African American communities in the United States have always suffered health disparities compared to white Americans. COVID-19 impacts are continuing this pattern, and exposing human rights failings. The Washington Post reported that “…in Illinois, a disparity nearly identical to Michigan’s exists at the state level, but the picture becomes far starker when looking at data just from Chicago, where black residents have died at a rate six times that of white residents. Of the city’s 118 reported deaths, nearly 70 percent were black—a share 40 points greater than the percentage of African Americans living in Chicago.”
The logistics to secure laboratory testing for COVID-19 in the United States present enormous challenges for people of color, many of whom live in poverty and have no health coverage. The US Census Bureau reported that in 2018, 27.5 million Americans (8.5%) were without health insurance, and 38.1 million (11.8%) were living in poverty. CDC guidelines for COVID-19 testing advise that people who suspect they have had exposure to the virus and have a fever and other symptoms, such as a cough or difficulty breathing, to call their healthcare providers for medical advice and also to call their doctor in advance of visiting. However, people without health insurance and living below the federal poverty line generally do not have any significant interactions with healthcare providers, and many do not have regular doctors. Obtaining laboratory testing is a mammoth task for people in those circumstances. It is clear that the guidelines pertaining to laboratory testing did not accommodate the circumstances of these communities, many of whom are African Americans and other people of color.
This public health crisis is exposing the huge racial health disparities and structural disadvantages that so many African Americans live with. This existential crisis could be addressed so that health outcomes are equalized for all in American society. It requires a focus on the link between social conditions and disease (COVID-19). The social determinants of health include the environmental and social conditions in which people live, work, and play, and they include people’s relationships with others in their community and country. Using the ‘social conditions’ approach, it is possible to assess and contextualize risk factors, including calculating likely exposure to viruses or other toxins. And so, in order to end health disparities, there is need to understand the social conditions of everyone in society and not just presume the same risks apply to everyone. Better health outcomes for African Americans require interventions to improve the social conditions that create health disparities, and to do this African Americans must participate in the processes. This would be the start of a human rights-based approach to improve African American health and one of its essential goals is necessarily ending systemic racism in American society. Only then can the egregious disparities associated with diseases like COVID-19 be reduced.
Prem Misir, PhD, MPH, FRSPH, is Immediate Past Pro Vice-Chancellor and Head of the School of Public Health, The University of the South Pacific, Solomon Islands