Before last week, it had been a long time since racial health disparities were the subject of a White House press briefing. But as evidence began to emerge that communities of color were suffering disproportionately from COVID-19, long-standing health disparities, particularly among African Americans, were thrust into the spotlight.
In his White House remarks, Dr. Anthony Fauci acknowledged that “we have known literally forever” that chronic conditions such as obesity, diabetes, hypertension, and asthma are deep-rooted plagues afflicting the African American community. The pandemic, Fauci noted, is “shining a bright light on just how unacceptable” these disparities are because they make COVID-19 more lethal.
Meanwhile, the Administration responded to concern about the lack of national data on racial inequities in the pandemic. Seema Verma, Administrator of the Centers for Medicare and Medicaid Service, assured the public that CMS “can now stratify by demographic information, so that we can look at race as a factor.”
It is heartening to see health inequities getting the attention they deserve at the highest level of government. Yet it is disconcerting that messages from the White House erase what we have known for decades—that racial health inequities are a consequence of systemic racism, not race.
Our leaders’ silence about the systemic causes of health inequities creates two problems.
First, it leaves a vacuum that is likely to be filled with noxious ideas. One example is the suggestion that racial health disparities are rooted in innate biological differences. This assumption has a sordid history in American medicine and persists despite overwhelming evidence that it is wrong.
Last Wednesday, Louisiana Sen. Bill Cassidy perpetuated the myth of innate racial difference in an interview with NPR. Cassidy, a physician, claimed that African Americans might experience higher rates of diabetes because of “genetics.” Sen. Cassidy offered no evidence to support his claim, nor could he—there isn’t any.
That brings us to the second problem: Evading the systemic causes of racial health inequities deflects attention from steps we could take right now to reduce unequal suffering.
Systemic racism refers to policies and practices that create and enforce racial inequities in major systems of society—our legal system, education system, health care system, and so on. Research makes clear that these systems are the source of racial health inequities. The evidence is particularly robust for the “underlying conditions” that appear make COVID-19 more deadly: obesity, diabetes, hypertension, and asthma.
The most obvious inequity is racialized poverty. Federal Reserve board data show that, for every dollar of wealth in median white households, median black households have about a dime. This massive wealth gap, which fuels the health gap, is not attributable to individual differences in savings habits or even to differences in income. It stems from decades of racist policies that subsidized white wealth and limited opportunities—including the opportunity for good health—among people of color.
Racist policies also explain race-based residential segregation, a fundamental cause of health inequities. Many health-sustaining resources vary by place: the quality of schools, condition of housing, exposure to pollution, reliability of transportation, availability of healthy food, access to safe places for exercise, access to quality health care. All of these factors are known to inflame racial health inequities, and all are amenable to policy change.
Beyond systems, we know that the stress of dealing with racism is toxic. Studies show that exposure to discrimination has far-reaching biological effects, including obesity, elevated blood pressure, poorer diabetes control, impaired immune function, and accelerated cellular aging. Discrimination in health care settings compounds these effects, exacerbating inequities in access to care. During the current crisis, these inequities are likely to grow, as the health care system comes under increasing strain.
In a White House briefing last week, President Trump expressed bewilderment at the magnitude of racial inequities. “This is something that has come up,” he said, referring to disproportionate death rates from COVID-19. “Why is it that the African American community is so much, numerous times more [likely to die] than everybody else? It doesn’t make sense.”
In reality, there is no mystery. As Dr. Fauci noted, racial health inequities didn’t just come up. And the deadly toll of COVID-19 in communities of color makes perfect, tragic sense once we acknowledge the real underlying condition: systemic racism. The only question is whether witnessing the suffering our system produces, seeing it laid bare, will finally move us to act.
Clarence (Lance) C. Gravlee is an associate professor in the Department of Anthropology at the University of Florida, where he holds affiliate appointments in the College of Public Health, the Center for the Study of Race and Race Relations, and African American Studies. His research on racial inequalities in health has been published in scientific journals, including American Journal of Public Health, American Journal of Human Biology, Annual Review of Anthropology, Economics & Human Biology, and Culture, Medicine & Psychiatry.