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On April 8, the Centers for Disease Control and Prevention director Rochelle Walensky, MD, declared that racism is a serious public health threat that directly affects the well-being of millions of Americans.¹ Moreover, the impacts of the COVID-19 pandemic are felt most severely in communities of color, she said, adding that “these communities have experienced disproportionate case counts and deaths, and [are] where the social impact of the pandemic has been most extreme.”¹

This topic will be the subject of a lecture at IFM’s Annual International Conference (AIC), where David R. Williams, PhD, from the Harvard T.H. Chan School of Public Health, will present “COVID-19: A Tutorial on Racism.” The lecture will describe the unequal impact of the pandemic across ethnic groups. It will show how institutional racism (segregation) can lead to increased risk and how interpersonal discrimination and implicit bias can adversely affect health outcomes. It will also describe how we, as a society, can build “herd immunity” by addressing the social determinants of health to protect vulnerable populations.

Research over the last four decades suggests that race-based mistreatment on the basis of physical characteristics takes a heavy toll on Black people, and statistics indicate that health inequities are increasing, with Black and Native American individuals having shorter life spans and more illness than white persons.² Specifically, researchers examined Black/white health disparities using data from the National Center for Health Statistics for the years 1950 to 2000 and found that although rates of heart disease were similar for Blacks and whites in 1950, by the year 2000, Blacks had a rate of heart disease 30% higher than that of whites.³ Social conditions such as chronic stress, racial residential segregation, and discrimination have all been suggested to impact cardiovascular disease (CVD) risk.^4,5

“Imagine a fully loaded jumbo jet, with 220 passengers and crew, taking off and crashing today. And the same thing happened every day next week, and every day next month, and every day for the rest of the year,” said Dr. Williams in a recent 60 Minutes Race & Health segment with host Bill Whitaker. “That’s exactly what is occurring when we say there are racial disparities in health in the United States. Over 200 Black people dying prematurely every single day.”

Dr. Williams calls COVID-19 a magnifying glass that highlights these larger racial/ethnic disparities in health.² To this end, studies have found that Black and Hispanic populations experience higher rates of SARS-CoV-2 infection and COVID-19–related mortality compared to white populations, with differences in healthcare access potentially driving the increased rates.⁶ A recent report revealed that Black patients with symptoms such as cough and fever were less likely than white individuals with the same symptoms to be given a COVID-19 test.^2,7

Economic status is another factor for the risk of exposure to SARS-CoV-2, and Dr. Williams points out, in a 2020 editorial in JAMA, that that segregation (a determinant of economic status) is a strong predictor of variations in health.² Segregation may adversely affect health due to the concentration of poverty and environmental stressors such as air and water pollution; exposure to air pollution has been linked to hypertension and asthma, as well as more severe cases of and higher death rates due to COVID-19.^2,8

Social scientists have long speculated that racism had adverse effects on the health of racially stigmatized populations, but how these processes occurred was not well understood. Over the last two decades, Dr. Williams has developed a strong record of theoretical analysis and empirical research focused on understanding the multiple ways in which racism can affect health. He has played a visible, national leadership role in raising awareness levels of the problem of health inequalities and identifying interventions to address them. To learn more about the racial/ethnic gaps that exist in health care, and to hear Dr. Williams speak about the strategies that can be taken to bring clarity to the social determinants of health and ultimately affect public policy, please visit the following link:

References

1. Centers for Disease Control and Prevention. Media statement from CDC director Rochelle P. Walensky, MD, MPH, on racism and health. Published April 8, 2021. Accessed May 3, 2021. https://www.cdc.gov/media/releases/2021/s0408-racism-health.html
2. Williams DR, Cooper LA. COVID-19 and health equity—a new kind of “herd immunity.” JAMA. 2020;323(24):2478-2480. doi:1001/jama.2020.8051
3. Williams DR, Jackson PB. Social sources of racial disparities in health. Health Aff. 2005;24(2):325-334. doi:1377/hlthaff.24.2.325
4. Troxel WM, Matthews KA, Bromberger JT, Sutton-Tyrrell K. Chronic stress burden, discrimination, and subclinical carotid artery disease in African American and Caucasian women. Health Psychol. 2003;22(3):300-309. doi:1037/0278-6133.22.3.300
5. Kershaw KN, Diez Roux AV, Burgard SA, Lisabeth LD, Mujahid MS, Schulz AJ. Metropolitan-level racial residential segregation and black-white disparities in hypertension. Am J Epidemiol. 2011;174(5):537-545. doi:1093/aje/kwr116
6. Mackey K, Ayers CK, Kondo KK, et al. Racial and ethnic disparities in COVID-19-related infections, hospitalizations, and deaths: a systematic review. Ann Intern Med. 2020;174(3):362-373. doi:7326/M20-6306
7. Farmer B. The coronavirus doesn’t discriminate, but U.S. health care showing familiar biases. NPR. Published April 2, 2020. Accessed May 1, 2021. https://www.npr.org/sections/health-shots/2020/04/02/825730141/the-coronavirus-doesnt-discriminate-but-u-s-health-care-showing-familiar-biases
8. Wu X, Nethery RC, Sabath MB, Braun D, Dominici F. Exposure to air pollution and COVID-19 mortality in the United States: a nationwide cross-sectional study. medRxiv. Preprint posted April 7, 2020. Revised April 27, 2020. Accessed May 4, 2021. doi:1101/2020.04.05.20054502