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The COVID-19 pandemic has revealed race-based health care disparities in many countries, including the United States, United Kingdom, Norway, Sweden, Canada, and Singapore.These disparities are believed to originate from structural racism in these countries which pre-dates the pandemic; a commentary in The BMJ noted that "ethnoracialised differences in health outcomes have become the new normal across the world" as a result of ethnic and racial disparities in COVID-19 healthcare, determined by social factors. Data from the United States and elsewhere shows that minorities, especially black people, have been infected and killed at a disproportionate rate to white people.
Data from different social identities (such as class, gender, age, and medical history) shows that minorities have been disproportionally affected by the pandemic, including racial minorities.In the US, African-Americans experience the second-highest current COVID-19 mortality and morbidity rates in the country–more than twice the rate of white and Asian Americans, who have the lowest current rates.
Many studies and socioeconomic observations have demonstrated that the African-American community was disproportionately impacted by the disease in multiple ways. For instance, in cities like Chicago, although African-Americans are only 30% of the population, they comprise more than 50% of COVID-19 cases and about 70% of COVID-19 deaths.
Racial disparities between African-Americans and other racial groups have been growing since the beginning of the pandemic, in areas related to health, jobs, prison, education, psychology, mental health and housing.[ citation needed ]
According to Maritza Vasquez Reyes in Health and Human Rights Journal, given that the COVID-19 pandemic is more than just a health crisis—it is disrupting and affecting every aspect of life including family life, education, finances, and agricultural production—it requires a multi-sectoral approach.
According to the World Health Organization’s report Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health, “poor and unequal living conditions are the consequences of deeper structural conditions that together fashion the way societies are organized—poor social policies and programs, unfair economic arrangements, and bad politics”.
The combination of structural factors as they play out during this time of crisis is disproportionately affecting African-American communities in the United States in many aspects of their life.
African-American people are more likely to have diseases such as hypertension, heart disease, and diabetes, conditions that amplify the severity of COVID-19 than that of white Americans, which is lower, except for lymphoma.Research has shown that not only do black people develop these diseases at a greater rate than white people, they also tend to develop them at a younger age. Medical experts attribute the disproportionate rates of these diseases in black people to higher levels of stress and racial discrimination.
Additionally, many black people live with people who are at high risk for developing serious illness from the COVID-19 because of their age or underlying medical conditions.
African-American people experience the highest COVID-19 mortality rates nationwide since the beginning of the pandemic; their mortality rate is twice as high as the rate for white Americans.
This statistic varies from state to state. For instance in Kansas, black people are seven times more likely to have died than white residents, while in Washington, D.C., the rate among black people is six times as high as for white people.In Missouri and Wisconsin, it is five times greater. Black people are 13% of the U.S. population that has released COVID-19 mortality data, but they account for 25% of the deaths. South Carolina and Michigan had the largest gaps — 25 points — between the percentage of black people in the population and the percentage of COVID-19 victims who were black, Virginia and North Carolina had the smallest gaps: three points.
This disproportionate impact can be explained by the racial inequalities in health insurance in the United States. For instance, according to the Kaiser Family Foundation, in 2018, 11.7% of African-American people in the United States had no health insurance, compared to 7.5% of white people.African-American communities have access to diminished health care and finances as the uninsured are far more likely than the insured to forgo needed medical visits, tests, treatments, and medications because of cost.
As the COVID-19 virus made its way throughout the United States, testing kits were distributed equally among labs across the 50 states, without consideration of population density or actual needs for testing in those states. Although there is a dearth of race-disaggregated data on the number of people tested, the data that are available highlight the overall lack of access to testing for African-American people. For example, in Kansas, as of June 27, according to the COVID Racial Data Tracker, out of 94,780 tests, only 4,854 were from black Americans and 50,070 were from white people. However, black people make up almost a third of the state's COVID-19 deaths (59 of 208). And while in Illinois the total numbers of confirmed cases among black and white people were almost even, the test numbers show a different picture: 220,968 white people were tested, compared to only 78,650 black people.
Similarly, American Public Media reported on the COVID-19 mortality rate by race/ethnicity through July 21, 2020, including Washington, DC, and 45 states.These data, while showing an alarming death rate for all races, demonstrate how minorities in the US are impacted harder by the pandemic.
