Scholarly Perspectives on COVID-19, Part 4: Social Inequalities Writ Large
August 11, 2020
This is the fourth in a series on Southwestern faculty perspectives on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 2019 (COVID-19). Part 1 focused on biology, part 2 on mathematics, and part 3 on economics.
As confirmed cases of COVID-19 have surpassed 5 million and the death toll surged past 163,000 in the U.S. alone, it’s clear that no one is immune to the outbreak of a disease that has sickened young and old, taken lives, left families bereaved, devastated economies, and changed human behavior. Still, specific racial and ethnic groups have borne the brunt of the COVID-19 pandemic: Black, Indigenous, and Latinx populations. According to the COVID Tracking Project, Black individuals are dying at 2.5 times the rate of white people while the mortality rate for Indigenous Americans is double that of white Americans. And whereas white Americans are currently averaging 30 deaths per 100,000 people, Latinx populations are seeing 40 deaths per 100,000.
Some are quick to blame the current Black Lives Matter protests against police brutality and institutional racism, erroneously suggesting that COVID-19 is spreading thanks to mass demonstrations. However, because these events have been taking place outdoors and most protesters have remained masked, scientists and public-health officials have found no uptick in infection rates linked to the protests; instead, the rising rates of contagion are attributable to the premature reopenings (or belated closings) of schools and businesses, with large groups congregating and socializing indoors in restaurants, bars, churches, stores, daycares, and colleges.
Nevertheless, the pandemic is connected to the Black Lives Matter movement in one significant way: both are revealing the systemic racial disparities that are plaguing Black communities and other people of color.
According to Maria Lowe, a Southwestern University professor of sociology who specializes in race, gender, and civil rights, “COVID-19 is exposing and exacerbating previously existing social inequalities.”
Racial disparities in overall health and access to healthcare
Discrepancies in the social determinants of health are contributing to a higher risk of hospitalization and mortality among many people of color, Lowe shares. One inequality is the higher rate of preexisting conditions: according to the Centers for Disease Control and Prevention (CDC), racial and ethnic minority groups are subject to discrimination in housing, education, criminal justice, and finance, which can result in chronic stress, lower immunity, and other factors that lead, in turn, to an increased incidence of asthma, obesity, diabetes, high blood pressure, heart disease, and lung disease—that is, illnesses that increase the risk of severity of COVID-19. The spiderweb of causality is complex. For example, if we were to pull focus on a single thread—how segregation and discriminatory housing policies have resulted in inadequate housing among Black and Indigenous Americans—we would see how lack of indoor plumbing and clean running water can inhibit one’s ability to wash their hands for any number of seconds. We would see how crowding more family members into a smaller space makes physical distancing impossible. And we would see how insufficient air filtering and increased air pollution within a home can lead to pulmonary diseases such as asthma or circulate viruses such as SARS-CoV-2.
In addition to being at greater risk for COVID-19 and its comorbidities, Black, Indigenous, and Latinx individuals are also less likely to have health insurance coverage. Unlike in other wealthy, developed nations, in the U.S., insurance is usually linked to employment, but Black, Latinx, and Indigenous workers are more prone to unemployment, and those populations that live in the South are disadvantaged because those states, except Louisiana, have not expanded Medicaid. This means that many people of color are less likely to have a single primary-care physician who is familiar with their medical history and can provide more consistent care. Even more importantly, they are less likely to seek any healthcare in the first place because it is outright unaffordable. That rationing of care can spell death for those suffering silently from COVID-19.
Even if they are insured, however, people from racial and ethnic minority groups are also less likely to have access to healthcare than white people, especially those who live in cities and suburbs, where stand-alone urgent- and emergency-care clinics abound. People of color, by contrast, are more likely to live in “healthcare deserts,” which refers to areas with a shortage of primary-care physicians and where there is no medical trauma center within five miles. People of color are more likely to lack transportation to providers’ offices and hospitals, they may have competing childcare obligations, or they may not be able to take time off work to visit a doctor. Moreover, Lowe says, “Black and Latinx individuals are less likely to receive the same quality of healthcare as their white counterparts.” That is, they might receive less effective care, often because medical professionals take their symptoms less seriously when they seek treatment; studies have revealed, for example, that Black patients are often prescribed smaller quantities or lower dosages of pain medication—or none at all—for injuries or ailments compared with their white counterparts. Patients of color are also more likely to receive expensive unnecessary care (e.g., tests and amputation procedures) or treatment in subpar facilities. Inequality in education has resulted in a shortage of Spanish-speaking, Indigenous, and Black healthcare providers, which can result in language barriers between doctors and patients or else unfamiliarity or even distrust between white healthcare providers and patients of color. And individuals who identify as racial minorities are “more likely to live in areas with fewer pharmacies,” Lowe observes.
