The disproportionate impact of COVID-19 on African American and Latino communities should come as no surprise to people familiar with the demographics of health and disease. In my case, one of my first primers as a fledgling health surveillance worker was the Report of the (HHS) Secretary’s Task Force on Black & Minority Health, issued in 1985. That groundbreaking report laid a foundation for understanding social influences on health and the importance of collecting race/ethnicity data.

To summarize briefly, it has been clear historically that poverty, health insurance status, employment status, and educational attainment are predictors of poor health outcomes. African American and Latino populations are disproportionately represented in these factors. Therefore, a higher incidence of disease is expected. More than three decades later, reports of health disparities are still greeted with surprise and disbelief, even while politicians and public health leaders in some jurisdictions question the need for collecting health data by race and ethnicity. As of May 6, 54% of COVID-19 cases reported by state health departments to the Centers for Disease Control do not include data on patient race. Urban areas frequently fare much better with this metric. But even the 14% of cases reported from the District of Columbia without race information can be problematic.

To be fair, we should understand how collecting these data is routine in communicable disease reporting. Standardized forms used by health departments reporting COVID-19 cases to the Centers for Disease Control and Prevention include a race variable. The Office of Management and Budget, in its OMB Directive 15 provides guidance on how population groups should be classified, to promote consistency in data collection at the national level. However, providers’ perceptions, patient identities, and OMB Directive 15 instructions sometimes clash. This is particularly true for Latinos, who some argue, do not fit neatly into the boxes created by federal directives. A frequent result of this confusion is the misclassification of Latinos in health reports. Moreover, while reports from medical providers are more likely to include race/ethnicity data, this element is frequently missing on reports from laboratories, where the actual patient may never be seen.

In an April 6 COVID-19 briefing, Dr. Anthony Fauci referenced long-standing health disparities in African American communities that exacerbate COVID-19, describing conditions such as diabetes, hypertension, obesity and asthma. All these conditions occur disproportionately in African American AND Latino populations. In fact, these groups are disproportionately represented in virtually all leading causes of death. Data from the US Bureau of Labor Statistics indicate our populations are more likely to have service industry jobs that require substantial public interaction, as well as being less likely to have office jobs that may allow working remotely “social distancing” in the safety of private homes. A study published by amfAR on May 5 provides further clarity, finding that “structural factors including health care access, density of households, unemployment, pervasive discrimination and others” drive COVID-19 disparities in African American communities, not intrinsic characteristics of the communities or individual-level factors.” Most notably, these researchers found such factors were better predictors of disparities in COVID-19 than underlying health conditions.

In the midst of this crisis, our priority must be an aggressive coordinated public health response. It should be led unfettered, by public health experts who are competent in addressing social influences on health and their impact on racial/ethnic health disparities. This is increasingly difficult in the current administration, as noted by frequently observed tensions between public health experts and the president.

We will get through this. When we do, we need a comprehensive plan to address the weaknesses in public health data that obscure our understanding of racial and ethnic trends of COVID-19 today. To be sure, these issues existed long before the COVID-19 outbreak, and they will continue if not rectified. A critical component in any such plan would be increasing awareness of the dynamics of health disparities among providers and policymakers. No one should be surprised, given what was clearly delineated in that HHS report 35 years ago.

Guy Weston is a retired public health professional that worked in HIV programs for 31 years.

WI Guest Author

This correspondent is a guest contributor to The Washington Informer.

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