New COVID-19 study points to systemic racism in US

In many countries—and in the United States in particular—racism is an ongoing public health crisis that has inflicted trauma on Black bodies and forced a disproportionate burden of disease onto Black communities for centuries.

The health inequities faced by Black Americans are as well documented and as apparent as any inequities PATH is working to address. Black Americans face higher rates of maternal mortality, HIV/AIDS, tuberculosis, injury and death due to violence, injury and death at the hands of police, and many other structural disparities.

One of PATH’s public health statisticians, Laina Mercer, recently collaborated outside working hours on a research project led by amfAR examining COVID-19’s effects on Black communities. Unsurprisingly, she and her co-authors saw these trends. In their recently published study, “Assessing differential impacts of COVID-19 on Black communities,” Laina and her colleagues used spatial statistics to tell the all-too-familiar story of overlapping health crises in the United States.

The major takeaway is straightforward—Black communities account for a disproportionate percentage of COVID-19 cases and deaths in the United States. Only about one quarter of US counties are disproportionately Black, but at the time of the study they accounted for more than half of COVID-19 cases and deaths nationwide.

Other studies have looked at this association in metropolitan areas, but this is the first to look at the entire country. Data was analyzed from more than 3,000 counties across the United States.

Even accounting for other risk factors—the prevalence of comorbidities, air pollution, age distribution, percent unemployed, percent uninsured, etc.—the study still shows higher rates of COVID-19 cases and deaths in Black communities.

In other words, Black communities are being disproportionately impacted by COVID-19 not just because of, but in addition to, the disproportionate impact of air pollution, unemployment, and so on.

Due to limited data on race and ethnicity for individual cases and deaths, the study was conducted at the community level. Without individual-level data, researchers are unable to assess causality. Thus, this study cannot directly tell us why Black individuals and communities are experiencing an increased COVID-19 disease burden, but it does join a growing and established body of literature associating social conditions and structural racism with negative health outcomes.

The United States is grappling with some of the same challenges faced by communities around the world in tracking and reporting on COVID-19.

While the study noted this lack of high-quality data, reports suggest that lower-income communities often have the lowest rates of testing. This is consistent with some of the challenges we see in the places where PATH traditionally works. Often the areas with the greatest disease burden have underreported individual-level health data because, like quality health care, surveillance is expensive to set up and maintain.

But data and careful analysis are important, and making sure diseases are tracked is an issue of equity. Epidemiologist Prabhat Jha said, “One of the best ways to help the living is to count the dead.” Of course, this also applies to counting illness and injury. Numbers motivate funders and decision-makers. Without data, communities are at risk of enduring disproportionate health burdens while also not receiving necessary intervention and support.

When asked about next steps for this work, Laina said, “My hope for this analysis is the same one I have for all analyses—that it will motivate additional research and provide data to support important conversations and policy decisions.”