Posted by The United States has one of the most unequal economies of all advanced countries. The Gini coefficient, which measures income inequality, is higher (more unequal) in the United States than in Canada, Australia, Japan or any of the high income European countries. This inequality in income leads to inequalities in health status. Michael Specter, writing in The Atlantic, presents these inequities in the starkest fashion: “the richest one per cent of American men live 14.6 years longer on average than the poorest one per cent. For women, the average difference is just over ten years.”
The California Health Care Foundation reports the following key findings about racial disparities in health outcomes in California:
- Life expectancy at birth in California was 80.8 years. It was lowest for Blacks, at 75.1 years, and highest for Asians, at 86.3 years, an 11-year gap.
- Latinos were more likely to report being in fair/poor health, to have incomes below the federal poverty level, and to be uninsured. About one in five Latinos did not have a usual source of care, and one in six Latinos reported difficulty finding a specialist.
- Blacks had the highest rates of new prostate, colorectal, and lung cancer cases, and highest death rates for breast, colorectal, lung, and prostate cancer.
- Blacks fare worse on maternal/childbirth measures, with higher rates of low-risk, first-birth cesareans, preterm births, low-birthweight births, infant mortality, and maternal mortality.
American Indians and other native-born populations have equally dismal mortality rates (see figure below.) Native American mortality rates from all causes are 30% higher than the American population as a whole, and are particularly dismaying for the “diseases of despair:” accidents (150% higher), alcohol-induced deaths (560% higher), drug induced deaths (50% higher), suicide (70% higher) and homicide (110% higher).
These deep inequities in American society –inequities of race, income, and health status –are causing the impact of covid-19 to vary in severity for different groups of people. In fact, American inequities are being exacerbated by the pandemic that is haunting our personal and social life. One cannot spend any time thinking about the overwhelming impact the pandemic has had on our society and not realize that the divisions in our society and our economy have led to different groups of people experiencing this disaster very differently. The differential impact of this pandemic on the health and welfare of our people should cause us to re-examine our economy and our society in order to promote greater fairness. This is an opportunity we cannot afford to miss.
Let us begin with the health impact. From the beginning it was clear that this pathogen was more dangerous for those people who are more vulnerable. There are two separate issues here: 1) who is more at risk of contracting the illness? And 2) who is more at risk of severe illness or death once they have the virus?
The populations most at risk of contracting the disease are 1) those who live in densely populated urban areas, 2) medical professionals and other with frequent contacts with the infected, and 3) those who live in group settings with little ability to distance themselves. From the beginning, it was clear that those most vulnerable to serious illness once they have the disease include the aged and the infirm.
Perhaps because of underlying health conditions or lack of access to good medical care, African-Americans are particularly likely to contract covid-19. According to Dr. Lisa Cooper of John Hopkins University, “As more data about the impact of the Covid-19 pandemic becomes available, it is increasingly clear that the disease is hitting the most vulnerable and disadvantaged populations in the U.S. the hardest. Although racial and ethnic information is currently available for only about 35% of the total deaths in the U.S., even this limited sample shows that Black Americans and other historically disadvantaged groups are experiencing infection and death rates that are disproportionately high for their share of the total population. For example, while Black Americans represent only about 13% of the population in the states reporting racial/ethnic information, they account for about 34% of total Covid-19 deaths in those states. Asian Americans and Latinx Americans also show elevated impacts in some regions.”
The following figure shows the racial disparity of covid-19 outcomes in Chicago, where blacks make up 30% of the population but 52% of all covid-19 cases and 69% of all deaths attributed to the corona virus.
Moreover, many African-Americans are both poor and in poor health. Thomas LaVeist, dean of public health and tropical medicine at Tulane University pointed to higher rates of diabetes, hypertension and heart disease – mostly tied to poverty – among black residents of Louisiana and other former deep South states including Alabama, Mississippi, Georgia and South Carolina. All these conditions are suspected of elevating risk of death from Covid-19.
The other social groups that are most at risk are the incarcerated and the homeless. According to NBC4, in the Marion Correctional Institution in Marion, Ohio, 1,828 inmates (out of a population of 2,500) and 109 staff have tested positive for covid-19. As we’ve seen with cruise ships and aircraft carriers, group living is an environment where the virus can spread rapidly. People living in group homes, dormitories, halfway houses, nursing homes, etc. are likely to be much more exposed than others living in more isolated housing.
The plight of the homeless is particularly heart-breaking. Shelters are full (and dangerous), the shelter-in-place means that panhandling is unlikely to result in any income. Common places to find shelter and a bathroom—libraries, gyms, fast food restaurants—are closed. Soup kitchens are closing, out of food, out of workers. Homelessness is incompatible with health. Emma Grey Ellis reports that experts like Margot Kushel, a professor of medicine at UC San Francisco who studies homelessness, have been saying so for decades, but, in the midst of the coronavirus pandemic, it’s never been truer. “It’s a calamity. It’s our worst nightmare,” Kushel says. “It’s an enormous crisis superimposed on an existing crisis.” Unhoused people are already among the most sick in society, and now they’re physically incapable of following the Centers for Disease Control and Prevention’s most basic virus-fighting directive: stay home.
She goes on to say, “It’s nearly impossible for homeless people to maintain social distance. Their needs are met en masse. The CDC recommends 110 square feet per person for people housed together during the outbreak. Most homeless shelters simply don’t have that kind of space. “There has always been an increased risk of communicable diseases like tuberculosis, hepatitis A, and influenza,” Kushel says. Covid-19 is just the newest addition to the list. Some shelters are rearranging the furniture to house people farther apart, but those adjustments inevitably mean fewer beds, leaving more people outdoors. In Las Vegas, people are sleeping in parking lots, confined to white painted rectangles spaced six feet apart.”
These health inequities are accompanied by profound economic inequities which we will discuss in our next post.