Solano County and nationwide: Coronavirus revealing inequities in public health due to societal factors

[NOTE: Latest COVID-19 analysis by Solano County Public Health shows Whites at 39% of the county’s population, but only 25% of cases, 23% of hospitalizations and 23% of deaths.  Vallejo and Fairfield account for 54% of the population, but 73% of COVID cases, surely reflecting the two cities’ relatively poorer and browner neighborhoods.  – R.S.]

The Interwoven Threads of Inequality and Health

The New Yorker, by Isaac Chotiner, April 14, 2020
People in a spread out line.
The coronavirus crisis is revealing the inequities inherent in public health due to societal factors, Nancy Krieger, a professor of social epidemiology, says. Photograph by Johannes Eisele / AFP / Getty

According to preliminary data about the coronavirus pandemic, African-Americans are bearing a strikingly disproportionate share of the suffering in the United States. In Illinois, where fourteen per cent of the population is African-American, black Americans represent more than forty per cent of the state’s confirmed coronavirus deaths. Coronavirus fatalities have a similar breakdown in Michigan, and several Southern states show even greater disparities.

The possible reasons for these inequities are myriad: African-Americans are less likely than white Americans to have the option of working from home and to receive high-quality medical care, and more likely to have preëxisting medical conditions that lead to worse outcomes from the novel coronavirus. New research links coronavirus deaths to air quality, which is often worse in poor communities and communities of color.

Nancy Krieger is a professor of social epidemiology at the Harvard T. H. Chan School of Public Health. Her work focuses on health disparities between demographic groups and the social structures that help determine those disparities. We recently spoke by phone about how American health inequities are playing out during the pandemic.  During our conversation, which has been edited for length and clarity, we discussed why the field of social epidemiology is crucial to understanding inequality, the causes of racial disparity in health outcomes, and what can be done to ameliorate the suffering of the most vulnerable Americans during this crisis.

Is the spread of the coronavirus, and especially its disproportionate impact on the African-American community, teaching us new things about racial disparities in health care and health outcomes or confirming things we have long known?

More the latter. What the virus is doing is pulling a thread that is showing how many things are actually connected, and how deeply people are actually connected. But it’s also revealing the very different conditions in which we live because of social structures that are inequitable, both within the United States and between countries. By pulling the thread, it’s revealing patterns that have been long known in public health.

So, when you think about something like this coronavirus, you have to think about who’s exposed in the first place and where they are exposed—at work, at home, and what are the conditions? You have to think about, if they’re exposed, do they get infected? You have to think about, if they get infected, do they get ill? And you have to think about, if they’re ill, do they actually die?

And you take each of those steps, which are all different steps in this process, and turn to what are the preliminary—and, I emphasize, preliminary—data on the excessive death rates. My state, Massachusetts…  […continued…]