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During this pandemic, racism is our most urgent public health emergency

COVID-19 is still very new. It spreads quickly, and despite all our technology and scientific know-how, there’s still a lot we don’t know about it.
REUTERS/Brendan Mcdermid
Black Americans are more likely to contract and die from COVID-19.
COVID-19 has claimed the lives of more than 120,000 Americans, including more than 1,400 Minnesotans. While we all share vulnerability to this novel virus, COVID-19 doesn’t impact people equally.

National data clearly show that, more than any other racial or ethnic group, Black Americans are more likely to contract and die from COVID-19. This statistic is not surprising; it is part of an unjust but predictable pattern of racial disparities in health outcomes caused by policies, practices, and structures that routinely disadvantage Black Americans, Indigenous communities, and people of color while creating advantage for white Americans.

It is clear that to eliminate health disparities, we need to name and address racism. This is why, in the midst of a global pandemic and protests demanding justice following the murder of George Floyd, there has been a growing movement to declare racism a public health emergency.

Structural racism is evident across multiple systems

Our health and well-being are shaped by multiple factors and systems that shape neighborhood conditions, opportunities for education and employment, and access to resources that support health and well-being. However, structural racism – which doesn’t require individual intent – is also present in how these systems function, leading to racial disparities across multiple outcomes, including health and well-being.

    • Criminal justice. Discriminatory policies and practices result in racial disparities at multiple points in the criminal justice system. George Floyd’s death brought greater attention to the longstanding issue of police brutality and practices that disproportionately impact Black men. A recent study estimated that 1 in 1,000 Black men will be killed by police, a rate 2.5 times greater than for white men. A report published by The Sentencing Project concluded that Black Americans are “more likely than white Americans to be arrested; once arrested, they are more likely to be convicted; and once convicted, and they are more likely to experience lengthy prison sentences.” The negative impacts of criminal justice involvement continue longer after conviction or incarceration, as an arrest record can be a significant barrier to employment and housing.
    • Housing and homeownership. Minnesota’s homeownership gap between people who are white and people of color are among the worst in the nation. Past policies, including redlining, racial covenants and discriminatory zoning, denied people of color the same opportunities to generate wealth as white homeowners and led to racially segregated neighborhoods. Chronic disinvestment in these neighborhoods leads to fewer employment opportunities, poorer housing quality, greater likelihood of exposure to environmental pollutants, and less access to resources that support health and well-being.
    • Health care. Multiple studies have shown that when treating Black patients, providers spend less time with patients, misinterpret or dismiss complaints, and undertreat pain, as compared with treatment for white patients. While individual bias can contribute to disparities in care, health care providers committed to treating people equally are working in the context of racist systems that create disparities in outcomes for people of different races.

Disproportionate impact

In the United States, the COVID-19 mortality rate for people who are Black is higher than for other racial groups. National data show that the mortality rate for Black Americans is 2.3 times higher than the rate for Americans who are white or Asian, and 2.2 higher than the rate for Latinx Americans.

Melanie Ferris
Melanie Ferris
In Minnesota, relative to the overall population, the percentage of Minnesotans who have tested positive for COVID-19 is disproportionately higher among Black residents (22%, compared with 7% of the population overall), Latinx residents (23%, compared with 6% of the population overall). These disparities may be even larger; race is unknown or is categorized as another race for approximately one-third of all COVID-19 cases.

COVID-19 presents new challenges and threatens to further widen existing health inequities. Black Americans and people of color already experience higher rates of chronic disease as a result of inequitable systems; these underlying conditions increase the risk of having more severe COVID-19 symptoms. Social distancing, our primary prevention strategy for slowing the spread of the virus, can be considered a form of privilege, easier for people with a stable home and who live in places with lower housing density, who have jobs where remote work is possible, and who can afford to have healthy food delivered to their door. People with health insurance or the ability to pay out-of-pocket for health care can seek testing and treatment, rather than delaying care.

We need both short-term and long-term work for change

There isn’t a simple short-term solution for eliminating these health inequities, but we can make changes. As nonprofit organizations and businesses, health care systems, school districts, and state and local governments respond to COVID-19, it is critical that we not only create a short-term safety net for all, but also do the long-term work to dismantle and rebuild the systems that contribute to inequities.

Without a long-term commitment to change, the same inequities will persist after the immediate threat of COVID passes. In our recent report, “The Role of Health Care in Eliminating Health Inequities in Minnesota,” we offered a framework to guide collective action for the health care sector and its partners. There have been other recent calls for the health care sector to take deliberate action, but a public health approach to addressing racism requires work to occur across multiple systems.

