CREDIT: PRODUCED BY HUNNI MEDIA FOR KNOWABLE MAGAZINE

The coronavirus pandemic has affected everyone, but in the United States, communities of color have recorded a disproportionate number of cases, hospitalizations and deaths. In this video, Harvard’s David Williams, a renowned scholar of the link between racial discrimination and health, explains why decades of inequality have left populations of Black, Latinx, Native American and others more vulnerable to Covid-19.

“Although all Americans are in the same storm — we are in the same pandemic — but we are not in the same boats,” Williams says. “Those boats that have wealth, you are better able to navigate the storm. You’re better able to protect yourself … than those [in] very fragile boats — households that have no wealth.”

Williams discusses how stress — be it economic, psychosocial, environmental or caused by facing racism — increases the risk of conditions such as high blood pressure, obesity and diabetes, all of which are associated with worse outcomes in Covid-19.

“Persons who report high levels of everyday discrimination are more likely to get diabetes. They’re more likely to develop high blood pressure. They’re more likely to become obese. So across a broad range of indicators…, we find that stress in general and discrimination [in particular] leads to poorer health,” Williams says.

The solutions, he says, lie in recognizing the problem we are facing, and working to bridge what he calls the “empathy gap” that’s enabled health disparities to persist for so long. “The biggest challenge that we have is the fact that, to put it bluntly, we don’t care enough about the populations of color that are suffering this disproportionate burden.”

Read more

This video is part of Reset: The Science of Crisis & Recovery, an ongoing series exploring how the world is navigating the coronavirus pandemic, its consequences and the way forward. Reset is supported by a grant from the Alfred P. Sloan Foundation. Watch more videos from Knowable Magazine.

Transcript

David Williams (professor of public health, Harvard University): “By the end of July [2020], over 16,000 African Americans had died, who would not have died if they had the same death rate from Covid-19 as whites. It’s just one example of getting a concrete sense of the racial differences in health really mean the dramatic loss of life on a large scale.

“We have known for more than a hundred years that race matters for health. There are racial-ethnic differences at the beginning of life. Black babies are 2.4 times more likely to die before their first birthday than white infants in the United States, and that pattern of racial-ethnic differences exists across the life course. If you look at the best data that we have on Covid-19 deaths, what we see is that African-Americans have death rates that are at least twice that of those of whites. So it’s a striking difference that exists. Although there’s been a lot of awareness among researchers that race matters for health, national public opinion data tells us that most Americans have been unaware that racial-ethnic differences even exist.

“They think that Martin Luther King and the Civil Rights Movement and the 1960s policies solved the problem — and so that today racism no longer exists, racism is a relic of the past, and today everyone has equal opportunity. In fact, an interesting study published a couple years ago found that the Americans who are most likely to overestimate the degree of equality are highly educated whites who believe in a just world. So people are not motivated to solve a problem if they don’t even know the problem exists. So the first challenge is we need to raise awareness levels.”

Race and economic status

David Williams: “In the United States and in other racialized countries, we have large racial-ethnic differences in socioeconomic status, income, education and wealth. Look at data for the United States (total household income in the year 2018): For every dollar of household income that white households receive, African-American households receive 59 cents. And as large as that racial gap in income is, it dramatically understates the racial-ethnic differences in economic status.

“There’s something else that’s important called wealth. Wealth is the economic reserves that households have — it’s the savings, it’s the home equity, it’s the cash reserves that households have. And the latest Federal Reserve Board data tells us that for every dollar of wealth that white households have, Black households have 10 pennies and Latino households have 12 pennies. And when you lack wealth, you can be one paycheck away from being homeless, you can be one paycheck away from being able to feed your family. And so what we are seeing with these large racial-ethnic differences in wealth in this pandemic of Covid-19 is that although all Americans are in the same storm — we are in the same pandemic — we are not in the same boats. And some boats, those boats that have wealth, you are better able to navigate the storm, you’re better able to protect yourself and take care of yourself in the storm than those very fragile boats (households) that have no wealth.

“So if we think of Covid-19 and we think of why is it that Blacks and Latinos and other populations of color were at higher risk. Research indicates that Blacks and Latinos were disproportionately among the essential workers who kept the trains running and who stocked the shelves in our grocery stores, and so that working from home was not an option for them. So it put them on the front lines and made them at high risk. And then living in more crowded communities where social distancing was often not an option, and then the lower levels of access to medical care.

“Research also documented that when you looked at where was testing available in a city for Covid-19, in those poor, disadvantaged communities there was less access to testing for Covid-19 as well. So being able to identify the problem early on was also a challenge. So in multiple ways, the conditions of life — the neighborhood conditions, the housing conditions, the employment conditions — are all things that conspire together to put populations of color at higher risk of the pandemic.”

Stress and health

David Williams: “One of my areas of research is the impact of stress on health, and what we find when we do studies in the United States is that African Americans and Latinos have higher levels of stress, of multiple types of stressful life experiences. So they have higher levels of economic stress — that means more likely to lose their job, more likely to have difficulty making their ends meet at the end of the month. They also have higher levels of psychosocial stress like the death of a loved one; higher death rates means that you have the disproportionate loss of family members. And bereavement and death is a very stressful life experience. But they also have higher levels of exposure to physical chemical stressors; air pollution is an example of that.

“On top of all of these stressors I’ve talked about, there is an added burden that minorities also carry — and that is the stress of interpersonal racism. And what research documents is that the stress of discrimination leads to a broad range of health problems. Persons who report high levels of everyday discrimination are more likely to get diabetes, independent of other risk factors. They’re more likely to develop high blood pressure. They’re more likely to become obese. So across a broad range of indicators of chronic disease and poor health, we find that stress in general — and discrimination, as well, as one type of stress — leads to poorer health. What’s the consequence of this? Well, the Centers for Disease Control tells us that African-Americans get most chronic illnesses like high blood pressure, like diabetes, like heart disease at younger ages than whites.

“Researchers who study this phenomenon have developed terms like ‘accelerated aging’ or ‘premature aging’ or ‘biological weathering’ to capture the added burden of stress on the lives of African-Americans and other populations of color. And why does that matter profoundly with Covid-19? Well, if you look at individuals who were hospitalized for Covid-19 in the United States, they have what we call some co-morbid condition: They’re more likely to be obese or have high blood pressure or have diabetes or have some respiratory condition.

“So basically what I’m saying is the stressors of daily life over decades of living in bad residential and working environments have been preparing individuals and making populations of color more vulnerable to the impact of a condition like Covid-19, which has a disproportionate negative impact on people who have underlying health conditions.”

The empathy gap

David Williams: “The biggest challenge that we have is the fact that — to put it bluntly — we don’t care enough about the populations of color that are suffering this disproportionate burden. And I go back to the powerful words of W.E.B. Du Bois: ‘The most difficult social problem in the matter of Negro health is the peculiar attitude of the nation toward the well-being of the race. There have been few other cases in the history of civilized peoples where human suffering has been viewed with such peculiar indifference.’

“What W.E.B. Du Bois called the ‘peculiar indifference,’ scholars today study and call it the ‘empathy gap.’ Most adults feel greater empathy, feel greater compassion for the suffering that occurs to someone of their own racial group than the suffering that occurs to someone of a different racial group.

“How do we build the empathy? How do we get the compassion? How can we generate that same kind of response to challenges that are sitting on our doorstep? That we can see the challenges and we can feel the pain of those who are suffering, and we will say this is unacceptable, and we will tell our political leaders we need to implement those strategies that have been shown to work and that will save our society money, so that we can allow every American child to have a chance at living the American dream.”