The overrepresentation of African-American people among confirmed COVID-19 cases and the number of deaths underscores the fact that the coronavirus pandemic is amplifying and exacerbating existing social inequalities tied to race, class, and access to the health care system according to many statistical studies.
Nearly 2.2 million people are in US jails and prisons, the highest rate in the world. According to the US Bureau of Justice, in 2018, the imprisonment rate among black men was 5.8 times that of white men, while the imprisonment rate among black women was 1.8 times the rate among white women.This overrepresentation of African-American people in US jails and prisons is another indicator of the social and economic inequality affecting this population.
According to the Committee on Economic, Social and Cultural Rights' General Comment 14, “states have an obligation to ensure medical care for prisoners at least equivalent to that available to the general population.”
However, there has been a very limited response to preventing transmission of the virus within detention facilities, which cannot achieve the physical distancing needed to effectively prevent the spread of COVID-19.
Around the country, black people make up a higher proportion of some low-paid professions that have elevated risks of virus exposure.
The types of work where people in some racial and ethnic groups are overrepresented can also contribute to their risk of getting sick with COVID-19.
Nearly 40% of African-American workers, more than seven million, are low-wage workers and have jobs that deny them even a single paid sick day. Workers without paid sick leave might be more likely to continue to work even when they are sick. This can increase workers’ exposure to other workers who may be infected with the COVID-19 virus.
Similarly, the Centers for Disease Control has noted that many African-American people who hold low-wage but essential jobs (such as food service, public transit, and health care) are required to continue to interact with the public, despite outbreaks in their communities, which exposes them to higher risks of COVID-19 infection. According to the Centers for Disease Control, nearly a quarter of employed Hispanic and black or African-American workers are employed in service industry jobs, compared to 16% of non-Hispanic white people. Black people make up 12% of all employed workers but account for 30% of licensed practical and licensed vocational nurses, who face significant exposure to the coronavirus.
In 2018, 45% of low-wage workers relied on an employer for health insurance. This situation forces low-wage workers to continue to go to work even when they are not feeling well. Some employers allow their workers to be absent only when they test positive for COVID-19. Given the way the virus spreads, by the time a person knows they are infected, they have likely already infected many others in close contact with them both at home and at work.
Staying home is not an option for the homeless. African-American people, despite making up just 13% of the US population, account for about 40% of the nation's homeless population, according to the Annual Homeless Assessment Report to Congress.Given that people experiencing homelessness often live in close quarters, have compromised immune systems, and are aging, they are more vulnerable to communicable diseases—including the COVID-19.
Segregation affects people’s access to healthy foods and green space. It can also increase excess exposure to pollution and environmental hazards, which in turn increases the risk for diabetes, heart, and kidney diseases.African-American people living in impoverished, segregated neighborhoods may live farther away from grocery stores, hospitals, and other medical facilities. Sociologist Robert Sampson writes on this disproportionate impact by stating that the coronavirus is exposing class and race-based vulnerabilities. He says that African Americans, even if they are at the same level of income or poverty as white or Latino Americans, are much more likely to live in neighborhoods that have concentrated poverty, polluted environments, lead exposure, higher rates of incarceration, and higher rates of violence. Many of these factors lead to long-term health consequences.
The pandemic is concentrating in urban areas with high population density, which are, for the most part, neighborhoods where marginalized and minority individuals live. Strategies most recommended controlling the spread of COVID-19—social distancing and frequent handwashing—are difficult to practice for those who are incarcerated or who live in highly dense communities with precarious or insecure housing, poor sanitation, and limited access to clean water.
Pre-pandemic, African-American people had the highest unemployment rates in the country. African-American households earned 59 cents for every dollar white households earned. For every dollar of personal savings that white households have, black households have 10 cents. Black job losses and reduced work hours have been as high as twice that of white people. Black households reported that their personal savings were depleted by the pandemic, that they had fallen behind on housing payments, or have had problems paying debts and/or utility bills.
Federal support for families from the CARES Act has expired and Congress continues to debate the funding many families desperately need. Black people and Latinos were hit especially hard when stay at home orders and social distancing mandates were enforced because they are over-represented in the leisure and hospitality industries.
