“I used to view White Supremacy as the folks marching in Klan robes, but have come to realize that it is an idea that operates most consequentially as the quiet default, and through systems that make White the ideal, provide White the benefit of the doubt, to the detriment of those who are not White, who are efficiently marked as less valuable in ways that require no shouting.
“The phrase 'White Supremacy' is jarring to most Whites and I fear being called ‘a Racist’ as much as almost anything. Sorting the world into Racists and Not Racists lets me off the hook and is a way of perpetuating the pernicious old idea that there is a hierarchy of human value, most commonly marked by race across U.S. history.
“The systems operating need to be named and rejected if we are ever to live into the notions of equality, stated as truths in the Declaration of Independence, that remain aspirations worth fighting for today.”
– Don Taylor, Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University
Let's examine a truth – there exists a disproportionate death toll of Blacks during the COVID-19 pandemic.
The Centers For Disease Control and Prevention (CDC) have revealed findings on the disproportionate burden of COVID-19 deaths among some racial and ethnic minority groups. A study of selected states and cities with data on COVID-19 deaths by race and ethnicity showed that 34% of deaths were among non-Hispanic Black people, though this group accounts for only 12% of the total U.S. Population.
L. Holmes, M. Enwere, J. Williams et al. “Black-White Risk Differentials in COVID-19 (SARS-COV2) Transmission, Mortality and Case Fatality in the United States: Translational Epidemiologic Perspective and Challenges.” Int J Environ Res Public Health. 2020.)
“In Michigan, over 40% of COVID-19 deaths are African Americans, while only 14% of the population is made up of African Americans. This is significant, and these numbers are changing every single day.”
– David J. Brown, M.D., associate vice president and associate dean for health equity and inclusion at Michigan Medicine
Whites may ask incredulously “I wonder why that is the case?” and note the presence of comorbidities as an explanation that makes the fact less scandalous. However, Taylor cites threes reasons for this Black/White COVID-19 mortality disparity, and they all flow from the multi-century history of White supremacy in the United States.
Taylor says …
“First, Blacks are at higher risk of occupational exposure because they disproportionately work jobs that are deemed essential, but are not paid as such, nor adequately protected on the job.
“Second, there are decades of research showing that Blacks are treated differently when seeking health care than are Whites, a phenomenon being reproduced today with COVID19.
“And finally, Racism and White Supremacy not only have structural impacts on Black people’s lives (housing, incarceration, income, education, health care) that put them at risk, but there are physiological impacts due to increased allostatic load that result in cellular changes through that is called 'the weathering hypothesis' that have effects on health and mortality independent of factors like poverty among Blacks as compared to Whites.”
(Don Taylor. “Telling the Truth About Race.” Don Taylor's RECKONING BLOG. MAY 29, 2020.)
Taylor concludes: “It is hard and scary but if White people do not speak up, then we are complicit, in direct proportion to our power and influence. I am not sure what to do next. Telling the truth is the best I can do right now.”
Telling the Truth
Let's examine further the truth of structural impacts on Blacks as they relate to the pandemic. The CDC confirms the evidence from the provisional death data of the National Center for Health Statistics and recent studies that clearly illustrate the disproportionate burden of COVID-19 deaths among racial and ethnic minority groups, particularly Hispanic or Latino, non-Hispanic Black, and non-Hispanic American Indian or Alaska Native people.
The CDC promotes the following redress: “To prevent deaths from COVID-19, we need to work together to address inequities in the social determinants of health that increase the risk of death from COVID-19 for racial and ethnic minority groups.”
(“COVID-19 Racial and Ethnic Health Disparities.” CDC. December 10, 2020.)
A new study reported in the Journal of the American Medical Association (JAMA) confirms older Black Americans hospitalized for COVID-19 face a greater risk of death than their white counterparts because they disproportionately receive care in facilities with worse outcomes for all.
(David A. Asch, MD, MBA1,2; Md Nazmul Islam, PhD, MBA3; Natalie E. Sheils, PhD3,; et al. “Patient and Hospital Factors Associated With Differences in Mortality Rates Among Black and White US Medicare Beneficiaries Hospitalized With COVID-19 Infection.” JAMA Netw Open. 2021 )
After analyzing the health records of 44,217 Medicare Advantage patients (average age 76) hospitalized with COVID-19 from January through Sept. 21, researchers found that the odds of dying within 30 days of hospitalization (or discharge to hospice care) were 11 percent higher for Black patients than for white patients.
As for the reason for the disparity, the study points to differences in the hospitals — rather than the patients — as the major cause.
“People often assume that Black-white differences in mortality are due to higher rates of chronic health conditions among Black individuals. But time and again, research has shown that where Black patients get their care is much more important, and that if you account for where people are hospitalized, differences in mortality vanish,” study coauthor Rachel M. Werner, M.D., executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania, said in a statement.
“Because patients tend to go to hospitals near where they live, these new findings tell a story of racial residential segregation and reflect our country’s racial history that has been highlighted by the pandemic,” study coauthor, David Asch, M.D., the executive director of Penn Medicine’s Center for Health Care Innovation, said in a statement.
