Dear Black America,
By now, you’ve seen or heard that it has been validated once again: when white America gets a cold, black people get pneumonia!
The early data emerging from the coronavirus pandemic in the United States has laid bare the disparities many public-health specialists are all too familiar with: Racial minorities are disproportionately affected by health crises such as this one. And in the case of COVID-19, more of them have died. As of this writing, there are over half-million confirmed cases, and over 20,000 dead. According to some experts, blacks, no matter where they live in this country, are thought to represent half of all those who have died, and upwards of 60-70 percent of confirmed cases.
In every one of the recent stories highlighting COVID-19, and its impact on African American communities all over this country, images, video, and commentary all magnify the “widespread” lack of compliance, the extreme vulnerability, and the disbelief that the virus is real. To the uninformed, it appears that black folks are just that “trifling”. If we buy into it, looking at the widespread devastation across this country, we could easily be made to feel that it’s our “fault”. Don’t let them make you mess with your sense of self-worth!
Somewhere, sooner or later, someone’s got to talk about institutional racism.
Everyone can agree that African Americans, have been slow to be tested; have difficulty complying with social distancing; tend to be “frontline” workers, without the ability to “work from home”; and are carrying a disproportionate burden of the full range of chronic diseases. As all of these points, certainly, are major contributing factors to the high infection and death rates from COVID-19 among African Americans, few acknowledge the link to institutional racism. While America was being built into the world’s greatest power, the disadvantages and marginalization of 400 years has left African Americans (for the most part) sicker, poorer, less educated; and more vulnerable at a time like this. “You can’t drive a bus or wash dishes on Zoom.
I felt an obligation to share some insights to help make sure that this does not become a “blame the victim” moment, or worse another effort to chip away at our collective sense of self-worth and/or self-esteem.
We have not historically been included in mainstream society. We lived within the framework of our cultural patterns and behaviors. Almost without exception, every area where we have worse outcomes, has at its core, the impact of having built a society, with its’ tenets grounded in institutional racism.
Let me give you an example.
When the Centers for Disease and Control guidelines were established, African American communities, by and large, were disadvantaged before the first test was conducted. The country was told not to go to the hospital or doctor’s office; call your doctor! Well…no one considered that a significant number of the black folks in this county don’t have a doctor! Newly insured under Obamacare, state exchanges, or Medicaid expansion often do not have a specific individual they can call. As a result, a large percentage of the entire black community was disadvantaged before the first test was even conducted. So, the first to be tested were the first to be hospitalized, and the first to get a ventilator. In addition, no testing means we were contagious longer and exposed larger numbers of other people who in turn infected others. Thus, the huge infection and death rates in our communities and families.
Another unacknowledged issue is the management of chronic diseases for African American patients. We were generally sicker with a disproportionate rate of diabetes, heart disease, kidney disease (look at all the dialysis centers), and the usual suspects, before COVID-19 hit. Now, not only are we seeing a strain on the medical workforce to care for those hit with the virus. What are the provisions to insure that adequate, quality primary care will continue to widely available to care for this segment of our population? If there is nothing done, coming out of this we will continue to be sicker and more vulnerable to whatever may hit us in the future. Then, we will really feel like we did something wrong. Don’t let them make you mess with your sense of self-worth!
Add to that the cultural behaviors in African American communities.
Webster’s defines social distancing as, “the practice of maintaining a greater than usual physical distance from other people or of avoiding direct contact with people or objects in public places during the outbreak of a contagious disease in order to minimize exposure and reduce the transmission of infection.” Every culture is a world of its own. Verbal communication and day to day way of life are the true expression of what the culture of a certain place is like.
You know, the same cultural behaviors that (in my opinion) almost wiped out Italy: close families; celebrations; funerals; physically affectionate. No one singled them out for their behavior.
Now, can we do better? Should we be doing better? You’re absolutely right. We can and we should; and I believe we are, and we will.
Don’t let them make you mess with your sense of self-worth! We’re smarter than that, and better than that.
Glenn Ellis, MPH, is a Harvard Medical School Research Bioethics Fellow and author of Which Doctor?, and Information is the Best Medicine. For more good health information visit: www.glennellis.com