Although many Caribbean countries have established physical isolation measures to reduce infection and prevent health systems from collapsing, the region’s structural problems have made it more complex to mount an immediate response to the crisis. A report from the Economic Commission for Latin America and the Caribbean (ECLAC) demonstrated that COVID-19 is exposing social inequalities of all kinds and the overrepresentation of Afrodescendants among the group living in poverty who are employed in informal and caregiving jobs.
As Afrodescendants have worse indicators of well-being than their non-Afrodescendant peers, they are seen as one of the groups most vulnerable to the COVID-19 pandemic in the Caribbean countries, in terms of both infection and mortality.
Various agencies and institutions, including the Pan American Health Organization, the United Nations Population Fund, the Office of the United Nations High Commissioner for Human Rights and the Inter-American Development Bank, have already pointed out that the Afrodescendant population is more vulnerable to COVID-19 owing to the structural inequality and racial discrimination to which it is subjected.
These institutions highlighted the importance of addressing health from a comprehensive perspective that considers emotional, physical and social well-being, as defined by the World Health Organization (WHO), where the relationship between health and its social determinants is taken into account. They urged countries to eliminate disparities in health status that might result from racism.
An INSEE study shows that the excess mortality from all causes is, for March and April 2020, twice as high among people born abroad in France.
In 2020, excess of mortality primarily affected people born abroad: increase in deaths increased by 36% for people born in Africa outside the Maghreb, by 29% in Asia and by 21% in the Maghreb, while the increase in deaths of people from Europe, Oceania and America has been similar to that of people born in France.
In France, people of foreign origin have held more positions, so-called "essential" occupations, and have had to continue to go to work during the lockdown. In addition, people from sub-Saharan Africa live in the most cramped housing, which can promote transmission, especially between different age groups.
In April 2020, the British Medical Association called on the government to investigate if and why people from black, Asian and minority ethnic (BAME) groups were more vulnerable to COVID-19, after the first 10 doctors to die were all from the group. The Labour Party called for a public enquiry after the first 10 deaths in the health service were from BAME backgrounds. The Mayor of London Sadiq Khan wrote to the Equality and Human Rights Commission asking them to investigate whether the effects of coronavirus on BAME groups could have been prevented or mitigated. A group of 70 BAME figures sent a letter to Boris Johnson calling for an independent public enquiry into the disproportionate impact of the coronavirus on people from black, Asian and minority ethnic backgrounds.
Research by the Intensive Care National Audit and Research Centre concluded that people from BAME backgrounds made up 34% of critical patients. NHS England and Public Health England were appointed to lead an inquiry into why people from black and minority ethnic backgrounds appear to be disproportionately affected by coronavirus. On 18 April, Public Health England said that they would start recording the ethnicity of victims of coronavirus.
Research carried out by The Guardian newspaper concluded that ethnic minorities in England when compared to white people were dying in disproportionately high numbers. They said that deaths in hospitals up to 19 April, 19% were from BAME backgrounds who make up only 15% of the population of England.
The Office for National Statistics (ONS), meanwhile, wrote that in England and Wales black men were four times more likely to die from coronavirus than white men, from figures gathered between 2 March to 10 April. They concluded that "the difference between ethnic groups in COVID-19 mortality is partly a result of socio-economic disadvantage and other circumstances, but a remaining part of the difference has not yet been explained". Some commentators including Dr. John Campbell have pointed to Vitamin D deficiency as a possible cause of the discrepancy, but the theory remains unproven.
Another study carried out by University of Oxford and the London School of Hygiene and Tropical Medicine on behalf of NHS England and a separate report by the Institute for Fiscal Studies corroborated the ONS' findings. An Oxford University led study into the impact of COVID-19 on pregnancy concluded that 55% of pregnant women admitted to hospital with coronavirus from 1 March to 14 April were from a BAME background. The study also concluded that BAME women were four times more likely to be hospitalised than white women.A study by Public Health Scotland found no link between BAME groups and COVID-19. A second Public Health England study found that those with a Bangladeshi heritage were dying at twice the rate of white Britons. Other BAME groups had between 10% and 50% higher risk of death from COVID-19.
COVID-19 has shown the impact on black and Asian people in Europe.
