Blacks & COVID-19 Explained: Digging Deeper to Understand Why Black Americans have Underlying Medical Conditions
After seeing recent reports of the incredibly high numbers of Black Americans dying from the coronavirus and mentally processing the unfathomable amount of friends and family impacted, I was motivated to attempt to shed light on why Black Americans are disproportionately impacted by COVID-19. It is true that Black Americans have underlying medical conditions, but I rarely hear why that is the case or how that came to be.
Dr. Anthony Fauci, NIAID Director on the impact of the coronavirus on Black Americans
“Those numbers take your breath away, they really do”
-Chicago Mayor Lori Lightfoot
By now, you’ve likely seen the reports out of Houston, New York, Detroit, New Jersey and many other cities. For those interested in the numbers: In Chicago, 72% of the people who have died from COVID-19 are Black, although they only make up 30% of the population. In the state of Louisiana 33% of the population are African Americans, and 70% of the deaths are African-Americans. In Michigan, African Americans are 14% of the population and account for approximately 40% of the deaths. It is beyond dispute that the coronavirus disproportionately impacts Black Americans at alarming rates. The reason? Black Americans have more underlying medical conditions and have less access to affordable health care.
In the video above, Dr. Fauci gets it right. He passionately talks about the existing medical issues prevalent in many Black American communities. He mentions diabetes, high blood pressure, obesity, and asthma. These conditions have been well documented over the years. However, Dr. Fauci stops short of addressing why Black Americans have underlying conditions. Is it that Black Americans are just unlucky? I’m afraid there’s much more to it.
Where Did These Underlying Conditions Come From?
The truth is complicated and cross cuts several interconnected issues. For our purposes, we can simplify our answer into buckets encompassing housing policy, and urban planning and design, which have all lead to the environments in which Black Americans live as being the biggest cause of underlying medical conditions in Black communities.
Here’s what happened (an abridged version). After slavery, local governments introduced exclusionary zoning, which prevented the sale of certain land to Blacks. After the Supreme Court ruled the practice unconstitutional, restrictive covenants which governed the private sale of land prevented Blacks from acquiring certain property. The Supreme Court later found restrictive covenants unconstitutional, but by then the practice was so widespread that the illegality of it was rendered moot. So you’ve got discrimination at the local level in the years following emancipation (exclusionary zoning), followed by socially acceptable discrimination through the 1940’s (racially restrictive covenants), and if that were not enough the Federal government instituted redlining policies after the Great Depression.
Through government agencies such as the Federal Housing Authority (FHA) and the Homeowners’ Loan Corporation (HOLC) redlining policies were implemented to intentionally separate the races and resulted in the deprivation of essential resources in African American communities. Redlining has had perhaps the biggest impact on the public health crisis impacting Black Americans. Redlining is where banks and other lending institutions deny mortgages or offer much higher rates to customers in certain neighborhoods based on their racial identity. It was commonly practiced by the FHA and the HOLC, and effectively disrupted much of the economic progress Black Americans made post-slavery. The Fair Housing Act of 1968 put an end to redlining, but its impacts were already pervasive throughout the country. Many of the neighborhoods that were labeled as undesirable through redlining in the early 20th century are still underdeveloped and lacking basic services — especially healthcare. These are the neighborhoods that tend to include plants, factories, bus depots and other industrial and hazardous facilities. Green spaces are often absent. These communities experience extreme environmental burdens such as exposure to toxic chemicals in the air, water, and the ground. The irony is that these facilities often lead to pollution rather than employment for nearby residents.
Brooklyn Redlining Map
New Orleans Redlining Map
Philadelphia Redlining Map
On top of redlining, it has been well established that neighborhood associations created by subdivision developers; industry associations such as the American Construction Council, the National Association of Real Estate Boards, and Better Homes in America campaign all encouraged discriminatory practices and played a vital role in where and how Black Americans live today. Block Busting and White flight, which was spurred by intentional propaganda campaigns also played a critical role.
These truths run deep and are seismic. All of the aforementioned factors directly connect back to where Black Americans live today and how they came to be there. It has been shown that housing disparities lead to other disparities. Housing disparities have resulted in transportation deserts, food desserts, the lack of access to jobs, access to health care, poor air quality and water quality due to, and much more. This inequity has lead to massive incarceration rates and a public health crisis that we are so painfully being confronted with now.
We tend to think of societal issues such as education, affordable housing, public health, and the environment as separate and distinct. Instead what we are forced to come to terms with is the impact of coronavirus in the Black community is merely an amalgamation of those issues. They represent a reflection of what was already there. Ta-Nehisi Coates wrote, “Housing determines access to transportation, green spaces, decent schools, decent food, decent jobs, and decent services. Housing affects your chances of being robbed and shot as well as your chances of being stopped and frisked.” Hmm. (see here)
Not So Fun Facts
- Black Americans have lower levels of health insurance coverage and are less likely to have insurance coverage through an employer. (see here)
- Black Americans were 75 percent more likely to live in places bordering a polluting facility like a factory or refinery compared to other Americans (see here)
- Hospitals in predominantly Black neighborhoods are more likely to close down than those in predominantly white neighborhoods (see here)
- Black Americans are more likely to live in urban areas and coronavirus spreads faster in locations with higher density such as urban areas. (see here)
Personal Reflections
The reports of what’s happening to the Black community while devastating are unsurprising. It’s sad, but true. My wife and I — neither of whom possess medical backgrounds predicted this outcome early on, and here we are. And I know we were not alone in our speculations. I’ve found that sometimes the truth has to strike some directly in the face for them to see what’s been there in front of them all along. For me, the steady stream of death announcements on my Facebook timeline is a not so subtle reminder of the inequalities of the American health care system, which is a direct result of housing and urban planning policy and design rooted in racism despite many efforts of some to change things for the better. Mothers, Fathers, Brothers, Sisters, Uncles, Aunts, Grandmothers, Grandfathers, Cousins. All gone. Just like that.
Dr. Fauci closed his remarks by stating that after we get over the coronavirus there still will be health disparities in the African-American community that we need to address. I would love to further explore just how we do that. In the interim, more racial and ethnic data is needed to more fully understand the impact of the coronavirus pandemic and how we can dedicate resources to incorrect systemic inequality.
Stay Safe.
More about redlining here (NY Times) and here (CityLab). More about public health disparities here (The Century Foundation).
Other resources:
