As part of an ongoing podcast series called Black Lives in the Era of COVID-19, hosts Profs. Mabel Wilson and Samuel Roberts joined panelists Dr. Wafaa El-Sadr, Prof. Gregg Gonsalves, and Dr. Bisola Ojikutu, on Thursday evening to discuss the impacts of structural racism on COVID-19 outcomes and treatments for Black people.
The talk began as Wilson, who is the Nancy and George Rupp Professor of Architecture, Planning and Preservation, a Professor in African American and African Diasporic Studies, and the director of the Institute for Research in African American Studies, and Roberts, who is an Associate Professor of History and of Sociomedical Sciences at the Mailman School of Public Health, shared some numbers. African Americans are, according to the CDC, 10% more likely to contract COVID-19 and twice as likely to die of COVID-19 than white Americans. In South Carolina, half of COVID deaths were among Black people, despite only making up 30% of the population. In Chicago, 70% of COVID deaths were among Black people, despite again making up only 30% of the population. Roberts said that COVID appears more commonly in places where multiple generations live together and where more people are classified as “essential workers:” food service workers, health care workers, etc. Wilson added that comorbidities, such as living near pollution, diet-related diseases, and mass incarceration, are more common among Black Americans. 34% of all prisoners in the US, for example, have been infected with COVID-19, as opposed to about 9% of all Americans. Roberts said that the percentage of Black recipients of the vaccine does not often match the death rate among Black people; while half of all Lenox Hill residents on the Upper East Side have been fully vaccinated, only about a quarter of Central Harlem and South Bronx residents, who have experienced far more devastation, have been fully vaccinated.
El-Sadr, who is University Professor of Epidemiology and Medicine at Columbia, the director of ICAP at Columbia, and the director of the Global Health Initiative at the Mailman School of Public Health, said that there are two multigenerational structural inequalities that are complementary: increased risk for adverse conditions, and increased risk for adverse outcomes given those conditions. She said that the HIV pandemic is still something to contend with and has shown us “lessons not learned” that we could have used to mitigate the impact of COVID-19. Of critical importance is “engaging with communities” and a response that addresses social needs as well as health needs.
Ojikutu, who is Assistant Professor of Medicine and Assistant Professor of Global Health and Social Medicine at Harvard Medical School as well as an infectious disease physician at Brigham and Women’s Hospital and Massachusetts General Hospital, said that there has been a failure to employ root cause analysis in dealing with both communicable and non-communicable diseases. She asked whether these problems are, in some ways, ones we are choosing not to fix since the structures that create these problems carry benefits for those currently in power. “Where is the real plan?” she wondered, to actually implement structural changes.
Gonsalves, who is an Assistant Professor of Microbial Disease Epidemiology and Associate Adjunct Professor of Law at Yale as well as Co-Director of the Global Health Justice Partnership, reminded the audience of a smallpox epidemic that killed about a quarter of freed slaves after the Civil War that has been completely wiped from the collective American memory. He said that the HIV pandemic has been treated much the same, as it has disproportionately affected sex workers, drug users, and Black members of the LGBTQ community. He said that it is political decisions that have determined these disproportionate impacts. Wilson responded that “crisis tends to produce a sense of ahistoricity.” Gonsalves then added that American public health responses have been characterized by “white ambivalence at every turn.”
Roberts referred to a concept he called “data genocide:” when a community is rendered invisible to data collectors that constitutes a violation of their rights on a collective scale.
El-Sadr then reflected on her time in practice at Harlem Hospital at the height of the HIV pandemic in the 1980s. She says that while HIV/AIDS is often referred to as a “hidden pandemic”, it was not hidden to her; she witnessed the suffering of the Harlem community under the yoke of the disease in plain sight. She added, however, that Harlem showed immense resilience and innovation during that trying time. Marginalized people, she said, need access to those who engage, listen, and respond. She then went on to mention that the lull in the pandemic in New York City last summer was not used wisely to develop vaccine deployment infrastructure, despite the fact that officials knew the vaccines were coming and knew that infrastructure was needed badly.
Ojikutu added that people in marginalized communities know their needs, but resources are being denied to them. This, she said, is unsustainable for marginalized groups if people outside those communities continue to hold the reins of power. She questioned how we define “access,” giving the example of large vaccine distribution centers in poorer neighborhoods being used more often by people who live outside those neighborhoods. Visibility, she said, is determined by people in power, and power needs to be moved away from people who don’t want to face problems and into the hands of the powerless.
Gonsalves said that there has been marked disinvestment in community health care, and particularly primary care, in favor of brand new teaching hospitals. The medical profession, he contended, has essentially been glamorized, de-fanged, and de-politicized. Roberts added that this emphasis on massive, Ivy League teaching hospitals is evidence of capital accumulation and an infatuation with a supposed “big technological fix”, which ironically ignores the technologically simple solutions needed to maintain the population’s general health. El-Sadr said she believes that the solution in this regard is establishing community health hubs and that community health should go hand in hand with efforts to improve education, housing, nutrition, and environmental quality.
The conversation then shifted toward mass incarceration. Gonsalves mentioned that US health expenditures far outweigh life expectancy. If we have a problem, he said, “we lock it up”, or criminalize it, mentioning West Virginia’s recent dismantling of needle exchange programs statewide despite the lifesaving impact of needle exchange programs for communities afflicted by the opioid crisis.
Ojikutu said that we are unprepared to deal with public health after everyone is vaccinated. She noted how community vaccination hubs are bringing in millions of people yet aren’t connecting them with other community resources that may address other non-pandemic related issues going on in their lives. “The status quo has not worked,” she said.
Gonsalves talked about how top pay for doctors is directed toward highly specialized surgeons rather than pediatricians and primary care physicians. He then added that the Black Lives Matter is itself a political response to our inadequacy to address the root causes of disparities in the COVID-19 pandemic. El-Sadr added that she hopes that the pandemic continues to add urgency to people’s impatience for justice and that it may act as an accelerant for change.
Roberts characterized the media narrative about vaccine hesitancy among Black people as less of an evidence based claim and more of an accusation, that Black people will somehow keep others from “going back to bars” by choosing not to get vaccinated. Ojikutu responded that, while our systems often foster distrust, the narrative has indeed pathologized Black people for not initially trusting medical professionals when distrust is a perfectly normal emotion, especially for marginalized groups. She said that often with time, trust does develop. Wilson added that the Black body is used for profit, even after death.
Gonsalves contended that, in addition to centuries-old institutional white supremacy, neoliberalism and austerity in recent decades have significantly damaged public health, creating a “pauperized state” in pursuit of profit. Health care is now run for profit and pushed toward the limit of technological advancement for profit’s sake rather than for mass availability. Ojikutu concurred, adding that technological advancements only matter if they are accessible to marginalized people.
Roberts concluded the event by voicing his aspiration that the need for the podcast will soon become obsolete as vaccination campaigns verge onward.
You can find more programming like this here, and you can find more episodes of “Black Lives in the Era of Covid-19” wherever you listen to podcasts.
Moderna vials via Bwog Archives