Racism: The most dangerous ‘pre-existing condition’

Edna Bonhomme 14 April 2020
Black Americans are dying disproportionately from COVID-19 and there is a reason for it.

History has shown us that the consequences of contagion are not equally felt by all communities.
More than 100 years ago, a 1926 syphilis survey conducted in the US state of Alabama showed that 36 percent of the people in Macon County had syphilis. Only 60 years after the legal abolition of slavery, Black Americans made up the majority of that county, barely keeping a living through sharecropping.
In 1932, the county was chosen to become a living laboratory in which for the next few decades, Black men would be tested and examined to track the development of syphilis. The study was led by what was then known as the Tuskegee Institute, which recruited hundreds of residents, misleading them that they were receiving treatment.
In the late 1940s, effective treatments became available for the disease, but the unwilling participants in the study were not given access to it. They did not become aware that they were being lied to until local media uncovered the truth in 1972.
This story was not an isolated accident but was rather part of the systematic disregard for African American lives by public and private institutions during the Jim Crow era. At that time, medical professionals openly espoused anti-Black racist beliefs and were convinced treatment for some diseases, like syphilis, was not possible among Black communities.
For instance, Thomas W Murrell, a doctor at the University College of Medicine in Richmond, Virginia, wrote in 1906:
“Those that are treated are only half cured, and the effort to assimilate a complex civilization drives their diseased minds until the results are criminal records. Perhaps here, in conjunction with tuberculosis, will be the end of the negro problem. Disease will accomplish what man cannot do.” 
Fast forward to 2020, when the United States is battling a pandemic of the COVID-19 virus, and a similar racialised pattern of contagion and treatment has come to the fore.
In early April, the online media outlet ProPublica reported that African Americans are getting infected by the novel coronavirus at a faster pace than white communities.
In the state of Michigan, Wayne County – where the black-majority city of Detroit is located – accounts for 47 percent of the state’s coronavirus cases. In New York City, Black people account for 28 percent of fatalities and account of 22 percent of the city’s population.
The contagion by now is known to wipe out whole families, as happened with Sandy Brown, an African American woman living in a suburb of the black-majority working-class town of Flint, Michigan, who lost her husband and son.
Inequality is ingrained in America and the latest statistics concerning this are damning. Unfortunately, the US government so far has not taken adequate action; instead, it has put the responsibility entirely on minority communities to protect themselves against health inequities they are not responsible for.
On April 10, Surgeon General Jerome Adams acknowledged during a press conference that Black Americans are more prone to COVID-19 because of social issues.
He advised African Americans and Latinos to adhere to the White House task force guidelines but did not say anything about how the US government planned to alleviate the social circumstances which have made these communities more susceptible to the virus.
The American medical-industrial complex likes to explicitly or implicitly blame Black Americans for their health outcomes rather than provide the resources and tools to eradicate health inequities. This is not too different from the Jim Crowe years when doctors believed that “lust and immorality, unstable families” among Black people were the reasons why there was a higher incidence of illness in their community.
In the past as in today, social factors that are beyond the control of communities of colour are responsible for the increased incidence of illness and are now putting them at a higher risk of a fatal outcome in case of a COVID-19 infection.
As Dr Lisa Cooper, a physician at Johns Hopkins University explained in an interview for US News: “This is because as a group, African Americans in the US have higher rates of poverty, housing and food insecurity, unemployment or underemployment, and chronic medical conditions and disabilities.”
In other words, racism has a biological impact on black and brown bodies; the chronic stress of everyday racism makes people sicker. African Americans are more likely to experience racial disparities which translate into higher rates of hypertension, asthma, diabetes, etc – “pre-existing conditions” that are linked to higher death rates from COVID-19 infections.
Many of these chronic illnesses emerge from environmental factors such as Black Americans living in underserved neighbourhoods that are disproportionately subjected to a lack of clean water such as in Flint, Michigan or higher rates of air pollution such as in the historically black neighbourhood of Harlem in New York City.
Apart from environmental racism, Black communities also face lower rates of healthcare coverage and are less likely to be taken seriously by a doctor, which also exacerbates health inequities.
Of three Black Americans who had COVID-19 interviewed by The Root recently, two said they were initially sent away when they tried to get tested. One, 27-year-old Geniece Ward, noted that she was experiencing a lot of pain and her temperature was 101.9 F (38.8 C), but she was told she had to have every single symptom in order to get tested.
Some Black physicians have already sounded the alarm that amid the pandemic, the Black community may suffer disproportionately because of unequal access to health care. In an interview for Slate, Dr Uche Blackstock said: “When it’s time for clinicians to ration resources, I think we can already assume that Black patients are going to be disadvantaged because they’re not going to be listened to.”
That African Americans are disproportionately more likely to suffer from a lack of adequate care is particularly dangerous amid this pandemic because their living conditions and employment may prevent them from following social distancing guidelines and put them at a higher risk of contracting the disease in the first place.
African Americans are more likely to have essential jobs which keep the country going amid lockdowns, including in home health assistance, sanitation, public transportation and grocery stores. In New York City, at least 1,167 Metropolitan Transit Authority employees have tested positive for COVID-19 and 33 have died.
African Americans are also facing health inequities in the prison system, where they are also disproportionately represented (a third of Black men are likely to spend time in prison).
There is already a history of epidemics of infectious diseases, such as HIV-AIDS, tuberculosis and hepatitis C spreading in the US prison system, and public health experts are worried that problems with health provision and hygiene could make outbreaks of COVID-19 that more deadly in private and public detention centres.
The Cook County Jail outside of Chicago has already become the largest place of prison infection in the US with more than 251 inmates and 150 employees ill with the virus.
The risk of Black people dying disproportionately is not new and is all too familiar for those born and raised in America. Coronavirus is not racist, rather, it reveals racism in American society – one that speaks to a massive wealth gap, healthcare gap and housing gap.
A century ago, when African Americans were subjected to medical testing, experimentation and racial terror, we had less information about the life of viruses. Today, we have the power and resources to provide universal healthcare in the United States, yet, this is withheld because of the political myopia of the majority of the elected officials and the greed of private insurance companies.
If we want to disrupt the racial health inequalities that we are witnessing today with African Americans, that requires employing holistic and humane health policies that speak to the material concerns, where access to healthcare is an indisputable human right for some, but a benefit for all.
The views expressed in this article are the author’s own and do not necessarily reflect Al Jazeera’s editorial stance.