Race and Ethnicity in the Era of Covid-19

African American Lives Barriers to healthcare color discrimination Global Pandemic Health Equity Healthcare Equity implicit bias Public health Policy racial bias racism in health SARS-CoV-2 Uncategorized

Racial and ethnic disparities in healthcare has always been a feature of the American health system. This is an issue that all minorities in the healthcare field address in their own way. Some get embroiled in this, others stay cognizant but accept it as just one of the things you have to deal with as an American, others just totally attempt to ignore it or in extreme circumstances deny of its existence. I believe my response has traversed many of these different approaches because in a way this is a problem that has been very frustrating to tackle. I was thus not surprised that there were racial disparities in Covid-19 diagnosis across the country. In a prior post we discussed observed disparity by sex and gender.

With the observed disparity in diagnosis and mortality of Covid-19 by race and ethnicity, all I can say is that the inequities that exist in our communities is once more on the forefront of our national conversation. For some with less experience on these issues this may seem like a possible breakthrough or even a reawakening. Unfortunately those of us who have lived with this problem know that only the very strong and the most ardent optimists can carry this for any length of time. Our history is definitely littered with the tragic lives of many that made similar problems their own. Racial and ethnic inequities in any area of our lives is one American problem that we definitely need to address if we are to really achieve the greatness that we have already claimed.

Inequities by race and ethnicity is unfortunately one issue that we are going to continue to struggle with. In my Ghanaian culture we consider such problems that never seem to go away over several generations as ancestral spirits. Such problems it is believed require an exorcism to wrench them from our midst. Without that we are doomed to seeing and experiencing them in our lives over generations and centuries.

Most of those who take this explanation to heart will be looking for a juju man, shaman or spiritualist to address such issues. Whilst this description may connote some form of supernatural cause to such problems I personally believe that we miss the real issue when we look beyond clear tangible causes and delve into the realm of the spirit. The differences in incidence and survival of Covid-19 by race and ethnicity that we are seeing is just another manifestation of the unspoken aspirations that drive our systems and the collective narrative that creates our reality.

In the state of Illinois Covid-19 related disparities is most glaring in Cook County; while only 30 percent of Chicago’s population is Black, 72 percent of the city’s COVID-19 deaths were among Blacks. The state of Louisiana has a similar situation, with a 33% Black population, Blacks in this state account for a little more than 70% of Covid-19 deaths. In New York City with 82% of data on race and ethnicity completed for deaths blacks represent 30.5% of total deaths even though they make up only 25% of the city’s population.

Map showing rates of Covid-19 diagnoses by zip code in New York City high rates over-represented in Burroughs with high proportions of minorities – Source: New York City, DOH

America as a nation is no stranger to these inequities across racial lines. The map above shows the rates of Covid-19 diagnosis by zip codes in New York City confirming these racial disparities in Covid-19 diagnosis. The Burroughs with the highest rates appears to be Queens, some parts of the Bronx and Brooklyn, these are also places with significant minority populations. There are some studies that may suggest that these inequities are not totally grounded in race. There are many reasons beyond just the color of our skins and what we inherited from our ancestors that explain why some of us are more affected by diseases of all kinds compared to our neighbors.

At this time we do not know enough to completely rule out impact our heritage as the explanation for the increased mortality from Covid-19 among African Americans in this country. I will like to start by saying that low case fatality rates in African countries calls this genetic explanation to question.

More African Americans are dying of Covid-19 for the same reasons that we die of HIV, diabetes and cancers; the story humanity created to support and prop up slavery and European colonization continues to this day to condemn non-whites to a second class status in most settings. Most of the acts and inactions that drive these differences are rooted in implicit racial bias. Implicit bias drives actions more often than not outside the realm of conscious decisions and actions.

When I say there is an ancestral spirit driving the disparities and inequities in this country I am not talking about some supernatural entity. We do not need to go outside the realm of the physical to explain these racial disparities in Covid-19 diagnosis. These inequities are just a manifestation of the stories we told ourselves and our children over the centuries about who deserves what and why. If we want to change the outcome we need to start changing that story. The story is more complex than we tell it and if we continue to maintain the simple narrative we would continue to feed that unhealthy ancestral spirit.

We don’t need an exorcist, let’s all be more intentional in our thoughts and stop feeding the ancestral spirit with the racialized narrative.

Leonard Sowah is a physician in Baltimore, Maryland


A physician providing primary medical care to patients across the lifespan

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