So for many racial and ethnic minority groups, COVID-19 exposes a number of inequalities, including the double whammy of higher risk of infection and lower access to healthcare.
The risk factor of unequal employment
Another inequality that has been revealed and exacerbated by the pandemic, Lowe shares, is that “Black and Latinx individuals are more likely to be employed in jobs to be considered essential services and are therefore less likely to have the luxury of working from home.” For example, white individuals are more likely to hold white-collar jobs that are easily transitioned to remote work, limiting one’s risk of contagion. In contrast, people of color are more likely to encounter barriers to high-quality education, which results in Black and Latinx individuals comprising a greater percentage of bus drivers and train operators, postal workers, grocery clerks, factory workers, nursing-home and childcare attendants, home healthcare aides, nurses, respiratory therapists, and janitors—positions that require on-site work, entail close proximity to others, and therefore increase workers’ exposure to the virus.
Many of these lower-paid jobs also fail to provide paid sick leave, meaning that employees who contract COVID-19 are faced with a terrible choice: either recover at home with no pay and risk losing one’s job, or go to work with pay while battling the illness and potentially infecting others.
And “in urban areas,” Lowe continues, “these individuals are also more likely to rely on public transportation,” which only adds to the risk of exposure.
Of course, vulnerable populations in frontline positions are also more likely to lose their jobs, not just from illness but also from layoffs. Black, Latinx, and Asian workers comprise a disproportionate share of restaurant, hotel, and retail employees, which means they are more prone to lose their jobs (and, again, their health insurance—if provided by their employer in the first place) when lockdowns cause customers to stay home and businesses to close.
“In addition to causing differences in COVID-19 infection and mortality rates among racial groups,” Lowe explains, “these factors will likely contribute to a significant increase in the racial wealth gap, a pattern that was also documented after the Great Recession.” That is, white individuals with healthcare insurance, higher incomes, greater liquid assets, savings accounts, and retirement portfolios are much more likely to recover relatively quickly from the economic fallout of the pandemic, just as they did after the 2007–2008 financial crisis. Meanwhile, people of color will continue to struggle with more debt, unaffordable healthcare costs, and unemployment. Unless government steps in to provide security for its most vulnerable citizens, the bleak cycle of precarity will likely be a perpetual one for especially people of color.
Racial profiling during a pandemic
As a sociologist who studies racial profiling, Lowe says that she has also been focusing particularly on “racialized surveillance during the pandemic.” For instance, two reporters have covered multiple incidents in which Black men in Florida, Illinois, and Tennessee were followed or even detained by police for wearing protective face coverings in public. “These examples of racial bias and profiling,” Lowe says, “fit with psychological and sociological research on biases about, and the treatment of, Black men.” Such studies have revealed that Black men are often perceived as physically larger, stronger, and more threatening than white men who are of the same height and build, which has led to unarmed Black men being disproportionately reported to law enforcement for suspicious activity and/or disproportionately surveilled, shot, and killed by police. “Given existing research, it is absolutely heartbreaking—but unfortunately not altogether surprising—that such biases inform some people’s assumptions about, and the treatment of, Black men who are wearing face coverings in public,” says Lowe. The pattern is especially alarming considering that masks have been recommended by the CDC and mandated in many states and cities to protect others from the spread of COVID-19. Black men, in other words, have been suspected of criminal activity when they are actually engaging in public-health measures to safeguard others.
COVID-19 has also heightened racism against Asian Americans. Lowe observes that “a related sociological issue is the experiences of Asian Americans from various ethnic backgrounds, including Chinese, Japanese, Korean, and Vietnamese, who are being targeted with violence during the pandemic.” According to the FBI, anti-Asian hate crimes had been decreasing over the past 15 years. “However, since the beginning of March, Asian Americans across the country have been targeted with verbal and physical abuse by people who blame them for COVID-19,” Lowe recounts. One woman filmed a man berating her on the New York City subway. Many Asian Americans have reported being spat on or cursed at. Asian restaurants and supermarkets have been targeted by xenophobic social-media posts erroneously reporting that staff were infected with COVID-19. Asian-American doctors have reported patients using slurs against them. And members of a Burmese-American family—including a two- and six-year-old—were stabbed in a Midland, Texas, store because the male perpetrator wrongly assumed they were Chinese and infecting people with the disease.
