ANN ARBOR – COVID-19 appears to be hitting minority communities especially hard across the country. In Michigan, African Americans account for 33% of COVID-19 cases and 40% of the deaths, according to state data, though they make up 14% of the state’s population.
Several possible factors—including a greater prevalence of underlying medical conditions among African Americans—have been advanced to explain the disparities.
On Thursday, Michigan Gov. Gretchen Whitmer created the Michigan Coronavirus Task Force on Racial Disparities. The task force, chaired by Lt. Gov. Garlin Gilchrist, will consist of leaders across state government and health care professionals from communities most impacted by the spread of coronavirus.
As of Thursday, Michigan had 21,504 confirmed cases of COVID-19 and 1,076 deaths, according to the state.
University of Michigan experts are available to discuss the topic.
Paul Mohai is a professor at the School for Environment and Sustainability, one of the founders of the U.S. environmental justice movement, and a faculty associate at the Survey Research Center. He serves on the inaugural Michigan Advisory Council on Environmental Justice, which advises the governor on environmental issues impacting low-income households and people of color.
“The reported links between air pollution concentrations and coronavirus deaths is not good news for people of color, as there is several decades of empirical research demonstrating that people-of-color communities are overburdened by environmental contaminants of a wide variety, including air pollution,” he said. “They also face a myriad of other problems, including water shut-offs, crowding and limited access to healthy foods, health care and other resources that could help them to cope with the COVID-19 outbreak.
“Unfortunately, these conditions are the legacy of a long history of racial discrimination, housing segregation and lack of investment in people-of-color communities. For example, the 2017 Michigan Civil Rights Commission’s report on the Flint Water Crisis provides a detailed racial history of Flint highlighting the outcomes of such discrimination.”
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Melissa Creary is an assistant professor of health management and policy at the School of Public Health. Her research focuses on the intersection of public health, science and technology studies, and medical anthropology. She can discuss how historical discrepancies and abuses might make data gathering and testing more difficult for communities of color and why solutions should include the broader community.
Interview on NPR’s Stateside: “COVID-19 pandemic highlights, exacerbates health inequities in marginalized communities”
Alford Young, professor of sociology in the College of Literature, Sciences, and the Arts, conducts research on low-income, urban-based African Americans.
“African Americans are more susceptible to COVID-19 as they are more likely than many Americans to suffer from cardiovascular afflictions. High blood pressure, heart disease, diabetes and other health ailments are more prevalent in that community than in others,” he said. “It is also the case that African Americans, particularly those of lower income status, have a much more tenuous connection to health systems and to health care professionals. Hence, they are more inclined to rely upon themselves when assessing their health status rather than connecting to physicians and health care professionals.
“Furthermore, as the extended family in the African American community often involves degrees of intimacy that are consistent with the immediate family in many American households, there is a tendency for African Americans to check in on their cousins, their aunts and uncles, and other relatives to see how they are managing in these troubling times in the same way that most others might simply take account of only those relatives living in their household.
“Finally, lower-income African Americans have much less access to private space and they are much more concentrated in the public and spaces they occupy. This poses a unique challenge for people who are asked to maintain social distance. All of this makes African Americans highly susceptible to getting and transmitting COVID-19 at higher rates than other demographic groups.”
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Arline Geronimus is a professor of health behavior and health education at the School of Public Health and associate director of the Population Studies Center, Institute for Social Research. She’s a member of the National Academy of Medicine.
“The disproportionate impact of COVID-19 on blacks, Latinx, Native Americans and the poor is extreme and alarming, but, unfortunately, not surprising,” she said. “Along the pathways through which Americans are exposed to COVID-19 and vulnerable to its worst impacts, members of these groups are at an entrenched disadvantage.
“Beyond medical professionals, so-called essential workers are more likely to be members of these groups and, thus, out in the world each day, in proximity to more people. Those who shelter in place, are more likely to do so in overcrowded and decaying homes that are often ripe with asthma triggers; and they are less likely to be in a position to work remotely, reducing household resources. Members of these populations bear a disproportionate probability of having the pre-existing conditions, such as asthma and diabetes, that increase the risk of death among those who are infected, including at young ages.
“Even short of a diagnosed condition, members of these populations are likely to have experienced ‘weathering,’ the dysregulation and stress-mediated wear and tear across body systems—immune, neuroendocrine, cardiovascular and metabolic—that, in effect, represents the acceleration of biological aging and can result in having weakened tissues and organs, more vulnerable to the ‘cytokine storms’ that appear to be one of the biological mechanistic pathways from COVID-19 infection to death rather than recovery.
