The piece below is excerpted from Clarence Lusane’s Twenty Dollars and Change from City Lights Publishers (November 2022).
When it became clear that African Americans were contracting COVID and dying at much higher rates than others, a range of arguments emerged to explain why. The “comorbidities” analysis came to dominate. According to this approach to the data, African Americans became sicker and died at higher rates due to “pre-existing” health conditions or comorbidities such as high blood pressure, diabetes, asthma and obesity.
These pre-existing conditions have fed racialized notions that African Americans themselves are at fault for their susceptibility to the worse effects of COVID-19. As Ibram X. Kendi writes, “Americans are blaming Black people” for their medical conditions “but, crucially, they’re not explaining why. Or they blame the choices made by Black people, or poverty or obesity—but not racism.”
In other words, what were the conditions in the first place that led to these disparities in health situations? Why have they been permitted to persist? What is being done to eliminate them? Not only were these questions not being asked regarding the roots of the pre-existing conditions in the Black community, but queries as to why African Americans are so vulnerable to becoming infected were being ignored. Black voices in the medical and social justice community began to push back against racist explanations for black suffering.
Writing in The New York Times, Professor Sabrina Strings said the ongoing legacies of white supremacy are the root of contemporary health disparities between people of color and white people. She wrote, “The era of slavery was when white Americans determined that black Americans needed only the bare necessities, not enough to keep them optimally safe and healthy. It set in motion black people’s diminished access to healthy foods, safe working conditions, medical treatment and a host of other social inequities that negatively impact health.”
The legacies of white supremacy have not only caused health discrepancies but continue to perpetrate narratives that blame African Americans themselves for poorer health.
Despite generations of progress, structural racism in the medical system persists. A study by the biotech data company Rubix Life Sciences, for example, found that African Americans with COVID-like symptoms, such as persistent cough or fever, were not treated the same way as white patients with similar symptoms. The company reviewed medical billing data across a number of states and concluded that in the early days of the pandemic “an African American with symptoms like cough and fever was less likely to be given one of the scarce coronavirus tests.”
This treatment correlates with other studies showing that a disturbing number of white people, including those with medical training, continue to believe there are biological differences between African Americans and white Americans. One study, published in the Proceedings of the National Academy of Sciences of the United States of America (PNAS), focused on medical students and residents. It concluded that “many white medical students and residents hold beliefs about biological differences between [B]lacks and whites, many of which are false and fantastical in nature, and that these false beliefs are related to racial bias in pain perception.”
Other research demonstrated similar bias. According to BlackDoctor.org, African Americans “were 40 percent less likely to receive medication to ease acute pain” and “34 percent less likely to receive opioids for acute pain” compared to white Americans. Latinx people were 25 percent and 13 percent less likely, respectively, compared to whites. These racist practices have led to higher levels of preventable suffering among African Americans and Latinx people.
Black people still have a significantly higher uninsured rate than white people (7.5 percent) or Asian Americans (6.3 percent). As of the first half of 2021, almost a quarter of the Latinx population did not have health insurance, up from a historical low of 19.3 percent in 2016. Until states and cities began to provide free COVID-19 tests, few could afford to pay the steep cost of determining whether or not they had the virus. Due to lack of insurance and potentially overwhelming medical bills, many Black families hesitated to go to the doctor when experiencing COVID-like symptoms. As a result, many waited until symptoms became severe and then went to the emergency room. Treating the infection earlier would have likely saved lives.
White supremacy and racial injustice have skewed medical practices just as they have skewed everything else. Despite decades of advocacy, disparities based on race, gender and income persist. While the Affordable Care Act has made a profound difference for many, people of color continue to suffer under a racialized system that refuses to operate in a fair and efficient matter. Epidemics and pandemics will continue, and without substantial change to the U.S. healthcare system, each future outbreak will only aggravate social cleavages. A single, national, tax-funded healthcare system that covers all U.S. citizens and residents with zero-to-minimum individual costs—sometimes referred to as “Medicare for all” or “single-payer”—is urgently needed. But that is not enough.
The adverse pre-existing health conditions that exacerbate the potential harm of COVID-19 are by-products of a social system biased to favor white people and the wealthy. Establishing a genuinely just national healthcare regime means abolishing these biases. As the CDC itself says, “Addressing the underlying inequities in social determinants of health is key to improving health and reducing health disparities.” Doing so is also a necessary prerequisite for freeing ourselves from the injustices that continue to be imposed on us today. Achieving health justice won’t happen by itself. First, we need to imagine it can be done. Then we need to organize and make it happen together.