The Council of Europe’s anti-racism commission (ECRI) in its 2020 annual report published in March 2021, ahead of the International Day against Racial Discrimination marked on 21 March, identified four key challenges Europe was facing last year. These are:
Even if many European countries avoid breaking down data along racial or ethnic lines out of concern over privacy or discrimination, COVID-19 data shows well ethnic inequalities in healthcare access.
The Runnymede Trust is a race equality think tank. It was founded in 1968 by Jim Rose and Anthony Lester as an independent source for generating intelligence for a multi-ethnic Britain through research, network building, leading debate and policy engagement. It is led by its director, Dr Halima Begum, who was appointed in September 2020. Its chairman is Sir Clive Jones.
Health equity arises from access to the social determinants of health, specifically from wealth, power and prestige. Individuals who have consistently been deprived of these three determinants are significantly disadvantaged from health inequities, and face worse health outcomes than those who are able to access certain resources. It is not equity to simply provide every individual with the same resources; that would be equality. In order to achieve health equity, resources must be allocated based on an individual need-based principle.
Covert racism is a form of racial discrimination that is disguised and subtle, rather than public or obvious. Concealed in the fabric of society, covert racism discriminates against individuals through often evasive or seemingly passive methods. Covert, racially biased decisions are often hidden or rationalized with an explanation that society is more willing to accept. These racial biases cause a variety of problems that work to empower the suppressors while diminishing the rights and powers of the oppressed. Covert racism often works subliminally, and often much of the discrimination is being done subconsciously. Sometimes, it originates instead in discrimination against poorer segments that simply happens to disproportionately affect individuals by race.
Race in the United States criminal justice system refers to the unique experiences and disparities in the United States in regard to the policing and prosecuting of various races. There have been different outcomes for different racial groups in convicting and sentencing felons in the United States criminal justice system. Experts and analysts have debated the relative importance of different factors that have led to these disparities.
Research shows many health disparities among different racial and ethnic groups in the United States. Different outcomes in mental and physical health exist between all census-recognized racial groups, but these differences stem from different historical and current factors, including genetics, socioeconomic factors, and racism. Research has demonstrated that numerous health care professionals show implicit bias in the way that they treat patients. Certain diseases have a higher prevalence among specific racial groups, and life expectancy also varies across groups.
Racial inequality in the United States identifies the social inequality and advantages and disparities that affect different races within the United States. These can also be seen as a result of historic oppression, inequality of inheritance, or racism and prejudice, especially against minority groups.
Societal racism is the formalization of a set of institutional, historical, cultural, and interpersonal practices within a society that places one or more social or ethnic groups in a better position to succeed and disadvantages other groups so that disparities develop between the groups over a period of time. Societal racism has also been called structural racism, because, according to Carl E. James, society is structured in a way that excludes substantial numbers of people from minority backgrounds from taking part in social institutions. Societal racism is sometimes referred to as systemic racism as well.
The weathering hypothesis was proposed to account for early health deterioration as a result of cumulative exposure to experiences of social, economic and political adversity. It is well documented that minority groups and marginalized communities suffer from poorer health outcomes. This may be due to a multitude of stressors including prejudice, social alienation, institutional bias, political oppression, economic exclusion and racial discrimination. The weathering hypothesis proposes that the cumulative burden of these stressors as individuals age is "weathering," and the increased weathering experienced by minority groups compared to others can account for differences in health outcomes. In recent years, the biological plausibility of the weathering hypothesis has been investigated in studies evaluating the physiological effects of social, environmental and political stressors among marginalized communities. This has led to more widespread use of the weathering hypothesis as a framework for explaining health disparities on the basis of differential exposure to racially based stressors. Researchers have also identified patterns connecting weathering to biological phenomena associated with stress and aging, such as allostatic load, epigenetics, and telomere shortening.
During the COVID-19 pandemic, human rights violations including censorship, discrimination, arbitrary detention and xenophobia were reported from different parts of the world. Amnesty International has responded that "Human rights violations hinder, rather than facilitate, responses to public health emergencies and undercut their efficiency." The World Health Organization (WHO) has stated that stay-at-home responses for slowing the pandemic must not be mandated at the expense of human rights. Broader concerns have been expressed about the effect of COVID-19 containment measures on human rights, democracy and governance.
