COVID-19 reveals a long history of health inequities
In 1793 Philadelphia was assaulted with the worst recorded case of yellow fever in the new nation’s history. Respected Philadelphian Benjamin Rush — considered the “Father of American Medicine” and also a Founding Father who was the country’s preeminent physician — took the lead in helping to create public health awareness about the devastating disease.
Rush asked ministers Richard Allen and Absalom Jones, two of the city’s most respected black leaders, to rally black Philadelphians to help yellow fever patients. Members of the black community answered the call. They served as grave diggers, nurses, garbage collectors and a host of other jobs during the epidemic. Rush did so because he believed African Americans were not as susceptible to the disease and might be immune to yellow fever.
The death toll numbers revealed how wrong Rush’s beliefs were about supposed black immunity from yellow fever. Five thousand Philadelphians died and nearly 10 percent of those who died were black residents.. In response to the disproportionately large numbers of deaths in the African American community, many of whom were on the front lines assisting the sick, a white publisher, Matthew Carey, wrote a damning pamphlet that berated black Philadelphians as conniving thieves who robbed the houses of those they cared for as nurses and caregivers during the epidemic. The pamphlet was in its fourth printing by the time the Allen and Jones published a rebuttal to Carey’s racist argument against the city’s black citizens.
Over 200 years later, African Americans are still more likely to suffer because of the social determinants of health that compound a lower quality of medical treatment. Medical racism is made even more apparent to members of the black community when statistical data reveals how complications from illnesses and death greatly impact them.
Since the 18th century, African Americans have had a fraught relationship with the medical field. Over centuries, they have been used as experimental patients, made to patronize segregated and poorly funded hospitals, doubted by physicians when they detailed painful illnesses, and die earlier and more so from preventable disease and conditions.
With the emergence of COVID-19, leading public health officials, black scholars of the history of medicine and racism, and experts on health inequities knew the virus would have a devastating effect on the black community. We were not prescient, we simply understood deeply what the historical records have shown us consistently about medical racism.
The reasons are varied of course. There is a disproportionate number of African
Americans who suffer from conditions such as hypertension, diabetes and are overweight. Yet, nearly 40 percent of all Americans are obese, nearly one-third of American whites have hypertension, and 10.5 percent of the U.S. population has been diagnosed with diabetes. Even with these alarming statistics, especially compared to other high-income earning nations, African Americans have died at disproportionately higher rates than their white counterparts in many urban centers throughout the Midwest and East Coast. For example, in St. Louis black people make up nearly all COVID-19 deaths. Unsurprisingly, New Orleans is the only Southern city with black death tolls that are comparable to New York City. Why do African Americans fare so badly in the United States when it comes to their health and disease? Largely because there has not been a national effort to establish racism as a public health crisis.
In the late 1990s, then Surgeon General David Satcher created a national initiative meant to eradicate health disparities between African Americans and white people by 2010. His goal was never met. The Centers for Disease Control and Prevention still has not made racism a public health crisis although racism meets the four criteria the agency established for a public health crisis. Racism places a massive burden on society, it disproportionately affects a segment of the country’s population, the U.S.’ current measures are not enough to stop the crisis, and lastly, an expansive and coordinated public health approach is needed to eliminate racism’s negative effect on society.
As the numbers of black victims of COVID-19 increase, those of us who study, write and teach about medical disparities between black and white people will unfortunately include COVID-19 death rates as another example of how fragile African American health is in a society that has stark inequities between those who receive good medical care and those who do not. Until the nation’s federal agencies and government prioritize how menacing racism is on this society, African Americans will continue to suffer from higher rates of death from pandemics like COVID-19 to maternal morbidity. As Americans, we must ensure that every citizen receives equal and good medical care and every statistic that the government has conducted for decades indicates that unequal treatment in health care is predicated upon racism, classism, citizenship, homophobia and a host of discriminators. Medical racism affects us all and its menacing presence has been a part of this country’s legacy for too long. It is time to surgically excise it for good.