COVID-19 impacts racial and ethnic minorities differently — to understand why, we must press for structural and systemic answers.
When COVID-19 spread across the US earlier this year, it quickly became apparent that the virus had a disproportionate impact on select racial and ethnic communities. Disparities are visible in who contracts the virus, who is hospitalized, and in the contrasting death rates between white populations and populations color. Under pressure from journalists and activists, the CDC now breaks down hospitalization and death rates by race — with the qualification that “race and ethnicity are risk markers for other underlying conditions that impact health.”
But although the data tells a clear story about the devastating impact of the pandemic, unpacking the relationship between race, “underlying conditions,” and health outcomes is anything but straightforward. Earlier in the summer, we spoke to Michael Yudell, Professor and Chair of the Department of Community Health and Prevention at the Dornsife School of Public Health at Drexel University, about the complexities of talking race and public health in the wake of the pandemic.
Yudell’s 2014 book, Race Unmasked: Biology and Race in the Twentieth Century, examines the concept of race in biology and its fraught legacy. He shares with us here the importance of changing how race is discussed in medical and biological research and the barriers to having a candid discourse on race and health.
How Pandemics Impact Different Communities
“From a historical perspective, I can tell you that pandemics impact people differently,” Yudell explains. “Poor people and members of racial and ethnic minorities throughout history in the US have fared worse during disease outbreaks. This outbreak, sadly, is no different.” According to CDC records, African American and Hispanic communities are more than twice as likely as white communities to contract COVID-19 and over four times more likely to be hospitalized.
Although few would dispute that the virus impacts minority groups differently, the real question is how we explain these disparities. Media sources often attribute higher hospitalization rates to the prevalence of “underlying conditions” in ethnic minorities, but what are we really suggesting when we associate minorities with “underlying conditions?”
This is a question Yudell is keen to pursue. He points out that discussions about disparities in health outcomes between different groups is crucial, but they often leave the door open for misinterpretations. “My fear is that we will fall back on easy biological explanations,” he tells us. Instead of asking pressing questions about structural and systemic reasons for poor health outcomes in African American and Hispanic communities, he fears that the public may begin to think of race as a sufficient explanation for vulnerability to disease.
How We Understand “Race” in Public Health
“What we know from 100 years of sociological science and biological science that race is a poor proxy for understanding our biological ancestry,” Yudell explains. “You have scientific papers acknowledging — up front — that race is a social construct and it presents a host of problems.”
But as Yudell is careful to point out, social constructs can have a very real impact: “It doesn’t mean that race isn’t real, that race isn’t a factor in determining the health of individuals in different communities.” He notes that different outcomes for different racial communities is more often than not an indicator of structural racism — access to care, income levels, and how much doctors trust patients’ accounts of their own symptoms.
The question is not whether race matters, but how we interpret data pertaining to race. “We’re in a moment when racial animosity is emanating from the White House — more than perhaps we’ve seen in almost a century,” Yudell observes. “We’re slipping back into retrograde ideas of biology — that there may be a biological phenomenon underlying racial differences. This is a misunderstanding that we have to tackle head on.”
When “Race” Is Really “Racism”
So how do you solve a problem deeply entrenched in American history and closely interwoven with America’s scientific institutions? To begin with, accounting for racial disparity involves acknowledging — across a variety of disciplines — that the concept of “race” presents a problem for scientific study. “We’re stuck and we need to get unstuck,” he observes.
One way to get “unstuck,” is to ask individuals to identify their own backgrounds. “There is power in having people identify themselves and their ancestries and in understanding the relationship between health and diversity,” Yudell argues. Historically, racial categories were used to systematically deny citizenship and rights to oppressed groups. Reintroducing the diversity of our ancestry helps demystify entrenched categorizations according to race.
Yudell’s work also proposes that we shift our focus from “race” to “racism” when looking for explanations for public health outcomes. “Race is a poor predictor of how these factors are playing out.” He explains, “But racism and other determinants of health are more reliable as predictors. It’s about access to care and health issues caused by housing and employment challenges that are endemic to our society.”
Currently, he is part of a renewed effort urging the National Institute of Health to reassess the use of racial data when studying the human genome. In a recent article published in Science Magazine, Yudell and several colleagues call on the NIH to “support the National Academy of Sciences to bring together a diverse group of scientists and scholars to develop a consensus statement on best practices in genetic, clinical, and social scientific studies for characterizing human genetic diversity, including guidance for using racial categories to study racism’s impact on human health.”
On the topic of Black Lives Matter and the nationwide demand for racial justice, Yudell is cautiously hopeful. “We’ve had enough of racism, we’ve had enough of police violence and other vigilante violence,” he observes. “So on that front, it’s been remarkable. But I’m cynical and I’m a historian, and things often take the shape that they’ve taken for generations — true change requires real, sustained effort.”