“Relative lack of access to health insurance and primary care physicians for these communities, coupled with the implicit racial bias many health care providers have, become a lethal combination when health care resources and technology are scarce, as they are now, and overstressed health personnel are pressed to make triaging decisions with few protocols.”
Denise Anthony is a professor of health management and policy at the School of Public Health. Her work examines the use of information technology in health care. Anthony and doctoral candidate Amanda Stanhaus are looking at a potential immunity certification system that is being considered in other countries to address public health needs while restarting the economy.
“Historically, some diseases, particularly communicable ones like polio, HIV, and even SARS, become a source of social stigma, discrimination and exclusion,” they said. “We are already seeing racism and discrimination in the coronavirus pandemic. To avoid serious unintended consequences of privileging immunity passport holders, we must ensure that protections are in place to combat the possibility of inequality and stigma.”
Sara Hughes is an assistant professor at the School for Environment and Sustainability. She studies urban policy and politics, including issues related to safe and affordable drinking water, urban responses to climate change, and environmental justice in cities.
“The disproportionate impacts of COVID-19 on Michigan’s African American communities are due, in part, to persistent underinvestment in the infrastructure and resources needed to support healthy, sustainable cities in our state,” she said.
In a paper accepted for publication in the journal Perspectives on Politics, Hughes argues that the Flint water crisis can be traced to policies—including Michigan’s Local Financial Stability and Choice Act, which places cities deemed by the state to be experiencing fiscal distress under the control of a state-appointed emergency manager—that marginalize minority communities, and that other cities are therefore similarly at risk.
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Jon Zelner, assistant professor of epidemiology at the School of Public Health, is a social epidemiologist focused on understanding and targeting the joint social and biological drivers of infectious disease risk. Zelner and Sharon Kardia, associate dean for education at the School of Public Health, recently discussed this issue: podcast and Q&A.
“One of the things we’re seeing with this current coronavirus pandemic is that your social position matters for whether you can avoid exposure,” Zelner said. “What kind of job do you have? Can you work from home? Can you afford to not work all together? We don’t know at this moment whether people who are in these positions are more likely to get infected, but it’s hard to believe that that’s not the case.”
Enrique Neblett is a professor of health behavior and health education at the School of Public Health. He’s one of the leading U.S. scholars in the area of racism and health, with a particular focus on understanding how racism-related stress influences the mental and physical health of young African Americans. He is the associate director of the Detroit Community-Academic Urban Research Center.
“It’s important to recognize the role of structural racism in COVID-19 racial disparities,” he said. “Poverty and economic disadvantage do not tell the whole story.”
Christopher Friese, the Elizabeth Tone Hosmer Professor of Nursing and professor of health management and policy at the School of Public Health, leads a research team focused on health care delivery in high-risk settings.
“Many workers in nursing homes, assisted living and home care are persons of color,” he said. “In many instances, these workers are part-time employees at multiple locations, increasing their likelihood of contracting and spreading the virus. It’s very clear that from the onset, these settings were ill-prepared to protect their employees from SARS-CoV-2. We need to consider a broader definition of vulnerable employees in future pandemic planning to assure these individuals receive the training and equipment they need to keep themselves safe and healthy.”
Cindy Leung is an assistant professor of nutritional sciences and nutrition epidemiologist at the School of Public Health whose research focuses on diet and health disparities in vulnerable populations. She can discuss food insecurity.
Paul Fleming, assistant professor of health behavior and health education at the School of Public Health and research affiliate at the Population Studies Center, uses a community-based participatory approach with Latino immigrants to examine how policies and discrimination contribute to poor physical and mental health outcomes.
“To solely state that underlying medical conditions cause racial disparities in coronavirus outcomes without explaining why some groups are disproportionately affected by conditions such as asthma, diabetes and hypertension is like saying that the Flint Water Crisis was caused by lead dissolving off the water pipes,” he said. “It may be technically true but it ignores the bigger picture about the racist policies and discrimination that are the root cause of the problem.”
Trish Koman, research investigator in environmental health sciences at School of Public Health, recently published a study that shows most of the cities in Michigan, and vulnerable populations that inhabit them, are disproportionately affected by the consequences of climate change.
Amy Schulz is a professor of health behavior and health education at the School of Public Health whose research centers on understanding social determinants of health in urban communities. She can discuss environmental exposures and cumulative risk as they contribute to racial inequities.
“This double jeopardy—greater likelihood of infection, combined with increased lethality of the infection—likely contributes to the emerging health inequities reflected in Michigan’s latest COVID numbers,” she said.
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