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Although numbers have risen significantly now, it was reported on May 19 that more than 1.5 million Americans were confirmed to have been infected by COVID-19, and more than 93,000 people had lost their lives. Data from various sources (states, federal government officials and various universities) indicate that African Americans make up about 13 percent of the U.S. population, yet they are 65 percent of all fatalities. I will explore how structural racism plays a part.

The following graph and data from Mississippi indicate the high rate of mortality among African Americans and how COVID-19 disproportionately impacts them (ref. 1 and 2).

One may ask why are African Americans highly infected, and will it continue? The U.S. media suggest that the primary causes of COVID-19-related morbidity and mortality among African Americans is health care inequality and economic disparities. It’s believed that a lack of opportunities is rooted in systemic injustice that has persisted throughout generations.

Even some health care professionals, regardless of their ethnic background, agree with the media. For example, Dr. Lisa Cooper, an internist and social epidemiologist with the Johns Hopkins Bloomberg School of Public Health, said: “I expect the COVID-19 pandemic to impact African Americans to a greater extent than other more socially advantaged groups.” She continued, “This is because as a group African Americans in the U.S. have higher rates of poverty, housing and food insecurity, unemployment or underemployment, and chronic medical conditions and disabilities.” (ref. 3.)

Dr. Mohammad Shahbazi addresses the distrust/mistrust in health care provider institutions along with systemic injustice that has persisted throughout generations.

Dr. Mohammad Shahbazi addresses the distrust/mistrust in health care provider institutions along with systemic injustice that has persisted throughout generations.

Having lived in the U.S. for almost four decades, with the past 20 years in Mississippi, I argue that we must look further beyond the obvious. There is no doubt that African Americans, like other minorities or socially marginalized groups, are at greater exposure. This includes socioeconomically poor white Americans.

Some in these categories are on the front lines laboring as essential workers in this pandemic. It is also true that some people may lack appropriate information on COVID-19 and think they are not at risk. Moreover, they have distrust/mistrust in health care provider institutions.

In public health, we call these and a number of other factors “social determinants of health” (SDH). In fact, SDH and their adverse impacts are not unique to U.S. populations. SDH has significant global implications so much so that the World Health Organization established the “Commission on Social Determinants of Health, 2005-2008.”

The panel supports countries and global health partners in addressing SDH. Dr. Michael Marmot (who was knighted in 2000 by Queen Elizabeth II for his services to epidemiology and research about health inequalities) chaired this commission. I represented the U.S.-based People Health Movement when the commission met in New Orleans in 2008. “The commission aimed to draw the attention of governments and society to the social determinants of health … particularly among the most vulnerable people” (ref. 4).

The overarching recommendations of the commission were:

  • Improve daily living conditions
  • Tackle the inequitable distribution of power, money and resources
  • Measure and understand the problem and assess the impact of action (ibid.)

Earlier, I stated that SDH was not unique to the U.S.; however, structural racism – an area well understood by those who are subjected to it but not openly discussed by others – is unique to the U.S. In my humble view, the root cause of African American morbidities/mortalities resulting from COVID-19 is structural racism, which is a cultural production from one generation to the next. A true story below combined with my 20 years of social experience in Mississippi support my theory that racism is culturally produced.

As a student of cultural anthropology, I can visualize how cultures reproduce themselves in human societies through unconscious processes. Sometimes, people become aware but often consciously remain part of the mainstreams because of the benefits. The following story by an American (Caucasian by ethnicity) named “Billy” shows how his culture instilled in him and dictated his community’s hatred of African Americans.

“I expect the COVID-19 pandemic to impact African Americans to a greater extent than other more socially advantaged groups. This is because as a group African Americans in the U.S. have higher rates of poverty, housing and food insecurity, unemployment or underemployment, and chronic medical conditions and disabilities.” — Dr. Lisa Cooper, an internist and social epidemiologist with the Johns Hopkins Bloomberg School of Public HealthBilly’s indoctrination into racism began very early. He could not remember a time in his childhood and youth when relatives and friends did not cultivate the idea that “people with dark skin were lesser beings than people with light-colored skin.” When he misbehaved, Billy occasionally heard the threat that a man with dark skin would punish him. He did not have any contact with dark-skinned people before he was eight years old, but adults threatened that there was a “n—–r with a knife hiding in the woodpile.”

