority groups are more likely to get COVID-19, and more likely to die from the virus. Racial minorities are also more likely to experience the economic impact of COVID-19, and are overrepresented among those who have experienced job loss. These data were followed by stories of people who shared that they were unable to get tests until showing nearly fatal symptoms, and how they felt unheard despite persistently expressing their concerns to medical professionals. Stories of people who died without ever receiving a test at all.
Not an isolated case
As a researcher who studies these disparities, and as a member of communities in Minnesota who are affected by them, I am moved, unsettled, and angered by these statistics and stories, but I am not surprised. COVID-19 is not an isolated case. The racial disparities in COVID-19 show how structural racism creates conditions that make communities of color vulnerable to disease morbidity and mortality. I am worried that the current focus on racial disparities will come and go without a real improvement in these conditions. I am even more worried that the impact of COVID-19 on census efforts to accurately count racial minorities will worsen these conditions and ensure that they persist for years to come.
The role of the census in addressing the social and structural roots of racial disparities cannot be overstated. Perhaps the most direct impact of the census on health outcomes is its role in resource allocation. Data retrieved through the census is used to apportion billions in federal dollars. In COVID-19, minorities face a disproportionate burden of disease because of the conditions in which they live and work. They are more likely to work in jobs deemed essential, more likely to have underlying conditions that impact disease severity, and more likely to live in neighborhoods with weaker health infrastructure. Addressing these structural problems is a necessary step in eliminating disparities in health. Improving educational, employment, and health opportunities requires the resources allocated through census enumeration.
The census also the basis for congressional representation. When the Census Bureau delivers the official apportionment counts in December, only those who are counted will be represented. An accurate count of minorities would mean an increase in the number of congressional representatives in areas where they live, and a better chance that the policies we see will work to improve these areas.
Racial minorities are already considered an undercounted group by the Census Bureau, especially in Minnesota, but COVID-19 threatens to make this situation worse. Census response is linked to income, education, language proficiency, and housing. The added stress of COVID-19 compounds the effect of these factors on nonresponse rates among racial and ethnic minorities.
COVID-19 also complicates in-person efforts to reach people who have not responded by mail, phone, or online. As Minnesota begins to slowly ease shelter-in-place policies, now is the time to begin developing methods to effectively reach underrepresented groups in spite of new barriers posed by COVID-19. In light of Minnesota’s existing racial disparities, it is especially important to ensure that all of the state’s residents count in our effort to construct a new normal. The first step in making sure they count is to make sure they are counted.
Hawi Teizazu is a doctoral student at Columbia University’s School of Public Health and a Health Policy Research Scholar sponsored by the Robert Wood Johnson Foundation. She is a former public health practitioner with the Centers for Disease Control and Prevention. Her bachelor’s degree in biology is from the University of Minnesota.
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