By Tanya Khemet Taiwo, Pamela Lein and Bianca Yaghoobi
Black and Latino people have been disproportionately affected by the coronavirus in a widespread manner that spans the country, throughout hundreds of counties in urban, suburban and rural areas, and across all age groups.
So concluded reporters for The New York Times who analyzed 640,000 cases reported to the U.S. Centers for Disease Control and Prevention (CDC) from nearly 1,000 U.S. counties. (1) Hispanic or Latino and non-Hispanic Black people were three times more likely to become infected with SARS-CoV-2, and nearly twice as likely to die from COVID-19 as their white neighbors. A report from the CDC a month later on August 7, 2020, indicated that Hispanic children are eight times more likely and Black children five times more likely to be hospitalized with COVID-19 than their white peers. (2)
The racial inequity of the viral pandemic underscores the reality that institutionalized racism extends beyond the racial inequities of the criminal justice system brought into sharp focus recently by the Black Lives Matter movement. Institutionalized racism – defined as differential access to the goods, services and opportunities of society by race – affects and reinforces personally-mediated racism, resulting in prejudice and discrimination based on race. The generational effects of systemic racism are a root cause of the poorer health outcomes in communities of Black, Indigenous, and People of Color (BIPOC) during the viral pandemic.
How has institutionalized racism contributed to the disproportionate impact of SARS-CoV-2 on BIPOC communities? The racial disparity in the COVID-19 mortality rate is widely attributed to higher rates of underlying health conditions that predispose virally-infected individuals to worse outcomes, such as diabetes, asthma, hypertension, and obesity, in BIPOC individuals compared to white people. Individual susceptibility to these health conditions is determined by complex interactions between genetic, lifestyle and environmental factors; however, exposure to environmental chemicals and other pollutants is strongly linked to not only risk but also the severity of these co-morbidities. It is well-documented that environmental exposures are, on average, far higher in BIPOC communities. In many countries, industrial sites, heavily-used roadways, and hazardous waste sites tend to be located close to poor communities, which disproportionately include BIPOC. Environmental exposures likely also directly influence individual susceptibility to COVID-19. For example, studies from multiple countries around the globe have identified a strong link between air pollution and higher rates of COVID-19-related deaths. BIPOC communities are exposed to significantly more polluted air than other communities, even when socioeconomic status is comparable.
Black and Latino people are more likely than white people to be exposed to the virus because many of them have frontline jobs that do not allow them to work from home. Census data from 2018 shows that across the US, 43 percent of Black and Latino workers are employed in service or production jobs that cannot be done remotely. Only about one in four white workers held such jobs.
A striking finding of The New York Times report was the racial imbalance in SARS-CoV-2 infection case rates. Importantly, the variable of race is not an indication of genetic predispositions that might contribute to differential susceptibility to viral infection. Race is not inherent to the individual, but is assigned by society based on phenotypic presentation. For example, individuals labelled “Black” in the U.S. include individuals of diverse backgrounds. In race-conscious societies, phenotype governs the distribution of risks and opportunities, including where people live and the types of jobs they hold. In this context, it is important to note that SARS-CoV-2 infections are far more prevalent among people who can’t work from home. Black and Latino people are more likely than white people to be exposed to the virus because many of them have frontline jobs that do not allow them to work from home. Census data from 2018 shows that across the US, 43 percent of Black and Latino workers are employed in service or production jobs that cannot be done remotely. Only about one in four white workers held such jobs. Additionally, BIPOC communities tend to rely more on public transportation, live in cramped apartments with a single bathroom or multigenerational homes and are pressured to keep working or quickly return to work, even in risky settings.
COVID-19 & environmental justice
The COVID-19 pandemic is highlighting the urgent need for improved understanding of the broader social forces that affect health so that racial disparities in not only the current viral pandemic, but also other health outcomes with broad impact can be mitigated. Environmental justice (EJ) is one approach for addressing this need. EJ research is most effective when researchers work with and are guided by residents of the BIPOC communities under study. A rigorous and nuanced approach is needed that recognizes and examines the systemic roots of differential exposures to environmental hazards based on socioeconomic status and race. This may include investigation of land-use decisions, persistent disinvestment in the community, and the nature of both the educational and criminal justice systems in the area under study. Such a combined approach can paint a clearer picture beyond repeatedly establishing that poor and minority communities are exposed to hazards at a higher rate than the rest of the population.
Consideration of the cumulative effects of exposures to environmental contaminants in the context of social stressors, political forces, and policy decisions affecting health can then guide enforcement of sustainable approaches while also improving environmental health literacy of the community. When researchers engage affected community members, the result can be empowerment rather than discouragement and disenfranchisement. BIPOC communities already know that their underlying health conditions are higher because they live in more polluted communities than the privileged. They need an understanding of the intersectionality of the issues they face. Researchers must build connections to the community because decades of educational disparities have led to stark underrepresentation of BIPOC in the environmental health research community.
Toward an inclusive framework
What is needed is an inclusive framework that advocates for all people and the planet and highlights how injustices happening to marginalized communities are interconnected with the degradation and poisoning of places where they live. We cannot ignore social inequality and expect to see progress in environmental health. As we struggle to overcome the complex issues associated with environmental justice, we must keep in mind that the solution to the next viral pandemic threatening the planet may be locked in the brain of a child living in a disadvantaged community experiencing higher levels of environmental pollution that limits not only their potential but also society’s benefit from their contribution.
Tanya Khemet Taiwo, PhD is Co-director of the Community Engagement Core at the UC Davis Environmental Health Sciences Center. She is an epidemiologist, midwife and professor specializing in health disparities and environmental justice policy.
Pamela Lein, PhD is the Co-director of the Career Development Program at the UC Davis Environmental Health Sciences Center. She is a neurotoxicologist and developmental neurobiologist, professor and chair of the Department of Molecular Biosciences in the School of Veterinary Medicine at UC Davis.
Bianca Yaghoobi is a PhD candidate in pharmacology and toxicology at UC Davis.