Two years ago, the United States shut down in response to the COVID-19 pandemic. However, the past two years have not been the same for everyone. Race, ethnicity, socioeconomic status, occupation, location, gender, and other factors have caused this time period to be more challenging and painful for certain demographics. Compared with white Americans, racial and ethnic minorities–particularly Black Americans, Native Americans, and Hispanic Americans–have experienced higher rates of COVID-19 infection, hospitalization, and death. This does not just affect the individuals who suffer from COVID-19 but also their loved ones and communities. Desha Hargrove lost her husband Jason Hargrove, a Detroit bus driver, and “five others - all of whom were Black, beautiful human beings” to COVID-19. She expressed, “I am simply devastated at how this virus has mainly impacted our communities.”
There are many potential explanations for why health disparities between white and non-white communities have occurred. This short article cannot cover all of the structural factors which compound to disadvantage people and communities of color in health outcomes, particularly with respect to COVID-19. However, it provides an overview of some of the potential factors.
To begin with, Black and Hispanic Americans are overrepresented in essential jobs, including in healthcare, warehouses, and other areas in which social distancing is not possible and exposure to COVID-19 is higher. Based on data from 2018, 33 percent of Black workers and 31 percent of Hispanic workers were essential workers while only 26 percent of white workers were in essential jobs. Native Americans are also overrepresented in frontline work.
Essential and frontline workers have faced a disproportionate risk of COVID-19 throughout the pandemic. A prospective cohort study through March and April 2020 found that frontline healthcare workers “had a significantly increased risk of COVID-19 infection” compared to the general public. Additionally, a study in Philadelphia found essential workers (including frontline healthcare and social assistance workers) to be 55 percent more likely to receive a positive COVID-19 test result than nonessential workers. Excluding healthcare and social assistance workers, essential workers were still 21 percent more likely to be infected with COVID-19 than the general public. The overrepresentation of Black, Hispanic, and Native American workers in the essential workforce means that exposure and risk from essential work has disproportionately fallen on such workers.
However, this does not account for all of the differences in health outcomes that racial and ethnic minorities have faced. Structural racism in education, hiring, and workplace expectations that disadvantage nonwhite workers produce disparities in income. These differences, compounded with inequality in housing, continue the generational wealth gap. Healthcare in the United States is incredibly expensive, and combined with the wealth gap, this has overly burdened people of color. Additionally, discrimination in healthcare and resulting mistrust in the healthcare system may lead to racial and ethnic minorities going to the hospital less. All of these factors contribute to the disproportionate health outcomes that people of color face in the United States. Because COVID-19 has occurred at such a large scale, it has further exposed these long-standing inequities. Another potential and less-discussed factor in different COVID-19 outcomes among racial and ethnic groups could be exposure to air pollution. An ongoing study in Italy found a correlation between exposure to low levels of air pollution, particularly to fine particles (PM2.5), and COVID-19 infection. However, causation has not been established, and future studies will be needed to confirm these findings.
So far, research has shown varying results. A study in Texas found no statistically significant relationship between concentrations of PM2.5 and rates of COVID-19 cases and deaths. Alternatively, an evaluation in Louisiana found an association between higher levels of air pollution, larger proportions of Black residents, and increased COVID-19 death rates. Although two years of living with COVID-19 may seem like a long time, it is still too early to determine the impact that air pollution has and will have on infection and death rates.Regardless, redlining, the siting of waste facilities, and social policies which have exacerbated the generational wealth gap in the United States have led to many disadvantages for racial and ethnic minorities, including disproportionate exposure to PM2.5, “the largest environmental cause of human mortality.” Without policies to remediate these impacts, this has and will continue to cause severe and unequal health impacts for racial and ethnic minorities beyond the COVID-19 pandemic.
The pandemic has exposed longstanding racial differences in health outcomes in the United States and should prompt action to be taken to address these inequalities.
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