Our report also provided the following as starting points for institutions and organizations working to reduce health inequities:

  • Use data to understand existing disparities, establish goals, and measure progress. Across sectors, data should routinely be reported by race and ethnicity to increase transparency and accountability for reducing racial inequities.
  • Move from simply gathering community input to sharing power with communities to drive action. Communities disproportionately impacted by disparities need to be co-creators of changes that establish equitable systems.
  • Identify and change the internal policies and practices that uphold structural racism. Reviewing hiring and promotion practices or updating policies that determine when and how community members can access services are two examples of steps organizations can take to identify and change policies that may be contributing to racial disparities.
  • Work to advance local, state, and federal policies that advance equity. Because eliminating health inequities requires change across multiple systems, including education, criminal justice, and housing, there are many ways to become involved in work to dismantle structural racism.

Naming racism as a public health emergency clarifies our direction forward, but will have no impact unless followed by action. This must be a moment to collectively recognize and address racism as a crisis that demands our attention and a true commitment to long-term change.

Melanie Ferris is a research scientist at Wilder Research. Since joining Wilder in 2006, Melanie has worked with multiple nonprofit organizations, local government entities, and health care systems to understand and address the root causes of health inequities and advance health equity. Melanie has a master’s of public health degree from the University of Minnesota School of Public Health.


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Comments (9)

  1. Submitted by Joe Smith on 06/26/2020 - 08:29 pm.

    I’m not sure a vitamin D deficiency is racist. Vitamin D deficiency has been proven to be an issue with COViD 19 deaths. Black people don’t convert the suns rays into vitamin D very well. The COViD 19 virus doesn’t have any idea what color you are, it is looking for an accessible host. The cytokine storm where your body attacks itself, can be reduced with vitamin D. The fact that a simple daily dose of vitamin D would help everyone with this virus should be common knowledge, that it isn’t, is tragic. Also very disturbing the author, Ms. Ferris, doesn’t mention this in her post.

  2. Submitted by lisa miller on 06/26/2020 - 09:58 pm.

    You know many of these articles are written by professional people of Euro Caucasian descent. They quote statistics, tell us what most of us know, then trot out the usual ‘this is what needs to be worked on’ and cover a wide array of things(all without specifics). Don’t get me wrong, I agree; however don’t you think by know we could move past the general observations to specifics–like perhaps how can we have the state move to a general funding of schools vs relying on property taxes; or perhaps why aren’t there more small affordable homes in southwest Mpls, Wayzata, etc? Or perhaps why can’t we fund more school guidance counselors and also require students to meet early on to better plan how they will graduate and what they plan to do upon graduation, etc..

    • Submitted by Betsy Larey on 06/27/2020 - 09:19 pm.

      This reminds me of everyone should get a medal. What is lost in this conversation, that no one wants to address, is the fact that many black children are born with a single parent. And that parent is relying on social services to make ends meet. I don’t know why you would have children if you could not afford to feed yourself.
      Education is free. The city of Mpls is building all the magnet schools in the poorer parts of town. I would think this will help. But it will not help unless you have a family that makes their kids go to school and do homework. Many don’t. It is not the responsibility of society to raise your children. It is yours.
      And I am truly tired of hearing people say they have a right to live in Wayzata or any other community. You do not. There are no affordable houses or pieces of property for you to build your 100K home. And you do not have a right to force a property owner to sell it to you for cheap.
      Affordable housing should be built in north Mpls, and the city should work with corporations to build manufacturing plants that can supply people who live there with decent paying jobs.
      If you think poor people have a right to live in the best parts of town, you’re not understanding how the free market works. And that’s what this country is based on. If you want to change it, it becomes socialism and nobody ( except maybe you ) wants that. I am tired of hearing white people apologizing for being white.

      • Submitted by Pat Terry on 06/28/2020 - 02:47 am.

        Actually, its the lack of a free market that limits housing. Its zoning restrictions that limits housing. The 2040 plan will help remedy that.

        I hope you stayed in Minnesota for the summer. Minnesota seems to be getting ahead of Covid, but Florida is looking like a complete disaster.

  3. Submitted by Pat Terry on 06/27/2020 - 08:56 am.

    I watched a video this morning on Facebook where a white woman in a store called an African-American woman the N-word multiple times.

