As a social worker, I watched with dismay and sadness the myriad of news reports announcing to the nation and the world that African Americans were disproportionately affected by the COVID-19 pandemic that is taking lives and changing the way we live. My dismay was not the breaking news, but the reaction to the breaking news.
African Americans receiving disparate health care is certainly no new news to most. For many decades data have documented that African Americans suffer more from chronic conditions. The death rate for African Americans is generally higher than whites for heart diseases, stroke, cancer, asthma, influenza and pneumonia, diabetes, and HIV/AIDS. And while life expectancy is increasing for Blacks, there is still a gap of four years. And when zip codes are considered, this gap is even larger. As far back as the late 1990s, I recall teaching students in social gerontology and research about the difference in life expectancy by zip code in the District of Columbia metropolitan area. Today, in the District of Columbia, life expectancy for residents of the District of Columbia can vary up to 27 years based upon their zip code that is correlated with race and poverty. These are not new facts. In fact, a widely distributed 2002 report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” by the Institute of Medicine Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care clearly addressed the social determinants and made recommendations to address the disparities.
The underlying factors to these inequalities are also known and well-documented. Any search on the internet will yield numerous articles that document the contributors to the disparities including poverty and its correlates access and quality of care. African Americans working in essential frontline and highly interactive positions also contribute to this harsh imbalance. Added to this are health beliefs that are culturally based and passed on from generation to generation. And finally, behaviors can be added to the list of social determinants. What is too often left out of the discussion about behaviors are the structural inequalities that may push individuals to rely upon substances and other harmful practices. Yet, how we handle the coping behaviors as a society is very different. I recall that the public policy associated with crack addiction in the 1980s was to criminalize the behavior. I was then a director of a housing authority and watched individuals become quickly addicted with families torn apart because of the incarceration of users and sellers. Yet, with the current opioid addiction epidemic, a public health crisis has been declared with primacy being given to treatment. The difference between a crime and a public health crisis is also a factor of zip code that is a proxy for race and poverty in geographic areas.
Watching families that I know lose loved ones has been difficult. It is made more distressing by the recognition that we, African Americans, are being disproportionately affected. This is more than an opportunity for journalistic discovery and pontification, rather, this is a matter of life and death for individuals made more vulnerable because we have not moved quickly enough to recognize that health disparities kill, and lives are lost that can never be replaced. Public policy needs to take a seat at the table and acknowledge its responsibility. Health care reform should be reframed to discuss saving lives and not saving money. I fervently believe that when we save lives, we save money because families are kept whole and feel they are valued.
As we navigate through this pandemic, let us not lose sight of our responsibility to use the “new” news about how African Americans are affected to insist that treatment be available to all who need it when they need it. This includes treatment for mental health and substance abuse problems that are both long-standing and newly emerging as families cope with “making ends meet” while social distancing. The bottom line is that the COVID-19 pandemic has exposed not the problem of disparities and social determinant, but rather the problem of not addressing it before the pandemic hit my community so harshly. We cannot save the lives that were lost, but we can push harder for change that continues to address the persistent inequalities that are across socio-economic groups in African American communities. We can push harder to assist with behavioral changes to lessen vulnerability to chronic conditions. We can use our vote to remember those who lost their lives. With time, for most, the grief and loss associated with the pandemic will lessen. However, premature loss of life and spirit will continue if “we the people” consider the disparities yesterday’s news when COVID-19 deaths and illnesses decline and the attention shifts to rebuilding the economy.
Sandra Edmonds Crewe is dean and professor of the Howard University School of Social Work.