COVID-19 affects men and women differently both in terms of the outcome of infection and the effect of the disease upon society. The mortality due to COVID-19 is significantly higher in men. Slightly more men than women contract COVID with a ratio of 1:0.9.
The ongoing COVID-19 pandemic has had a significant impact on the LGBT community. Gay pride events were cancelled or postponed worldwide. LGBTQ+ themed organizations, businesses, and communities have been impacted both by COVID-19 itself and its economic impact at disproportionate rates. Gay bars such as the Stonewall Inn have required fundraising to stay afloat, and some without considerable fundraising capability have closed permanently.
Nishi Chaturvedi is a Professor of Clinical Epidemiology at University College London. Her research considers how ethnicity and lifestyle impact people's risk factors for disease. During the COVID-19 pandemic, Chaturvedi explained that the increased coronavirus mortality rate for people from black and minority ethnic backgrounds was due to societal inequality and how this intersects with healthcare.
Rachel Renee Hardeman is an American public health academic who is Associate Professor of Division of Health Policy and Management at the University of Minnesota. She holds the inaugural Blue Cross Endowed Professorship in Health and Racial Equity. Her research considers how racism impacts health outcomes, particularly for the maternal health of African-Americans.
The Lammy Review is a 2017 review on discrimination within the policing and criminal justice systems in the UK, led by David Lammy and commissioned by David Cameron and Theresa May. The Lammy Review found significant racial bias in the UK justice system.
The World Health Organization (WHO) defines maternal mortality as death that occurs during pregnancy, birth and up to 42 days postpartum. Black maternal mortality in the United States refers to the incidence of maternal mortality in the U.S. specifically for those identifying as black or African American. The usual causes of maternal mortality are conditions that occur or are exacerbated during pregnancy. Therefore, most instances of maternal mortality are preventable deaths. In the U.S., the CDC reported that black women experience maternal mortality at a rate two to three times higher than that of white women. Researchers have identified several reasons for the black–white maternal mortality disparity in the U.S., including historical reasons, access to care, socioeconomic status, incidence of preexisting conditions, medical racism, and abortion access, all of which are social determinants of health in the United States.
This article presents official statistics gathered during the COVID-19 pandemic in the United Kingdom.
The impact of the COVID-19 pandemic on Native American tribes and tribal communities has been severe and has emphasized underlying inequalities in Native American communities compared to the majority of the American population. The pandemic exacerbated existing healthcare and other economic and social disparities between Native Americans and other racial and ethnic groups in the United States. Along with Black Americans, Latinos, and Pacific Islanders, the death rate in Native Americans due to COVID-19 was twice that of white and Asian Americans, with Native Americans having the highest mortality rate of all racial and ethnic groups nationwide. As of January 5, 2021, the mortality impact in Native American populations from COVID-19 was 1 in 595 or 168.4 deaths in 100,000, compared to 1 in 1,030 for white Americans and 1 in 1,670 for Asian Americans. Prior to the pandemic, Native Americans were already at a higher risk for infectious disease and mortality than any other group in the United States.
There are various factors affecting the health of ethnic minorities within the UK due to health inequalities. The term "BAME" is often used however, the use of this term can be problematic for various reasons, such as an indicating power relations and also having a focus on skin colour. Therefore, this article will use the term ethnic minorities.
The COVID-19 pandemic has had an unequal impact on different racial and ethnic groups in the United States, resulting in new disparities of health outcomes as well as exacerbating existing health and economic disparities.
White Americans, as the majority and comparatively advantaged racial group in the United States, have historically had better health outcomes than other oppressed racial groups in America. However, in recent years, the scholarly discourse has switched from recognition of the immense positive health outcomes of White Americans towards understanding the growing persistence of negative outcomes unique to this racial group. Scholars have discussed the effects of racial prejudice and its negative effect on health outcomes to not only those being oppressed but also those being given privileges. In addition to the effects of living in a racialized society, White Americans have the highest rate of suicide and lifetime psychiatric disorders than any other ethnicity or racial category. In conjunction with these psychiatric issues, there are higher rates of alcohol usage alongside lower levels of psychological flourishing. In this context, flourishing is defined as a positive mental state associated with no mental disorders and high levels of psychological well-being. Given this information, the health status of White Americans has gained increasing importance due to the differences in health outcomes between White Americans and White people from other parts of the world.