When U.S. COVID-19 infection and death rates including race were first reported in April 2020, it was clear there was a significant racial disparity. Black Americans were and are dying of this virus at more than 1.5X the rate of white Americans.

The media response was swift and decisive: this high death rate was down to the Black community’s higher rate of underlying conditions like heart disease, hypertension, diabetes and asthma (with the subtext that these are ultimately the result of bad behaviors on an individual level). 

Some went further, claiming it was down to Black people not taking the virus as seriously as white people (note that this was later refuted by survey data).

The reality is much more nuanced.

Chronic health conditions certainly increase the risk of COVID-19 infection and death — but the more important question is why Black folks have higher rates of these conditions, to begin with. 

Contrary to assumptions that it’s down to individuals’ behaviors or inherent racial genetic differences, it’s well-established that “social determinants” are behind the racial disparities in health, specifically:

• Income and wealth

• Access to quality healthcare, health insurance and even emergency medical care (ever heard of “trauma deserts”?)
 Employment status and work conditions
•  Access to quality food (“food deserts” are much more common in predominantly Black neighborhoods, even after controlling for income)
•  Air and water quality
•  Chronic and acute stress

And there’s evidence that racism has a direct influence, too — through unequal care due to racial discrimination by healthcare workers, through bias in algorithms that are increasingly making healthcare decisions on behalf of providers, through stress directly caused by racism, and even through internalized racism that Black Americans experience. 

Some academics have argued that racism is a significant enough factor that it should be considered a social determinant of health. Milwaukee’s Commissioner of Health, Dr. Jeanette Kowalik, has even declared racism a public health issue in Milwaukee.

You can probably see links between all of the above factors and other forms of systemic racism, for instance, residential segregation has created disparities in access to quality food, access to emergency medical treatment, and air and water quality. 

We call systemic racism a web of barriers and oppression because all of these systems are interrelated and reinforcing.

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