The coronavirus burden is falling heavily on black Americans. Why?
As public health departments, heeding calls from activists, start to release data about Covid-19 cases and deaths according to race and ethnicity, it has become clear that the burden of these deaths, like too many health outcomes, is falling disproportionately on the black community.
While the data is still emerging, different theories have been proposed to explain these disparities. Black Americans are more likely to live in urban areas that been hit the hardest by the epidemic. At the same time, many black Americans live in southern states whose governments have often been slow to respond to the current crisis. This pandemic is also revealing long present racial disparities in health. Due to structural factors like racism, housing discrimination, poverty and unequal and discriminatory treatment in the medical system, black Americans are more likely to have a number of the health co-morbidities that place individuals at a higher risk for Covid-19 deaths.
The role that work contributes to these racial and ethnic disparities also deserves attention. Due to occupational segregation, black Americans have often been disproportionately represented in industries and occupations that face the greatest risks of known occupational hazards. The same seems to be the case with Covid-19.
Black Americans are more likely to be part of the essential workforce than other racial/ethnic groups. Although the definition of essential services differs substantially from state to state, the Brookings Institution has categorized industries as essential based on guidelines from the federal government. According to research from the Current Populations Survey, black workers were more likely to be employed in essential services than white workers, with 37.7% of black workers employed in these industries compared with 26.9% of white workers. This disparity is even clearer when you look at the healthcare industry. Black workers are about 50% more likely to work in the healthcare and social assistance industry and 40% more likely to work in hospitals, compared with white workers.
Healthcare workers are going to shoulder the heaviest burden of infections acquired in the course of completing their job. Previousresearch has examined differences in the risk of being infected at work. A greater proportion of black workers are employed in jobs with a higher likelihood of being exposed to infections compared with white workers. Black workers are more than twice as likely to be respiratory therapists (an occupation shown to be at a particularly high risk) as white workers.
Black workers are also more likely to work jobs that require close proximity to others. For example, black workers comprise a disproportionate share of bus drivers and postal workers, two essential occupations that require close contact with the public. Occupations that combine both hazards – high risk of infections and close proximity to others, such as personal care aides – are also disproportionately filled by black workers.
Unfortunately, despite this high degree of risk, black workers often have lower access to benefits that could potentially mitigate the risk or protect them if they do become sick. Although, temporary paid sick leave provisions have been passed for some workers, black workers have been less likely to be employed in jobs that provide paid sick leave. Black workers are also less likely to work in jobs that allow for telecommuting.
This lower access to telecommuting is a reminder that black workers are not only vulnerable to the direct health impacts of Covid-19, but also more likely to be vulnerable to the economic fallout of this pandemic. This economic fallout will also have health consequences, perhaps as severe as Covid-19 itself. As millions apply for unemployment, it is clear that even if we are able to flatten the curve, we will also be confronting the dire health consequences of many Americans having their economic wellbeing destroyed.
With this impact too, it looks as though black workers will bear a disproportionate share of the impact. Another analysis from Brookings examined industries at the highest risk for job losses in the current climate. Two of those industries that employ the most workers – food services/drinking places and general merchandise stores – also employ a disproportionate share of black workers.
We can only guess at the health impacts of this crisis, which will likely turn into a recession. We are still dealing with the fallout of the last recession. Unemployment is associated with a number of health outcomes, including overall mortality. In a country where so much insurance coverage is employerbased, large job losses will likely only exacerbate racial and ethnic disparities in access to insurance.
Black workers are putting themselves at great personal risk in the healthcare field and fulfilling essential services. As with all workers, employers should do whatever they can to protect them and to provide for them when they become sick in the course of this work. This protection and support should include personal protective equipment, paid sick leave and workers’ compensation benefits for those who get sick in the course of their work.
Too often, black workers have shouldered an unequal share of the burden in our national struggles. We should do everything we can to prevent the current pandemic from adding to this history.
Devan Hawkins in an instructor of public health at the Massachusetts College of Pharmacy and Health Sciences