In a Washington Post column, Asch and Werner wrote that hospitals located in poorer neighborhoods tend to treat more patients who are uninsured or insured by Medicaid with inadequate reimbursement rates.
“In effect, doctors and hospitals in the United States are paid less to take care of Black patients than they are paid to take care of white patients. When we talk about structural racism in health care, this is part of what we mean,” they wrote.
(Peter Urban. “Blacks Hospitalized for COVID-19 Face Higher Odds of Death.” AARP. June 24, 2021.)
Allow me to repeat – Doctors and hospitals in the U.S. are “paid less to take care of Black patients than they are to take care of white patients.” That is a classic example of structural racism.
Structural Racism is a system in which public policies, institutional practices, cultural representations, and other norms work in various, often reinforcing ways to perpetuate racial group inequity. It has been part of the social, economic, and political systems in which we all exist. It is part of America’s past and its present.
Weathering Hypothesis
Arline Geronimus, Sc.D., professor of health behavior and health education at the Univerity of Michigan School of Public Health, believes it's completely implausible that there’s one single factor that explains these major differences across populations.
Geronimus coined and has studied the “weathering hypothesis,” which describes what happens to black people’s bodies across body systems and down to the cellular level from living in a racist society.
Geronimus hypothesizes that weathering of the immune system could be contributing to more serious illness in these populations, even across socioeconomic lines. The hypothesis is …
“The sustained high effort coping with environmental, psychosocial, and material stressors over years and decades and across generations that Blacks must engage and endure in a racist system leads to cellular damage and accelerated biological aging, resulting in high prevalence and early onset of chronic diseases and increased vulnerability to the worst impacts of infectious disease.”
(A.T. Geronimus. “The weathering hypothesis and the health of African-American women and infants: evidence and speculations.” Ethn Dis. Summer 1992.)
“In medical school, when they teach you how to diagnose illness, they say when you hear hoof beats, think horses not zebras. Weathering is the horses and, while complex, is really right in front of our faces; there’s no need to start speculating about an out-sized role of vitamin D deficiency or single genes” Geronimus says.
The weathering hypothesis was initially proposed as a sociological explanation for health disparities, but it is closely related to biological theories like the Allostatic load model, which proposes that an individual's exposure to repeated or chronic stress over their lifetime has physiological consequences which can be measured through various biomarkers.
There is a growing body of evidence implicating the role of elevated allostatic load in adverse pregnancy outcomes among women of color. Some studies argue that there is a moral imperative to assign additional resources to reduce the effects of elevated allostatic load before, during, and after pregnancy to improve the health of women and their children. Traditional explanations for disparate outcomes, such as personal health behaviors, socioeconomic status, health literacy, and access to healthcare, do not sufficiently explain why non-Hispanic Black women continue to die at three to four times the rate of White women during pregnancy, childbirth, or postpartum.
Kirsten A. Riggan, Anna Gilbert & Megan A. Allyse. “Acknowledging and Addressing Allostatic Load in Pregnancy Care. Journal of Racial and Ethnic Health Disparities 8, 69–79. 2021.)
Conclusions
The evidence is strong: naming and rejecting White privilege and structural racism is crucial for implementing societal changes that will save the lives of Black Americans. The disproportionate death toll of Blacks during the COVID-19 pandemic puts crucial statistics squarely before our eyes … there for all of us to see.
But, can we remove ourselves from our own misconceptions and long-held attitudes to face the truth? While almost all of us reject racism in its hideous and easily detectable forms like Klan hoods, knees on necks, and ethnic slurs, many still refuse to acknowledge systematic and structural barriers to equality.
Why?
Indirect, aversive racism is practiced by those who regard themselves as non-prejudiced but, at the same time, who harbor negative feelings and beliefs about members of minority groups. Many of these people may not even be conscious they hold these deep-seated feelings. And, these aversive racists often fear giving up advantages of majority and control. In short, these Whites have privilege but only wish to share if they have the power to grant benefits they deem necessary … thus, simply extending the same system they have controlled all of their lives. The alternative? I think you know.
So, if you think Covid is a left-wing conspiracy; you think it is “just the flu”; and you refuse to take the vaccine – you can be privilege to know one fact: the virus is bigoted as hell. It cuts down minorities to a much greater extent than it does pale faces. I assume White nationalists care little about this unhealthy inequality.
“The most effective adaptation of racism over time is the idea that racism is conscious bias held by mean people. This 'good/bad binary,' positing a world of evil racists and compassionate non-racists, is itself a racist construct, eliding systemic injustice and imbuing racism with such shattering moral meaning that white people, especially progressives, cannot bear to face their collusion in it.
“(Pause on that, white reader. You may have subconsciously developed your strong negative feelings about racism in order to escape having to help dismantle it.)”
-- Katy Waldman, staff writer at The New Yorker in a review on White Fragility by Robin DiAngelo (2018)
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