Inequality is magnified in times of national hardship. Perhaps nowhere is this clearer than in communities of color, which have long endured inequalities across American economic, social, and civic systems. Persistent segregation has restricted tens of millions of people of color to some of the most densely populated urban areas in the country; structural and environmental racism has produced extraordinarily high rates of serious chronic health conditions among people of color; and entrenched barriers in the health system continue to prevent people of color from obtaining the care they need. Now, these same factors threaten to exacerbate the current national hardship: a potentially deadly coronavirus, which causes the disease COVID-19, that has infected tens of thousands of Americans and could affect millions more.
Amid this major public health crisis, the compounding effect of existing inequities puts people of color in an increasingly precarious situation. As federal, state, and local officials consider sweeping initiatives to address the human and economic cost of COVID-19, they must center America’s most vulnerable communities. It is crucial that lawmakers understand why and how this crisis could disproportionately harm people of color and take steps to mitigate the effects of entrenched structural racism and promote health equity for all.
Pandemics and people of color: Lessons from the H1N1 virus
According to the Centers for Disease Control and Prevention (CDC), “In the spring of 2009, a novel influenza A (H1N1) virus emerged. It was detected first in the United States and spread quickly across the United States and the world.” In just one year, the CDC estimated 60.8 million H1N1 cases, 274,304 hospitalizations, and 12,469 deaths in the United States alone.
During this pandemic, people of color were far more likely to self-report influenza-like illness and to experience hospitalization due to the H1N1 virus. Data also suggest that Hispanic and American Indian/Alaska Native (AI/AN) people in particular endured far higher H1N1-related mortality rates than non-Hispanic white Americans.
Experts believe that urban crowding, reliance on public transportation, absence of paid sick leave, and language barriers contributed to increased H1N1 exposure and susceptibility as well as delayed treatment in communities of color. In other words, structural racism put people of color at greater risk during the H1N1 pandemic. Many of the factors that put people of color at greater risk of exposure remain present today.
People of color disproportionately reside in densely populated metropolitan areas that could increase exposure to the coronavirus
American housing policies have long restricted people of color to segregated neighborhoods in urban areas. People of color now constitute a majority of residents in the five most densely populated cities in the country. They have less access to green space and are more likely to reside in substandard housing than their white counterparts. Many people of color also rely on crowded public transportation systems to travel to work, purchase groceries, and obtain medical care.
America’s failure to ensure adequate coronavirus testing has caused the disease to spread undetected through some cities, and communities are rushing to reduce transmission by limiting mobility and person-to-person contact. Social distancing is essential in combating COVID-19 in order to reduce the risk of contagious people coming into contact with healthy people. But rampant segregation makes social distancing much more difficult for people of color, many of whom consider crowded laundromats, grocery stores, elevators, and sidewalks unavoidable features of daily life in a densely populated area. New York City has emerged as an epicenter of the outbreak and a clear example of the dangers of population density during a pandemic. Two-thirds of the city’s residents are people of color, and many do not have the luxury of self-isolation. People of color in New York and elsewhere have been caught in the middle of a major health emergency as a result of long-standing segregation and economic oppression.
Higher rates of serious chronic health conditions make the coronavirus potentially more dangerous for people of color
From automobile and refinery pollution to lead-contaminated water and food deserts, structural and environmental racism has contributed to higher rates of serious chronic health conditions in communities of color. Today, approximately 24 percent of AI/AN people, 23 percent of multiracial Americans, and 18 percent of Black Americans have been diagnosed with asthma. As many as 18 percent of AI/AN people, 15 percent of Black Americans, and 12 percent of Hispanic and Native Hawaiian/Pacific Islander Americans have been diagnosed with diabetes. People of color also experience higher rates of obesity, HIV/AIDS, chronic obstructive pulmonary disease, and other chronic conditions. On a good day, these conditions make life more complicated and difficult—but during a global pandemic, they are life-threatening.
According to the CDC, while COVID-19 can affect anyone, people with serious chronic medical conditions are among the groups more likely to get very sick if they contract the disease. Therefore, the agency has warned such people to take extra precautions to avoid the virus. However, as noted above, while people of color are more likely to have these conditions, they are less likely to be able to avoid exposure. As a result, this virus could lead to even worse outcomes if it begins to spread rapidly in communities of color.
Barriers in the health care system may prevent people of color from obtaining necessary care
While the U.S. health care system has made remarkable progress in dismantling structural barriers, too many people of color struggle to obtain the care they need due to cost, language access, and outright discrimination. Millions of people gained coverage under the Affordable Care Act, but people of color, especially AI/AN and Hispanic people, remain far more likely to be uninsured than their white counterparts due to many states’ refusal to expand coverage. According to a new CAP analysis of CDC data, 16 percent of Black people, 20 percent of Hispanic people, 19 percent of AI/AN people, and 18 percent of Asian Americans were unable to see a doctor in 2018 due to cost. By contrast, just 10 percent of white Americans were unable to see a doctor due to cost. Racial disparities in self-reported inability to afford care persist even after controlling for insurance coverage.
Language barriers also prevent countless people of color from obtaining crucial information about disease treatment and prevention. More than 350 different languages are spoken in the United States. Millions of Americans—including 35 percent of Hispanic and Asian Americans and 14 percent of Native Hawaiian/Pacific Islander people—are also limited English proficient (LEP), meaning they speak English “less than very well.” LEP Americans have the legal right to access care in their preferred language. However, few hospitals require their medical residents to receive interpreter services training or offer medical staff formal assessments of their foreign language proficiency.
Lastly, racial discrimination remains an ever-present barrier to treatment for people of color. In fact, 32 percent of African Americans, 20 percent of Latinos, 23 percent of Native Americans, and 13 percent of Asian Americans have experienced racial discrimination when going to a doctor or health clinic. By contrast, only 5 percent of white Americans have experienced racial discrimination when seeking care.
People of color have always needed and deserved access to affordable, safe, and high-quality health care. Now, as the coronavirus spreads to these at-risk communities, there is renewed urgency in ensuring lawmakers and health officials dismantle financial and linguistic barriers to affordable and quality health care.
Recommendations
As the Trump administration, Congress, and elected officials across the country continue to put forward policy to help Americans, it is essential that they put the most vulnerable people at the center of their discussions. Unfortunately, the Trump administration has revealed, through its policy proposals and public statements, that it cares far more about corporations, the stock market, and its own reputation than it does about the health and well-being of American families. Many governors and local elected officials are leading the way by adopting policies to limit exposure and promoting information transparency.
States and localities have demonstrated that they are willing to make difficult choices in order to save lives and support communities. Lawmakers who are interested in doing more to ensure that people of color are protected should pursue the following measures:
- Ensure paid sick leave and paid family and medical leave for all workers
- Secure additional translation services for hospitals and health clinics
- Ensure low-income individuals have access to no-cost testing and treatment related to COVID-19
- Ensure official coronavirus-related publications are translated for single-language minority groups with a large presence in their jurisdiction
- Send cash and other financial assistance directly to households
The COVID-19 pandemic is a glaring reminder that inequality puts America’s most vulnerable communities at increased risk. To prevent such occurrences from disproportionately harming people of color, lawmakers must consider serious equity implications highlighted by the civil rights community and work to dismantle structural racism in American economic, housing, and health care systems. By doing so, they will ensure that America is better able to equitably respond to unexpected emergencies in the future.
Connor Maxwell is a senior policy analyst for Race and Ethnicity Policy at the Center for American Progress.
Methodology
The author used the CDC’s Behavioral Risk Factor Surveillance System, a nationally representative survey, to estimate cost barriers to health care and history of serious chronic health conditions. This analysis used data from 2018 which have a sample size of 390,000 people, which is sufficient for statistically meaningful disaggregation by race. Percentages were then weighted to reflect population characteristics.
To find the latest CAP resources on the coronavirus, visit our coronavirus resource page.