The first two dark-skinned people that Billy met were a Catholic priest and a Catholic brother.  These two arrived in a sub-parish named St. Denis, which was a satellite of the St. Jerome Catholic Church Parish. St. Jerome is headquartered in Fancy Farm in the western part of Graves, which is located in the eastern part of Hickman County. Ursuline Sisters of Mount St. Joseph typically taught the classes at St. Denis Catholic Parochial School. The only exception was in 1948. That’s when a Benedictine priest, Father Harvey, and a Benedictine brother, Brother Henry, taught classes at St. Denis for a short period of time.

Before meeting the two religious men with dark skin, Billy had had a bit of cognitive dissonance about whether “horses – animals he loved and admired – were superior to people with dark skin.” He would soon discover that Father Harvey and Brother Henry were resourceful, humorous and caring people. While some horses had behaviors that he admired, Billy realized these “men of color were superior to horses.”

Nevertheless, the social environment was very hostile to Father Harvey and Brother Henry. They were unable to purchase anything from any store within 12 miles of St. Denis. They could not get a haircut, purchase gasoline for a car, or buy produce from a farmer. They had to travel to the small city of Mayfield, Kentucky, where they could purchase products and services in a segregated neighborhood of people of color.

Billy remembered when his father always required everybody in their immediate family to go to bed at 8 p.m. This meant they would get plenty of rest, and it would conserve lamp oil. In the winter, early rest would also save heating fuel. One Sunday evening in mid-September of 1948, Billy was admiring the moon from his second-story bedroom that he shared with his three brothers. They were supposed to be sleeping, but he heard the crunching of a horse’s hooves on the gravel in the driveway. It led to a rocky road that ran past the front of the sharecropper shack in which he and his family lived. The noise was from a white mare that his father was riding. Billy observed that his father was carrying a white sheet. He would later learn that his father was headed to a rendezvous with several neighboring farmers. They were committed to driving Father Harvey and Brother Henry out of Hickman and Graves Counties.

An example of cultural racism against blacks: When Billy misbehaved he occasionally heard the threat that a man with dark skin would punish him. He did not have any contact with dark-skinned people before he was eight years old, but adults threatened that there was a “n—–r with a knife hiding in the woodpile.” Billy’s social experiences conveyed through the above statement are a telling story in support of my cultural production theory. Very few people drift away from their cultural norms or question their own past activities. Fortunately, Billy did. In fact, Billy is sure that cultural norms that governed his ancestors’ worldviews were reproduced by his siblings and relatives. Ultimately, they were passed on to their children, who also voiced hatred against African Americans and treated and viewed them as inferior.

Therefore, it is no surprise that we face insidious problems such as hidden biases that white doctors have toward black patients. Black Americans’ historical mistrust of the medical system could exacerbate an already bad situation by accelerating transmission of the virus in struggling communities. Such patterns of behaviors on both sides have deep roots in structural racism and reaction to racism.

Attempting to soften peoples’ hearts or alter their minds might make them display some politically correct behaviors – a kind of reform. Unfortunately, centuries-old wrongdoing in American society was intentionally injected, constructed politically, and reproduced socioculturally to devalue people of color. To foster a just human society with nondiscriminatory behaviors would require a CULTURAL REVOLUTION. Then, and only then, can we begin to meaningfully address health disparities in our beloved USA.

References

  1. https://www.bloomberg.com/graphics/2020-coronavirus-outbreak-us-african-american-death-rate/
  2.    https://www.sunherald.com/news/coronavirus/article242689531.html
  3. https://www.usnews.com/news/healthiest-communities/articles/2020-03-25/why-black-americans-face-an-uphill-battle-against-the-coronavirus
  4.  https://www.who.int/social_determinants/thecommission/finalreport/about_csdh/en/

(Sources accessed on June 17, 2020

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Dr. Mohammad Shahbazi, Ph.D., MPH, MCHES
JSU Professor, Department of Behavioral and Environmental Health
Former Interim Dean (2016-2019), JSU School of Public Health

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