These attacks, Lowe says, are “a pattern that may have been influenced by certain political leaders using terms such as the ‘Chinese virus’ and the ‘Wuhan virus’ when referring to the pandemic. Some view such descriptors as racial dog whistles that attempt to link foreigners with disease, a pattern that has had a long history in the U.S., especially as it relates to people of Asian descent.” That history extends back to the 1882 Chinese Exclusion Act, the first anti-immigration law to blacklist an entire ethnic group. It also includes 1920s–1940s detention camps in which Chinese and Japanese laborers and their families were held for as long as six months and subjected to invasive medical exams without consent. Both the Chinese Exclusion Act and these immigrant detention facilities resulted from the rhetoric of the “yellow peril”: Asians being misrepresented as carriers of smallpox and bubonic plague even though they manifested no symptoms of disease. Similar racist assumptions rebounded during the 2003 SARS outbreak and have reared their ugly head again in 2020.
Ironically, Lowe points out, “these patterns have existed alongside stereotypes of Asian Americans as a ‘model minority’ or ‘honorary whites.’” During the past five decades, Asian Americans have been depicted as a high-achieving, polite, and law-abiding immigrant group that has, through “good behavior” such as silence and hard work, achieved the American dream and deservedly achieved prosperity. However, the model-minority myth has been detrimental to Asian Americans and to race relations more broadly in the U.S. For example, it obscures differences among individuals, grouping all Asian Americans into a single stereotype, and it conflates different Asian cultures (even though people of Chinese, Japanese, Thai, Filipino, and Hmong descent have different cuisines, beliefs, and backgrounds). The model-minority myth also leads people of all races and ethnicities to overestimate Asian Americans’ relative socioeconomic standing, which creates a barrier to achieving actual equality. Moreover, the stereotype has driven a wedge between Asian Americans and other nonwhite groups, such as Black and Latinx communities, in what seems to be a race for racial equality—at the expense of other people of color.
Of course, COVID-19 is underscoring one of the most insidious aspects of the model-minority myth: that whether one buys into or denies the stereotype of Asian Americans as somehow more successful than their fellow people of color, they seem to be permanently coded as foreign or “other” relative to white Americans. As Lowe explains, “The pandemic has laid bare these fallacies by showing how quickly these allegedly positive statuses can be revoked and how, as Mia Tuan, Ronald Takaki, and Derald Sue and others have argued, Asian Americans, regardless of how many generations their families have lived in the U.S., are sometimes viewed and treated by others as ‘forever foreigners.’”
COVID-19 may be generating marketing messages suggesting that “we’re all in this together,” but it has also underscored that the United States, in many ways, does not live up to its name.
Social awareness through social distancing
The 2020 coronavirus pandemic has, in some ways, brought sharp focus to the many ills that plague American society today: political partisanship, lack of trust in institutions, deep fissures in our healthcare system (including mental healthcare), concerns about surveillance, and differing definitions of civil liberties. But as the COVID-19 outbreak continues to especially devastate Black, Latinx, and Indigenous communities, the effects of structural racism have certainly earned our attention.
And those impacts pose a threat not just to the U.S. but to the world at large. According to the World Bank in its Global Crisis Response Platform, the most significant threats to human life and economic security in both developing and developed countries are (1) climate change and its consequent natural disasters, (2) wars and conflicts that displace populations, and (3) pandemics. But as Lowe points out, socioeconomic disparities and racial discrimination exist in a dangerous feedback loop with disease—with inequality increasing the risk of serious illness and death during a pandemic that, in turn, exacerbates socioeconomic and racial inequality.
It’s no wonder that eradicating inequality has been widely touted by scholars, governments, and international agencies alike as just one vaccine against future public-health crises on the scale of COVID-19.
Bibliography and Further Reading
- Akee, Randall, “How COVID-19 Is Impacting Indigenous Peoples in the U.S.,” PBS News Hour
- American Sociological Association, Contexts: Sociology for the Public (ongoing COVID-19 coverage)
- The Atlantic COVID Tracking Project and the Boston University Center for Antiracist Research, The COVID Racial Data Tracker
- The Centers for Disease Control and Prevention, “Health Equity Considerations and Racial and Ethnic Minority Groups”
- The Conversation, COVID-19
- De Leon, Adrian, “The Long History of Racism Against Asian Americans in the U.S.,” PBS News Hour
- Emory University, COVID-19 Health Equity Interactive Dashboard
- Fisher, Max and Emma Bubola, “As Coronavirus Deepens Inequality, Inequality Worsens Its Spread,” New York Times
- Flaherty, Colleen, “Social Scientists on COVID-19,” Inside Higher Ed
- Johns Hopkins University and Medicine, “Racial Data Transparency,” Coronavirus Resource Center
- Natividad, Ivan. “Coronavirus: Fear of Asians Rooted in Long American History of Prejudicial Policies,” Berkeley News
- Quinn, Sandra Crouse and Supriya Kumar, “Health Inequalities and Infectious Disease Epidemics: A Challenge for Global Health Security,” Biosecurity and Bioterrorism