    The thing that struck me, other than the horrible racism on display, was that the white woman was wearing a mask and the African-American woman was not. This was in California, so the were legally required to wear a mask.

  4. Submitted by Constance Sullivan on 06/27/2020 - 10:32 am.

    This article pretends to be about the covid-19 pandemic, but it isn’t. It’s the now-ritualistic recitation of all the evils or systemic racism in our society, reiterated by a youngish white woman. In fact, she and her AGE , not racial cohort may be the villains in a real “Who Are the Victims?” scenario that does, indeed, focus on the coronavirus pandemic.

    The author looks like a millenial. She, and especially her younger peers, are not generally following the CDC guidelines on how to prevent spreading the virus to vulnerable populations. They don’t like to wear masks, they insist on congregating in enclosed spaces like bars and restaurants without any social distancing, they don’t wash their hands regularly, etc. They’re not paying attention because they feel they are invulnerable to the disease–and that includes lots of black people, not just whites. Not all the reasons for this behavior patterns can be traced to race and systemic discrimination leading to current housing conditions.

    Importantly, according to statistics, more than 81% of Minnesotans WHO DIE OF THE VIRUS are over the age of 60. The elderly are the vulnerable, not a particular race.This virus doesn’t care what race you are, or how much money you have or if you own your home or live in a multi-generational house. It spreads wherever people are careless about not spreading it.

    We can all agree with the now-standard analysis of our systemic racism, which this article repeats, without letting the author get away with the false idea that race is at the bottom of our horrible contagion-and-death statistics on the covid-19.

    It’s the young infecting the old, carelessly (plus a lot of political failures, of course, mostly Republican). The old catch it, and they die. All races. All economic classes.

  5. Submitted by Joel Stegner on 06/27/2020 - 09:58 pm.

    When looking at variation, one just not jump to one cause (structural racism), but teases out the causation and then goes beyond talk to action. And walk the talk. Protest injustice while wearing face masks so you don’t infect each other.

    Fact 1. Minority people are poorer than average – racism certainly is a major contributor.

    Fact 2. Minority people are less likely to have a primary care physician, particularly one of their race and culture, are less likely to have insurance, and more likely to have insurance with poor coverage.

    Fact 3. Minority people have less access to spacious or any housing, living in smaller spaces, again due to poverty and racism.

    Fact 4. Minority people are less likely to be able to work from home and stay home when they are sick, as low wage workers often have no paid sick leave.

    I could trot out a lot of issues that directly cause the difference. They boil down to how poverty and racism increase risk on virtually every issue. Health indicators are always worse, but have improved improved as society addresses racism and poverty.

    Also look at where the government spends money. Give everyone $1200, whether the pandemic has hurt them or not, and people feel they deserve it However, if people temporarily make more due to being unemployed, they are deadbeats if they don’t come right back to work.

    That $1200 stimulus payment is welfare. Everyone got it and doesn’t question anything except why they didn’t get more. In fact, Trump made sure that the rich, such as real estate developers, got more.

    The root cause is the contempt many feel toward the poor. When minority people have more money, like many Asian Americans, they can buy themselves out of the worst of racism. Andrew Tang got it right – guaranteed annual income is protective of many things, including health.

    You can focus on an issue like racism, which we have utterly failed to irradiate, or you can spend money to address the unmet needs of those our economic system failed. For example, why didn’t our Legislature require business to provide paid sick leave, potentially with subsidies for the very small employers for which it is most challenging? We simply cannot have sick people infecting others. Why did they not guaranteed access for all students to virtual school, when students are very likely to be dealing with it next year? This is urgent. It hurts all poor children. Stop blaming the poor what they cannot provide for their children.

    Quit with all the talking and do something constructive.

    • Submitted by Joe Smith on 06/30/2020 - 08:56 am.

      Joel, since 1964 the USA has spent over 22 Trillion, yes with a T, on eradicating poverty. The major changes seen by this are worse schools, poorer education for our children, fatherless homes going up, more folks on welfare, bigger Government, this is for all races. Getting out of poverty is not Government driven, it is individual driven. It starts with education, making good choices, being accountable and being dependable. None of those are Big Government policies, those are individual decisions.

  6. Submitted by Pat Terry on 06/28/2020 - 12:50 pm.

    I was out at a couple of stores in St. Paul yesterday. I think every single white person I saw was wearing a mask, while fewer than half of the people of color I saw had masks. I realize that this is anecdotal evidence and an un-representative sample, but is this widespread? Is there an education or messaging problem that preventing communication with certain communities?

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